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Hesami O, Ramezani M, Ghasemi A, Fatehi F, Okhovat AA, Ziaadini B, Kariminejad A, Nafissi S. COLQ-Congenital myasthenic syndrome in an Iranian cohort: the clinical and genetics spectrum. Orphanet J Rare Dis 2024; 19:113. [PMID: 38475910 DOI: 10.1186/s13023-024-03116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Congenital myasthenic syndrome (CMS) is a group of neuromuscular disorders caused by abnormal signal transmission at the motor endplate. Mutations in the collagen-like tail subunit gene (COLQ) of acetylcholinesterase are responsible for recessive forms of synaptic congenital myasthenic syndromes with end plate acetylcholinesterase deficiency. Clinical presentation includes ptosis, ophthalmoparesis, and progressive weakness with onset at birth or early infancy. METHODS We followed 26 patients with COLQ-CMS over a mean period of 9 years (ranging from 3 to 213 months) and reported their clinical features, electrophysiologic findings, genetic characteristics, and therapeutic management. RESULTS In our population, the onset of symptoms ranged from birth to 15 years. Delayed developmental motor milestones were detected in 13 patients (∼ 52%), and the most common presenting signs were ptosis, ophthalmoparesis, and limb weakness. Sluggish pupils were seen in 8 (∼ 30%) patients. All patients who underwent electrophysiologic study showed a significant decremental response (> 10%) following low-frequency repetitive nerve stimulation. Moreover, double compound muscle action potential was evident in 18 patients (∼ 75%). We detected 14 variants (eight novel variants), including six missense, three frameshift, three nonsense, one synonymous and one copy number variation (CNV), in the COLQ gene. There was no benefit from esterase inhibitor treatment, while treatment with ephedrine and salbutamol was objectively efficient in all cases. CONCLUSION Despite the rarity of the disease, our findings provide valuable information for understanding the clinical and electrophysiological features as well as the genetic characterization and response to the treatment of COLQ-CMS.
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Affiliation(s)
- Omid Hesami
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Neurology Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahtab Ramezani
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Ghasemi
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Okhovat
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bentolhoda Ziaadini
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Shahriar Nafissi
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Neurology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Yin Y, Cao J, Fan Y, Xu Y. COLQ-mutation congenital myasthenic syndrome in late adolescence: Case report and review of the literature. Heliyon 2023; 9:e19980. [PMID: 37809778 PMCID: PMC10559664 DOI: 10.1016/j.heliyon.2023.e19980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Congenital myasthenia syndromes (CMS) are a heterogeneous group of hereditary disorders of the neuromuscular junction. The symptoms include fatigue, muscle weakness, ptosis, mastication or swallowing problem, respiratory distress. We present a 42-year-old male patient who was admitted with complaints of paroxysmal limb weakness for 25 years and got repeated apnea crisis due to using AchE inhibitors. We considered this patient to be COLQ-related CMS because of two types characteristics. One is the symptom will deteriorate or non-responsive after giving AchE inhibitors and the other is repeated compound action potentials may appear after one current stimulation. At last we confirmed the diagnosis by genetic testing. It is a rare CMS case caused by homozygous mutation in the COLQ gene which occurred at late adolescence. Our case demonstrates that for those serum-negative MG patients, CMS gene mutation screening should be considered, especially if the patient has an symptom onset of childhood and adolescence.
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Affiliation(s)
- Yatao Yin
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cao
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yuanteng Fan
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yan Xu
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China
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Shao S, Shi G, Bi FF, Huang K. Pharmacological Treatments for Congenital Myasthenic Syndromes Caused by COLQ Mutations. Curr Neuropharmacol 2023; 21:1594-1605. [PMID: 36703579 PMCID: PMC10472815 DOI: 10.2174/1570159x21666230126145652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/30/2022] [Accepted: 11/18/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Congenital myasthenic syndromes (CMS) refer to a series of inherited disorders caused by defects in various proteins. Mutation in the collagen-like tail subunit of asymmetric acetylcholinesterase (COLQ) is the second-most common cause of CMS. However, data on pharmacological treatments are limited. OBJECTIVE In this study, we reviewed related reports to determine the most appropriate pharmacological strategy for CMS caused by COLQ mutations. A literature review and meta-analysis were also performed. PubMed, MEDLINE, Web of Science, and Cochrane Library databases were searched to identify studies published in English before July 22, 2022. RESULTS A total of 42 studies including 164 patients with CMS due to 72 different COLQ mutations were selected for evaluation. Most studies were case reports, and none were randomized clinical trials. Our meta-analysis revealed evidence that β-adrenergic agonists, including salbutamol and ephedrine, can be used as first-line pharmacological treatments for CMS patients with COLQ mutations, as 98.7% of patients (74/75) treated with β-adrenergic agonists showed positive effects. In addition, AChEIs should be avoided in CMS patients with COLQ mutations, as 90.5% (105/116) of patients treated with AChEIs showed either no or negative effects. CONCLUSION (1) β-adrenergic agonist therapy is the first pharmacological strategy for treating CMS with COLQ mutations. (2) AChEIs should be avoided in patients with CMS with COLQ mutations.
