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Dijkstra JN, Rasing NB, Boon HTM, Altena-Rensen S, Cup EHC, Lanser A, Siemann IJ, van Engelen BG, Erasmus CE, Voermans NC. Quality of life and support needs in children, adolescents, and young adults with facioscapulohumeral dystrophy, a mixed-method study. Eur J Paediatr Neurol 2024; 50:64-73. [PMID: 38692157 DOI: 10.1016/j.ejpn.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/26/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Quality of life (QoL) in children with facioscapulohumeral dystrophy (FSHD) seems plausible decreased. Little is known about factors influencing QoL in children with FSHD. Our objective is to explore factors contributing to the QoL of children, adolescents, and young adults with FSHD, to describe how they experience life with FSHD, and to report their support needs. METHODS We performed a mixed-method study with individual age-appropriate semi-structured interviews assessing QoL in children, adolescents, and young adults with FSHD and their parents. To characterize the sample, quantitative data on QoL, pain, fatigue, and participation were collected. Interview data was analyzed using a thematic analysis. RESULTS Fourteen patients participated (age between 9 and 26 years old, eight males and six females). The degree of FSHD severity, as indicated by the FSHD-score, did not correlate with QoL. Older children had a lower QoL than younger children. Children and adolescents strived for normality regardless of physical discomfort. Phenotypical features of FSHD led to insecurity aggravated by hurtful comments of others. The unpredictability of disease progression and its implications for career and parenthood choices led to a generalized feeling of uncertainty about the future. Support was found within family and friends. Participants expressed a need for peer support and psychological support as well as recommending it to others. DISCUSSION Quality of life in childhood FSHD is diminished caused by their physical limitations, altered appearance, fear of social rejection, and uncertainty of the disease progression in the future. A fear of social rejection most likely contributes to striving for normality regardless of physical discomfort. Support should be focused on acceptance and coping with hurtful comments. It should preferably be individualized, easily accessible and not offered as therapy but rather as tutoring for children.
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Affiliation(s)
- Jildou N Dijkstra
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nathaniël B Rasing
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Helena T M Boon
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sandra Altena-Rensen
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Edith H C Cup
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anke Lanser
- Patient Representative and Chairman FSHD Advocacy Group, Patient Organization for Muscular Diseases Spierziekten Nederland, Baarn, the Netherlands
| | - Ietske J Siemann
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Baziel G van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
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Kools J, Aerts W, Niks EH, Mul K, Pagan L, Maurits JSF, Thewissen R, van Engelen BG, Voermans NC. Assessment of the burden of outpatient clinic and MRI-guided needle muscle biopsies as reported by patients with facioscapulohumeral muscular dystrophy. Neuromuscul Disord 2023; 33:440-446. [PMID: 37099913 DOI: 10.1016/j.nmd.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
Muscle biopsies are used in clinical trials to measure target engagement of the investigational product. With many upcoming therapies for patients with facioscapulohumeral dystrophy (FSHD), the frequency of biopsies in FSHD patients is expected to increase. Muscle biopsies were performed either in the outpatient clinic using a Bergström needle (BN-biopsy) or in a Magnetic Resonance Imaging machine (MRI-biopsy). This study assessed the FSHD patients' experience of biopsies using a customized questionnaire. The questionnaire was sent to all FSHD patients who had undergone a needle muscle biopsy for research purposes, inquiring about biopsy characteristics and burden, and willingness to undergo a subsequent biopsy. Forty-nine of 56 invited patients (88%) completed the questionnaire, reporting on 91 biopsies. The median pain score (scale 0-10) during the procedure was 5 [2-8], reducing to 3 [1-5] and 2 [1-3] after one and 24 h, respectively. Twelve biopsies (13.2%) resulted in complications, eleven resolved within 30 days. BN-biopsies were less painful compared to MRI-biopsies (median NRS: 4 [2-6] vs. 7 [3-9], p = 0.001). The burden of needle muscle biopsies in a research setting is considerate and should not be underestimated. MRI-biopsies have a higher burden compared to BN-biopsies.
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Affiliation(s)
- Joost Kools
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, the Netherlands.
| | - Willem Aerts
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, the Netherlands
| | - Erik H Niks
- Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333, Leiden, ZA, the Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, the Netherlands
| | - Lisa Pagan
- Centre for Human Drug Research, Zernikedreef 8, 2333, Leiden, CL, the Netherlands; Department of Gynaecology and Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, ZA, the Netherlands
| | - Jake S F Maurits
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, the Netherlands
| | - Renée Thewissen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, the Netherlands
| | - Baziel G van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, the Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, the Netherlands
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de Winter JM, Bouman K, Strom J, Methawasin M, Jongbloed JDH, van der Roest W, Wijngaarden JV, Timmermans J, Nijveldt R, van den Heuvel F, Kamsteeg EJ, van Engelen BG, Galli R, Bogaards SJP, Boon RA, van der Pijl RJ, Granzier H, Koeleman B, Amin AS, van der Velden J, van Tintelen JP, van den Berg MP, van Spaendonck-Zwarts KY, Voermans NC, Ottenheijm CAC. KBTBD13 is a novel cardiomyopathy gene. Hum Mutat 2022; 43:1860-1865. [PMID: 36335629 PMCID: PMC10100581 DOI: 10.1002/humu.24499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/22/2022] [Accepted: 09/12/2022] [Indexed: 11/08/2022]
Abstract
KBTBD13 variants cause nemaline myopathy type 6 (NEM6). The majority of NEM6 patients harbors the Dutch founder variant, c.1222C>T, p.Arg408Cys (KBTBD13 p.R408C). Although KBTBD13 is expressed in cardiac muscle, cardiac involvement in NEM6 is unknown. Here, we constructed pedigrees of three families with the KBTBD13 p.R408C variant. In 65 evaluated patients, 12% presented with left ventricle dilatation, 29% with left ventricular ejection fraction< 50%, 8% with atrial fibrillation, 9% with ventricular tachycardia, and 20% with repolarization abnormalities. Five patients received an implantable cardioverter defibrillator, three cases of sudden cardiac death were reported. Linkage analysis confirmed cosegregation of the KBTBD13 p.R408C variant with the cardiac phenotype. Mouse studies revealed that (1) mice harboring the Kbtbd13 p.R408C variant display mild diastolic dysfunction; (2) Kbtbd13-deficient mice have systolic dysfunction. Hence, (1) KBTBD13 is associated with cardiac dysfunction and cardiomyopathy; (2) KBTBD13 should be added to the cardiomyopathy gene panel; (3) NEM6 patients should be referred to the cardiologist.
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Affiliation(s)
| | - Karlijn Bouman
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
| | - Joshua Strom
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
| | - Mei Methawasin
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
| | - Jan D H Jongbloed
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Wilma van der Roest
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Robin Nijveldt
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | | | | | | | - Ricardo Galli
- Department of Physiology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Reinier A Boon
- Department of Physiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Robbert J van der Pijl
- Department of Physiology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
| | - Bobby Koeleman
- Department of Human Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ahmad S Amin
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - J Peter van Tintelen
- Department of Human Genetics, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Karin Y van Spaendonck-Zwarts
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands.,Department of Human Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Coen A C Ottenheijm
- Department of Physiology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, USA
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Sezer S, Cup EHC, Roets-Merken LM, Lanser A, Siemann I, Weikamp JG, Mul K, van Engelen BG, Satink T, Voermans NC. Experiences of patients with facioscapulohumeral dystrophy with facial weakness: a qualitative study. Disabil Rehabil 2022; 44:6775-6782. [PMID: 34529524 DOI: 10.1080/09638288.2021.1973122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This study focuses on the functional and psychosocial consequences of facial weakness of patients with facioscapulohumeral muscular dystrophy (FSHD) and how they manage their daily lives. MATERIALS AND METHODS We conducted a qualitative study. Sixteen FSHD patients with varying degrees of facial weakness were interviewed using a semi-structured interview guide. Data were analyzed using the constant comparison approach based on the Straussian Grounded Theory. RESULTS Reduced facial expression affected different aspects of a participant's life, which is reinforced by fatigue. Particularly the younger participants described the confrontation with reduced facial expression as upsetting. The unpredictability of the progression of facial weakness makes many participants insecure and concerned. They generally tend to avoid discussing facial weakness with loved ones as well as with strangers. CONCLUSIONS Patients would like the expert teams to shed more light on effective skill training and psychosocial support, especially for the younger patient group. A multidisciplinary approach is needed in addition to programs focusing on the individual aspects of facial weakness. As the experienced psychosocial effect is not commonly equal to the objective degree of facial weakness, we recommend a tailored approach. Finally, these programs should point out the importance of the patient's own ingenuity.Implications for RehabilitationFacial weakness affects both activities and social participation in patients with facioscapulohumeral muscular dystrophy (FSHD), which is reinforced by fatigue.Many participants try to stay down to earth and focus on their ability to self-manage their obstacles regarding facial weakness.Thus, future treatment programs should have a multidisciplinary approach and should point out the importance of the patient's own ingenuity.
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Affiliation(s)
- Sümeyye Sezer
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edith H C Cup
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lieve M Roets-Merken
- Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke Lanser
- Patient Representative & Chairman FSHD Advocacy Group, Patient Organization for Muscular Disease Spierziekten Nederland, Baarn, The Netherlands
| | - Ietske Siemann
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke G Weikamp
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel G van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ton Satink
- Department of Occupational Therapy, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Molenaar JP, van Zandvoort E, van Engelen BG, Voermans NC, Doorduin J. Reproducibility and robustness of motor cortical stimulation to assess muscle relaxation kinetics. Physiol Rep 2022; 10:e15491. [PMID: 36267028 PMCID: PMC9585355 DOI: 10.14814/phy2.15491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) of the motor cortex can be used during a voluntary contraction to inhibit corticospinal drive to the muscle and consequently induce involuntary muscle relaxation. Our aim was to evaluate the reproducibility and the effect of varying experimental conditions (robustness) of TMS‐induced muscle relaxation. Relaxation of deep finger flexors was assessed in 10 healthy subjects (5 M, 5 F) using handgrip dynamometry with normalized peak relaxation rate as main outcome measure, that is, peak relaxation rate divided by (voluntary plus TMS‐evoked)force prior to relaxation. Both interday and interrater reliability of relaxation rate were high with intraclass correlation coefficient of 0.88 and 0.92 and coefficient of variation of 3.8 and 3.7%, respectively. Target forces of 37.5% of maximal voluntary force or higher resulted in similar relaxation rate. From 50% of maximal stimulator output and higher relaxation rate remained the same. Only the most lateral position (>2 cm from the vertex) rendered lower relaxation rate (mean ± SD: 11.1 ± 3.0 s−1, 95% CI: 9.0–13.3 s−1) compared to stimulation at the vertex (12.8 ± 1.89 s−1, 95% CI: 11.6–14.1 s−1). Within the range of baseline skin temperatures, an average change of 0.5 ± 0.2 s−1 in normalized peak relaxation rate was measured per 1°C change in skin temperature. In conclusion, interday and interrater reproducibility and reliability of TMS‐induced muscle relaxation of the finger flexors were high. Furthermore, this technique is robust with limited effect of target force, stimulation intensity, and coil position. Muscle relaxation is strongly affected by skin temperature; however, this effect is marginal within the normal skin temperature range. We deem this technique well suited for clinical and scientific assessment of muscle relaxation.