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Affiliation(s)
- Shuai Shao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Guanzhong Shi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Fang-Fang Bi
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Kun Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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Luo X, Wang C, Lin L, Yuan F, Wang S, Wang Y, Wang A, Wang C, Wu S, Lan X, Xu Q, Yin R, Cheng H, Zhang Y, Xi J, Zhang J, Sun X, Yan J, Zeng F, Chen Y. Mechanisms of Congenital Myasthenia Caused by Three Mutations in the COLQ Gene. Front Pediatr 2021; 9:679342. [PMID: 34912755 PMCID: PMC8667818 DOI: 10.3389/fped.2021.679342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/08/2021] [Indexed: 01/12/2023] Open
Abstract
The gene encoding collagen like tail subunit of asymmetric acetylcholinesterase (COLQ) is responsible for the transcription of three strands of collagen of acetylcholinesterase, which is attached to the endplate of neuromuscular junctions. Mutations in the COLQ gene are inherited in an autosomal-recessive manner and can lead to type V congenital myasthenia syndrome (CMS), which manifests as decreased muscle strength at birth or shortly after birth, respiratory failure, restricted eye movements, drooping of eyelids, and difficulty swallowing. Here we reported three variants within COLQ in two unrelated children with CMS. An intronic variant (c.393+1G>A) and a novel missense variant (p.Q381P) were identified as compound heterozygous in a 13-month-old boy, with the parents being carriers of each. An intragenic deletion including exons 14 and 15 was found in a homozygous state in a 12-year-old boy. We studied the relative expression of the COLQ and AChE gene in the probands' families, performed three-dimensional protein structural analysis, and analyzed the conservation of the missense mutation c.1142A>C (p.Q381P). The splicing mutation c.393+1G>A was found to affect the normal splicing of COLQ exon 5, resulting in a 27-bp deletion. The missense mutation c.1142A>C (p.Q381P) was located in a conserved position in different species. We found that homozygous deletion of COLQ exons 14-15 resulted in a 241-bp deletion, which decreased the number of amino acids and caused a frameshift translation. COLQ expression was significantly lower in the probands than in the probands' parents and siblings, while AChE expression was significantly higher. Moreover, the mutations were found to cause significant differences in the predicted three-dimensional structure of the protein. The splicing mutation c.393+1G>A, missense mutation c.1A>C (p.Q381P), and COLQ exon 14-15 deletion could cause CMS.
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Affiliation(s)
- Xiaona Luo
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Chunmei Wang
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Longlong Lin
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Fang Yuan
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Simei Wang
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Yilin Wang
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Anqi Wang
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Chao Wang
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Shengnan Wu
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Xiaoping Lan
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Quanmei Xu
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Rongrong Yin
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Hongyi Cheng
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Yuanfeng Zhang
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Jiaming Xi
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Jie Zhang
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Xiaomin Sun
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Jingbin Yan
- National Health Commission (NHC) Key Laboratory of Medical Embryogenesis and Developmental Molecular Biology and Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai, China
| | - Fanyi Zeng
- National Health Commission (NHC) Key Laboratory of Medical Embryogenesis and Developmental Molecular Biology and Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai, China
| | - Yucai Chen
- Department of Neurology, Shanghai Children's Hospital, Shanghai JiaoTong University, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Medical Embryogenesis and Developmental Molecular Biology and Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai, China
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Abstract
OBJECTIVES Congenital myasthenic syndromes (CMSs) are a genotypically and phenotypically heterogeneous group of neuromuscular disorders, which have in common an impaired neuromuscular transmission. Since the field of CMSs is steadily expanding, the present review aimed at summarizing and discussing current knowledge and recent advances concerning the etiology, clinical presentation, diagnosis, and treatment of CMSs. METHODS Systematic literature review. RESULTS Currently, mutations in 32 genes are made responsible for autosomal dominant or autosomal recessive CMSs. These mutations concern 8 presynaptic, 4 synaptic, 15 post-synaptic, and 5 glycosilation proteins. These proteins function as ion-channels, enzymes, or structural, signalling, sensor, or transporter proteins. The most common causative genes are CHAT, COLQ, RAPSN, CHRNE, DOK7, and GFPT1. Phenotypically, these mutations manifest as abnormal fatigability or permanent or fluctuating weakness of extra-ocular, facial, bulbar, axial, respiratory, or limb muscles, hypotonia, or developmental delay. Cognitive disability, dysmorphism, neuropathy, or epilepsy are rare. Low- or high-frequency repetitive nerve stimulation may show an abnormal increment or decrement, and SF-EMG an increased jitter or blockings. Most CMSs respond favourably to acetylcholine-esterase inhibitors, 3,4-diamino-pyridine, salbutamol, albuterol, ephedrine, fluoxetine, or atracurium. CONCLUSIONS CMSs are an increasingly recognised group of genetically transmitted defects, which usually respond favorably to drugs enhancing the neuromuscular transmission. CMSs need to be differentiated from neuromuscular disorders due to muscle or nerve dysfunction.
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Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Veterinary University of Vienna, Postfach 20, 1180, Vienna, Austria.
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