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Affiliation(s)
- Joery P. Molenaar
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands,Department of NeurologyRijnstateArnhemThe Netherlands
| | - Elianne van Zandvoort
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Baziel G. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands
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Kroon RHMJM, Kalf JG, de Swart BJM, van der Sluijs BM, Glennon JC, Raz V, van Engelen BG, Horlings CGC. Longitudinal Assessment of Strength, Functional Capacity, Oropharyngeal Function, and Quality of Life in Oculopharyngeal Muscular Dystrophy. Neurology 2021; 97:e1475-e1483. [PMID: 34380753 PMCID: PMC8575133 DOI: 10.1212/wnl.0000000000012640] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 07/21/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Oculopharyngeal muscular dystrophy (OPMD) is a late-onset, progressive muscle disease. Disease progression is known to be slow, but details on the natural history remain unknown. We aimed to examine the natural history of OPMD in a large nationwide cohort to determine clinical outcome measures that capture disease progression and can be used in future clinical trials. METHODS Patients invited by their treating physicians or identified from the national neuromuscular database and invited family members were examined twice 20 months apart with fixed dynamometry; Medical Research Council (MRC) grading; maximum bite force and isometric tongue strength; Motor Function Measure (MFM); 10-step stair test; maximum swallowing, chewing, and speech tasks; and quality of life assessments. RESULTS Disease progression was captured by 8 of 18 measures over 20 months in 43 patients with genetically confirmed OPMD. The largest deterioration was seen in deltoid muscle strength (-27% [range -17% to -37%]), followed by the quadriceps (-14% [range -6 to -23%]), iliopsoas (-12.2%), tongue (-9.9%), and MRC sum score (-2.5%). The 10-step stair test (-12.5%), MFM part D1 (-7.1%), and maximum repetition rate of /pa/ (-5.3%) showed a significant decrease as well (all p < 0.05). The Physical Functioning domain of the Short Form-36 Health Survey significantly deteriorated (p = 0.044). No relationship was found between disease progression and genotype or disease duration (p > 0.05). DISCUSSION Despite the slow disease progression of OPMD, this study showed that several outcome measures detected progression within 20 months. Deltoid muscle strength, measured by fixed dynamometry, showed the greatest decline. These longitudinal data provide clinical outcome measures that can be used as biomarkers in future clinical trials.
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Affiliation(s)
- Rosemarie H M J M Kroon
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.v.E., C.G.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Neurology (B.M.v.d.S.), Gelre Hospital Zutphen, the Netherlands; Conway Institute of Biomolecular and Biomedical Research (J.C.G.), School of Medicine, University College Dublin, Ireland; Department of Human Genetics (V.R.), Leiden University Medical Centre; and Department of Neurology (C.G.C.H., Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johanna G Kalf
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.v.E., C.G.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Neurology (B.M.v.d.S.), Gelre Hospital Zutphen, the Netherlands; Conway Institute of Biomolecular and Biomedical Research (J.C.G.), School of Medicine, University College Dublin, Ireland; Department of Human Genetics (V.R.), Leiden University Medical Centre; and Department of Neurology (C.G.C.H., Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bert J M de Swart
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.v.E., C.G.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Neurology (B.M.v.d.S.), Gelre Hospital Zutphen, the Netherlands; Conway Institute of Biomolecular and Biomedical Research (J.C.G.), School of Medicine, University College Dublin, Ireland; Department of Human Genetics (V.R.), Leiden University Medical Centre; and Department of Neurology (C.G.C.H., Maastricht University Medical Center, Maastricht, the Netherlands
| | - Barbara M van der Sluijs
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.v.E., C.G.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Neurology (B.M.v.d.S.), Gelre Hospital Zutphen, the Netherlands; Conway Institute of Biomolecular and Biomedical Research (J.C.G.), School of Medicine, University College Dublin, Ireland; Department of Human Genetics (V.R.), Leiden University Medical Centre; and Department of Neurology (C.G.C.H., Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jeffrey C Glennon
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.v.E., C.G.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Neurology (B.M.v.d.S.), Gelre Hospital Zutphen, the Netherlands; Conway Institute of Biomolecular and Biomedical Research (J.C.G.), School of Medicine, University College Dublin, Ireland; Department of Human Genetics (V.R.), Leiden University Medical Centre; and Department of Neurology (C.G.C.H., Maastricht University Medical Center, Maastricht, the Netherlands
| | - Vered Raz
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.v.E., C.G.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Neurology (B.M.v.d.S.), Gelre Hospital Zutphen, the Netherlands; Conway Institute of Biomolecular and Biomedical Research (J.C.G.), School of Medicine, University College Dublin, Ireland; Department of Human Genetics (V.R.), Leiden University Medical Centre; and Department of Neurology (C.G.C.H., Maastricht University Medical Center, Maastricht, the Netherlands
| | - Baziel G van Engelen
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.v.E., C.G.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Neurology (B.M.v.d.S.), Gelre Hospital Zutphen, the Netherlands; Conway Institute of Biomolecular and Biomedical Research (J.C.G.), School of Medicine, University College Dublin, Ireland; Department of Human Genetics (V.R.), Leiden University Medical Centre; and Department of Neurology (C.G.C.H., Maastricht University Medical Center, Maastricht, the Netherlands
| | - Corinne G C Horlings
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.v.E., C.G.C.H.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Neurology (B.M.v.d.S.), Gelre Hospital Zutphen, the Netherlands; Conway Institute of Biomolecular and Biomedical Research (J.C.G.), School of Medicine, University College Dublin, Ireland; Department of Human Genetics (V.R.), Leiden University Medical Centre; and Department of Neurology (C.G.C.H., Maastricht University Medical Center, Maastricht, the Netherlands
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7
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Reumers SFI, Erasmus CE, Bouman K, Pennings M, Schouten M, Kusters B, Duijkers FAM, van der Kooi A, Jaeger B, Verschuuren-Bemelmans CC, Faber CG, van Engelen BG, Kamsteeg EJ, Jungbluth H, Voermans NC. Clinical, genetic, and histological features of centronuclear myopathy in the Netherlands. Clin Genet 2021; 100:692-702. [PMID: 34463354 PMCID: PMC9292987 DOI: 10.1111/cge.14054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Centronuclear myopathy (CNM) is a genetically heterogeneous congenital myopathy characterized by muscle weakness, atrophy, and variable degrees of cardiorespiratory involvement. The clinical severity is largely explained by genotype (DNM2, MTM1, RYR1, BIN1, TTN, and other rarer genetic backgrounds), specific mutation(s), and age of the patient. The histopathological hallmark of CNM is the presence of internal centralized nuclei on muscle biopsy. Information on the phenotypical spectrum, subtype prevalence, and phenotype–genotype correlations is limited. To characterize CNM more comprehensively, we retrospectively assessed a national cohort of 48 CNM patients (mean age = 32 ± 24 years, range 0–80, 54% males) from the Netherlands clinically, histologically, and genetically. All information was extracted from entries in the patient's medical records, between 2000 and 2020. Frequent clinical features in addition to muscle weakness and hypotonia were fatigue and exercise intolerance in more mildly affected cases. Genetic analysis showed variants in four genes (18 DNM2, 14 MTM1, 9 RYR1, and 7 BIN1), including 16 novel variants. In addition to central nuclei, histologic examination revealed a large variability of myopathic features in the different genotypes. The identification and characterization of these patients contribute to trial readiness.
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Affiliation(s)
- Stacha F I Reumers
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Paediatric Neurology, Radboud University Medical Center - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Karlijn Bouman
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Paediatric Neurology, Radboud University Medical Center - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Maartje Pennings
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Meyke Schouten
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benno Kusters
- Department of pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floor A M Duijkers
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke van der Kooi
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bregje Jaeger
- Department of Paediatric Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Catharina G Faber
- Department of Neurology, School of Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Baziel G van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK.,Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, FoLSM, King's College, London, UK
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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8
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Heskamp L, Okkersen K, van Nimwegen M, Ploegmakers MJ, Bassez G, Deux JF, van Engelen BG, Heerschap A. Quantitative Muscle MRI Depicts Increased Muscle Mass after a Behavioral Change in Myotonic Dystrophy Type 1. Radiology 2020; 297:132-142. [PMID: 32808888 DOI: 10.1148/radiol.2020192518] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Patients with myotonic dystrophy type 1 (DM1) increased their physical activity and exercise capacity following a behavioral intervention. However, it is unknown what is altered in muscles of patients with DM1 as a result of this intervention. The increased exercise capacity suggests that decelerated fat infiltration or increased muscle cross-sectional area (CSA) could be involved. Purpose To assess the effect of this activity-stimulating behavioral intervention on the lower extremity muscles of patients with DM1 with longitudinal quantitative muscle MRI. Materials and Methods In this prospective trial, participants with DM1 were randomized to a behavioral intervention (n = 14) or continued regular care (standard care; n = 13); no age-matched pairing was performed. Participants underwent MRI of the lower extremities at baseline and 10-month follow-up (January 2015 to March 2016). Fat fraction (FF), muscle CSA, and muscle water T2 (T2water) as markers for fat infiltration, muscle mass, and alteration in tissue water distribution (edema), respectively, were assessed with a chemical shift-encoded Dixon sequence and multiecho spin-echo sequence. Longitudinal within-group and between-group changes were assessed with paired-samples t tests and multivariable regression models. Results A total of 27 patients with DM1 (15 men) were evaluated. Patient age was comparable between groups (intervention, 45 years ± 13 [standard deviation]; standard care, 5 years ± 12; P = .96). Muscle CSA increased 5.9 cm2 ± 7.8 in the intervention group during the 10-month follow-up (P = .03) and decreased 3.6 cm2 ± 7.2 in the standard care group (P = .13). After 10 months, the mean difference between the groups was 9.5 cm2 (P = .01). This effect was stronger in muscles with baseline FF below the mean ± standard deviation of unaffected volunteers (-0.4 cm2 ± 0.15; P < .001). FF increased 0.9% ± 1.0 in the intervention group (P = .02) and 1.2% ± 1.2 for standard care (P = .02), with no between-group difference (P = .56). T2water did not change significantly in either group (intervention, P = .08; standard care, P = .88). Conclusion A behavioral intervention targeting physical activity increased lower extremity muscle cross-sectional area in patients with myotonic dystrophy, preferentially in healthy-appearing muscle. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Linda Heskamp
- From the Department of Radiology and Nuclear Medicine, Radboud Institute for Molecular Life Sciences (L.H., M.J.P., A.H.), and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (K.O., M.v.N., B.G.v.E.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Neuromuscular Reference Center, Sorbonne University, INSERM UMRS 974, AP-HP, Pitié-Salpêtrière Hospital, Paris, France (G.B.); and Department of Radiology, Henri Mondor University Hospital, Paris, France (J.F.D.)
| | - Kees Okkersen
- From the Department of Radiology and Nuclear Medicine, Radboud Institute for Molecular Life Sciences (L.H., M.J.P., A.H.), and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (K.O., M.v.N., B.G.v.E.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Neuromuscular Reference Center, Sorbonne University, INSERM UMRS 974, AP-HP, Pitié-Salpêtrière Hospital, Paris, France (G.B.); and Department of Radiology, Henri Mondor University Hospital, Paris, France (J.F.D.)
| | - Marlies van Nimwegen
- From the Department of Radiology and Nuclear Medicine, Radboud Institute for Molecular Life Sciences (L.H., M.J.P., A.H.), and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (K.O., M.v.N., B.G.v.E.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Neuromuscular Reference Center, Sorbonne University, INSERM UMRS 974, AP-HP, Pitié-Salpêtrière Hospital, Paris, France (G.B.); and Department of Radiology, Henri Mondor University Hospital, Paris, France (J.F.D.)
| | - Marieke J Ploegmakers
- From the Department of Radiology and Nuclear Medicine, Radboud Institute for Molecular Life Sciences (L.H., M.J.P., A.H.), and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (K.O., M.v.N., B.G.v.E.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Neuromuscular Reference Center, Sorbonne University, INSERM UMRS 974, AP-HP, Pitié-Salpêtrière Hospital, Paris, France (G.B.); and Department of Radiology, Henri Mondor University Hospital, Paris, France (J.F.D.)
| | - Guillaume Bassez
- From the Department of Radiology and Nuclear Medicine, Radboud Institute for Molecular Life Sciences (L.H., M.J.P., A.H.), and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (K.O., M.v.N., B.G.v.E.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Neuromuscular Reference Center, Sorbonne University, INSERM UMRS 974, AP-HP, Pitié-Salpêtrière Hospital, Paris, France (G.B.); and Department of Radiology, Henri Mondor University Hospital, Paris, France (J.F.D.)
| | - Jean-Francois Deux
- From the Department of Radiology and Nuclear Medicine, Radboud Institute for Molecular Life Sciences (L.H., M.J.P., A.H.), and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (K.O., M.v.N., B.G.v.E.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Neuromuscular Reference Center, Sorbonne University, INSERM UMRS 974, AP-HP, Pitié-Salpêtrière Hospital, Paris, France (G.B.); and Department of Radiology, Henri Mondor University Hospital, Paris, France (J.F.D.)
| | - Baziel G van Engelen
- From the Department of Radiology and Nuclear Medicine, Radboud Institute for Molecular Life Sciences (L.H., M.J.P., A.H.), and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (K.O., M.v.N., B.G.v.E.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Neuromuscular Reference Center, Sorbonne University, INSERM UMRS 974, AP-HP, Pitié-Salpêtrière Hospital, Paris, France (G.B.); and Department of Radiology, Henri Mondor University Hospital, Paris, France (J.F.D.)
| | - Arend Heerschap
- From the Department of Radiology and Nuclear Medicine, Radboud Institute for Molecular Life Sciences (L.H., M.J.P., A.H.), and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (K.O., M.v.N., B.G.v.E.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Neuromuscular Reference Center, Sorbonne University, INSERM UMRS 974, AP-HP, Pitié-Salpêtrière Hospital, Paris, France (G.B.); and Department of Radiology, Henri Mondor University Hospital, Paris, France (J.F.D.)
| | -
- From the Department of Radiology and Nuclear Medicine, Radboud Institute for Molecular Life Sciences (L.H., M.J.P., A.H.), and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (K.O., M.v.N., B.G.v.E.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Neuromuscular Reference Center, Sorbonne University, INSERM UMRS 974, AP-HP, Pitié-Salpêtrière Hospital, Paris, France (G.B.); and Department of Radiology, Henri Mondor University Hospital, Paris, France (J.F.D.)
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9
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Molenaar JP, Verhoeven JI, Rodenburg RJ, Kamsteeg EJ, Erasmus CE, Vicart S, Behin A, Bassez G, Magot A, Péréon Y, Brandom BW, Guglielmi V, Vattemi G, Chevessier F, Mathieu J, Franques J, Suetterlin K, Hanna MG, Guyant-Marechal L, Snoeck MM, Roberts ME, Kuntzer T, Fernandez-Torron R, Martínez-Arroyo A, Seeger J, Kusters B, Treves S, van Engelen BG, Eymard B, Voermans NC, Sternberg D. Clinical, morphological and genetic characterization of Brody disease: an international study of 40 patients. Brain 2020; 143:452-466. [PMID: 32040565 PMCID: PMC7009512 DOI: 10.1093/brain/awz410] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/30/2019] [Accepted: 11/16/2019] [Indexed: 11/17/2022] Open
Abstract
Brody disease is an autosomal recessive myopathy characterized by exercise-induced muscle stiffness due to mutations in the ATP2A1 gene. Almost 50 years after the initial case presentation, only 18 patients have been reported and many questions regarding the clinical phenotype and results of ancillary investigations remain unanswered, likely leading to incomplete recognition and consequently under-diagnosis. Additionally, little is known about the natural history of the disorder, genotype-phenotype correlations, and the effects of symptomatic treatment. We studied the largest cohort of Brody disease patients to date (n = 40), consisting of 22 new patients (19 novel mutations) and all 18 previously published patients. This observational study shows that the main feature of Brody disease is an exercise-induced muscle stiffness of the limbs, and often of the eyelids. Onset begins in childhood and there was no or only mild progression of symptoms over time. Four patients had episodes resembling malignant hyperthermia. The key finding at physical examination was delayed relaxation after repetitive contractions. Additionally, no atrophy was seen, muscle strength was generally preserved, and some patients had a remarkable athletic build. Symptomatic treatment was mostly ineffective or produced unacceptable side effects. EMG showed silent contractures in approximately half of the patients and no myotonia. Creatine kinase was normal or mildly elevated, and muscle biopsy showed mild myopathic changes with selective type II atrophy. Sarcoplasmic/endoplasmic reticulum Ca2+ ATPase (SERCA) activity was reduced and western blot analysis showed decreased or absent SERCA1 protein. Based on this cohort, we conclude that Brody disease should be considered in cases of exercise-induced muscle stiffness. When physical examination shows delayed relaxation, and there are no myotonic discharges at electromyography, we recommend direct sequencing of the ATP2A1 gene or next generation sequencing with a myopathy panel. Aside from clinical features, SERCA activity measurement and SERCA1 western blot can assist in proving the pathogenicity of novel ATP2A1 mutations. Finally, patients with Brody disease may be at risk for malignant hyperthermia-like episodes, and therefore appropriate perioperative measures are recommended. This study will help improve understanding and recognition of Brody disease as a distinct myopathy in the broader field of calcium-related myopathies.
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Affiliation(s)
- Joery P Molenaar
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jamie I Verhoeven
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Richard J Rodenburg
- Department of Pediatrics, Translational Metabolic Laboratory, Radboud Center for Mitochondrial Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Erik J Kamsteeg
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Savine Vicart
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Canalopathies Musculaires, Centre de Référence des Maladies Neuromusculaires-Paris Est et Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Anthony Behin
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Canalopathies Musculaires, Centre de Référence des Maladies Neuromusculaires-Paris Est et Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Guillaume Bassez
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Canalopathies Musculaires, Centre de Référence des Maladies Neuromusculaires-Paris Est et Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Armelle Magot
- CHU Nantes, Centre de Référence Maladies Neuromusculaires AOC, Nantes, France
| | - Yann Péréon
- CHU Nantes, Centre de Référence Maladies Neuromusculaires AOC, Nantes, France
| | - Barbara W Brandom
- Department of Anesthesiology, Children's Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Valeria Guglielmi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Gaetano Vattemi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | | | - Jean Mathieu
- Neuromuscular Clinic, Centre de Réadaptation en Déficience Physique de Jonquière, Jonquière, Québec, Canada
| | - Jérôme Franques
- Centre de référence des maladies neuromusculaires et de la SLA, hôpital La Timone, AP-HM, Aix-Marseille université, avenue Jean-Moulin, Marseille, France
| | - Karen Suetterlin
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | - Marc M Snoeck
- Department of Anaesthesiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Mark E Roberts
- Department of Neurology, Salford Royal NHS Foundation Trust, Greater Manchester, UK
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Roberto Fernandez-Torron
- Neuromuscular Area, Biodonostia Health Research Institute, Department of Neurology, University Hospital Donostia, CIBERNED, San Sebastián, Spain
| | | | - Juergen Seeger
- Sozialpädiatrisches Zentrum Frankfurt Mitte, Neuromuskulares Zentrum, Frankfurt, Germany
| | - Benno Kusters
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Susan Treves
- Departments of Anesthesia and Biomedicine, Basel University and Basel University Hospital, Basel, Switzerland.,Department of Life Sciences, University of Ferrara, Ferrara, Italy
| | - Baziel G van Engelen
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bruno Eymard
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Canalopathies Musculaires, Centre de Référence des Maladies Neuromusculaires-Paris Est et Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Nicol C Voermans
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Damien Sternberg
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Canalopathies Musculaires, Centre de Référence des Maladies Neuromusculaires-Paris Est et Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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10
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Westra D, Schouten MI, Stunnenberg BC, Kusters B, Saris CGJ, Erasmus CE, van Engelen BG, Bulk S, Verschuuren-Bemelmans CC, Gerkes EH, de Geus C, van der Zwaag PA, Chan S, Chung B, Barge-Schaapveld DQCM, Kriek M, Sznajer Y, van Spaendonck-Zwarts K, van der Kooi AJ, Krause A, Schönewolf-Greulich B, de Die-Smulders C, Sallevelt SCEH, Krapels IPC, Rasmussen M, Maystadt I, Kievit AJA, Witting N, Pennings M, Meijer R, Gillissen C, Kamsteeg EJ, Voermans NC. Panel-Based Exome Sequencing for Neuromuscular Disorders as a Diagnostic Service. J Neuromuscul Dis 2019; 6:241-258. [PMID: 31127727 DOI: 10.3233/jnd-180376] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Neuromuscular disorders (NMDs) are clinically and genetically heterogeneous. Accurate molecular genetic diagnosis can improve clinical management, provides appropriate genetic counseling and testing of relatives, and allows potential therapeutic trials. OBJECTIVE To establish the clinical utility of panel-based whole exome sequencing (WES) in NMDs in a population with children and adults with various neuromuscular symptoms. METHODS Clinical exome sequencing, followed by diagnostic interpretation of variants in genes associated with NMDs, was performed in a cohort of 396 patients suspected of having a genetic cause with a variable age of onset, neuromuscular phenotype, and inheritance pattern. Many had previously undergone targeted gene testing without results. RESULTS Disease-causing variants were identified in 75/396 patients (19%), with variants in the three COL6-genes (COL6A1, COL6A2 and COL6A3) as the most common cause of the identified muscle disorder, followed by variants in the RYR1 gene. Together, these four genes account for almost 25% of cases in whom a definite genetic cause was identified. Furthermore, likely pathogenic variants and/or variants of uncertain significance were identified in 95 of the patients (24%), in whom functional and/or segregation analysis should be used to confirm or reject the pathogenicity. In 18% of the cases with a disease-causing variant of which we received additional clinical information, we identified a genetic cause in genes of which the associated phenotypes did not match that of the patients. Hence, the advantage of panel-based WES is its unbiased approach. CONCLUSION Whole exome sequencing, followed by filtering for NMD genes, offers an unbiased approach for the genetic diagnostics of NMD patients. This approach could be used as a first-tier test in neuromuscular disorders with a high suspicion of a genetic cause. With uncertain results, functional testing and segregation analysis are needed to complete the evidence.
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Affiliation(s)
- Dineke Westra
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Meyke I Schouten
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas C Stunnenberg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benno Kusters
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christiaan G J Saris
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel G van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia Bulk
- Service de Génétique Humaine, CHU de Liège, Liège, Belgium
| | | | - E H Gerkes
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Christa de Geus
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - P A van der Zwaag
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Sophelia Chan
- Department of Pediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Brian Chung
- Department of Pediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | - Marjolein Kriek
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Yves Sznajer
- Center de Génétique Humaine, Clinique Universitaires Saint Luc, Bruxelles, Belgium
| | | | - Anneke J van der Kooi
- Department of Neurology, Amsterdam Medical Center, Amsterdam UMC, University of Amsterdam, Neuroscience institute, Amsterdam, The Netherlands
| | - Amanda Krause
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, The University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Suzanne C E H Sallevelt
- Department of Clinical Genetics, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Magnhild Rasmussen
- Department of Child Neurology and Unit for Congenital and Inherited Neuromuscular Disorders, Oslo University Hospital, Oslo, Norway
| | - Isabelle Maystadt
- Center de Génétique Humaine, Institut de Pathologie et de Génétique, Gosselies, Belgium
| | - Anneke J A Kievit
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nanna Witting
- Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - Maartje Pennings
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rowdy Meijer
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christian Gillissen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Bhansing KJ, van Rosmalen MH, van Engelen BG, van Riel PL, Pillen S, Vonk MC. Muscle ultrasonography is a potential tool for detecting fasciitis in dermatomyositis and polymyositis: comment on the article by Yoshida et al. Arthritis Rheumatol 2019; 69:2248-2249. [PMID: 28853226 DOI: 10.1002/art.40240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | - Piet L van Riel
- Scientific Institute for Quality of Health Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sigrid Pillen
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Madelon C Vonk
- Radboud University Medical Center, Nijmegen, The Netherlands
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12
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Menting J, Tack CJ, Bleijenberg G, Donders R, Droogleever Fortuyn HA, Fransen J, Goedendorp MM, Kalkman JS, Strik-Albers R, van Alfen N, van der Werf SP, Voermans NC, van Engelen BG, Knoop H. Is fatigue a disease-specific or generic symptom in chronic medical conditions? Health Psychol 2018; 37:530-543. [PMID: 29781654 DOI: 10.1037/hea0000598] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Severe fatigue is highly prevalent in various chronic diseases. Disease-specific fatigue models have been developed, but it is possible that fatigue-related factors in these models are similar across diseases. The purpose of the current study was to determine the amount of variance in fatigue severity explained by: (a) the specific disease, (b) factors associated with fatigue across different chronic diseases (transdiagnostic factors), and (c) the interactions between these factors and specific diseases. METHOD Data from 15 studies that included 1696 patients with common chronic diseases and disorders that cause long-term disabilities were analyzed. Linear regression analysis with the generalized least-squares technique was used to determine fatigue-related factors associated with fatigue severity, that is, demographic variables, health-related symptoms and psychosocial variables. RESULTS Type of chronic disease explained 11% of the variance noted in fatigue severity. The explained variance increased to 55% when the transdiagnostic factors were added to the model. These factors were female sex, age, motivational and concentration problems, pain, sleep disturbances, physical functioning, reduced activity and lower self-efficacy concerning fatigue. The predicted variance increased to 61% when interaction terms were added. Analysis of the interactions revealed that the relationship between fatigue severity and relevant predictors mainly differed in strength, not in direction. CONCLUSIONS Fatigue severity can largely be explained by transdiagnostic factors; the associations vary between chronic diseases in strength and significance. This suggests that severely fatigued patients with different chronic diseases can probably benefit from a transdiagnostic fatigue-approach which focuses on individual patient needs rather than a specific disease. (PsycINFO Database Record
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Affiliation(s)
- Juliane Menting
- Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center
| | - Gijs Bleijenberg
- Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center
| | - Rogier Donders
- Department of Health Evidence, Radboud University Medical Center
| | | | - Jaap Fransen
- Department of Rheumatology, Radboud University Medical Center
| | | | - Joke S Kalkman
- Department of Medical Psychology, Radboud University Medical Center
| | | | - Nens van Alfen
- Neuromuscular Centre Nijmegen, Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center
| | | | - Nicol C Voermans
- Neuromuscular Centre Nijmegen, Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center
| | - Baziel G van Engelen
- Neuromuscular Centre Nijmegen, Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center
| | - Hans Knoop
- Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center
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13
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Wohlgemuth M, Lemmers RJ, Jonker M, van der Kooi E, Horlings CG, van Engelen BG, van der Maarel SM, Padberg GW, Voermans NC. A family-based study into penetrance in facioscapulohumeral muscular dystrophy type 1. Neurology 2018; 91:e444-e454. [PMID: 29997197 DOI: 10.1212/wnl.0000000000005915] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/20/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE An observational cross-sectional study was conducted in a national facioscapulohumeral muscular dystrophy (FSHD) expertise center to estimate the penetrance of FSHD1 and to evaluate phenotype-genotype correlations. METHODS Ten FSHD1 probands carrying 4-9 D4Z4 unit alleles and 140 relatives were examined. All 150 participants were genetically characterized, including D4Z4 methylation levels in the mutation carriers. Mutation carriers were classified as (1) symptomatic: with symptoms of muscle weakness on history and muscle FSHD signs on examination; (2) asymptomatic: without symptoms of muscle weakness but with muscle FSHD signs on examination; and (3) nonpenetrant: without symptoms of muscle weakness on history and without muscle FSHD signs on examination. We assessed the relationship between age-corrected clinical severity score and repeat size, sex, and D4Z4 methylation levels. RESULTS The maximum likelihood estimates of symptomatic and those of symptomatic plus asymptomatic FSHD showed that penetrance depends on repeat size and increases until late adulthood. We observed many asymptomatic carriers with subtle facial weakness with or without mild shoulder girdle weakness (25% [17/69]). Nonpenetrance was observed less frequently than in recent population studies (17% [12/69]), and most asymptomatic patients reported some shoulder pain. D4Z4 methylation tended to be lower in moderately to severely affected mutation carriers with 7 or 9 repeats. DISCUSSION This family-based study detected a lower overall nonpenetrance than previously observed, probably due to many asymptomatic mutation carriers identified by careful examination of facial and shoulder muscles. The recognition of asymptomatic mutation carriers is essential for selection of participants for future trials, and the likelihood estimates are helpful in counseling.
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Affiliation(s)
- Mariëlle Wohlgemuth
- From the Department of Neurology (M.W., C.G.H., B.G.v.E., G.W.P., N.C.V.), Donders Institute for Brain, Cognition and Behavior, and Radboud Institute for Health Sciences (M.J.), Radboud University Medical Center, Nijmegen; Department of Neurology (M.W.), ETZ, Tilburg; Department of Human Genetics (R.J.L., S.M.v.d.M.), Leiden University Medical Center; and Department of Neurology (E.v.d.K.), MCL, Leeuwarden, the Netherlands
| | - Richard J Lemmers
- From the Department of Neurology (M.W., C.G.H., B.G.v.E., G.W.P., N.C.V.), Donders Institute for Brain, Cognition and Behavior, and Radboud Institute for Health Sciences (M.J.), Radboud University Medical Center, Nijmegen; Department of Neurology (M.W.), ETZ, Tilburg; Department of Human Genetics (R.J.L., S.M.v.d.M.), Leiden University Medical Center; and Department of Neurology (E.v.d.K.), MCL, Leeuwarden, the Netherlands
| | - Marianne Jonker
- From the Department of Neurology (M.W., C.G.H., B.G.v.E., G.W.P., N.C.V.), Donders Institute for Brain, Cognition and Behavior, and Radboud Institute for Health Sciences (M.J.), Radboud University Medical Center, Nijmegen; Department of Neurology (M.W.), ETZ, Tilburg; Department of Human Genetics (R.J.L., S.M.v.d.M.), Leiden University Medical Center; and Department of Neurology (E.v.d.K.), MCL, Leeuwarden, the Netherlands
| | - Elly van der Kooi
- From the Department of Neurology (M.W., C.G.H., B.G.v.E., G.W.P., N.C.V.), Donders Institute for Brain, Cognition and Behavior, and Radboud Institute for Health Sciences (M.J.), Radboud University Medical Center, Nijmegen; Department of Neurology (M.W.), ETZ, Tilburg; Department of Human Genetics (R.J.L., S.M.v.d.M.), Leiden University Medical Center; and Department of Neurology (E.v.d.K.), MCL, Leeuwarden, the Netherlands
| | - Corinne G Horlings
- From the Department of Neurology (M.W., C.G.H., B.G.v.E., G.W.P., N.C.V.), Donders Institute for Brain, Cognition and Behavior, and Radboud Institute for Health Sciences (M.J.), Radboud University Medical Center, Nijmegen; Department of Neurology (M.W.), ETZ, Tilburg; Department of Human Genetics (R.J.L., S.M.v.d.M.), Leiden University Medical Center; and Department of Neurology (E.v.d.K.), MCL, Leeuwarden, the Netherlands
| | - Baziel G van Engelen
- From the Department of Neurology (M.W., C.G.H., B.G.v.E., G.W.P., N.C.V.), Donders Institute for Brain, Cognition and Behavior, and Radboud Institute for Health Sciences (M.J.), Radboud University Medical Center, Nijmegen; Department of Neurology (M.W.), ETZ, Tilburg; Department of Human Genetics (R.J.L., S.M.v.d.M.), Leiden University Medical Center; and Department of Neurology (E.v.d.K.), MCL, Leeuwarden, the Netherlands
| | - Silvere M van der Maarel
- From the Department of Neurology (M.W., C.G.H., B.G.v.E., G.W.P., N.C.V.), Donders Institute for Brain, Cognition and Behavior, and Radboud Institute for Health Sciences (M.J.), Radboud University Medical Center, Nijmegen; Department of Neurology (M.W.), ETZ, Tilburg; Department of Human Genetics (R.J.L., S.M.v.d.M.), Leiden University Medical Center; and Department of Neurology (E.v.d.K.), MCL, Leeuwarden, the Netherlands
| | - George W Padberg
- From the Department of Neurology (M.W., C.G.H., B.G.v.E., G.W.P., N.C.V.), Donders Institute for Brain, Cognition and Behavior, and Radboud Institute for Health Sciences (M.J.), Radboud University Medical Center, Nijmegen; Department of Neurology (M.W.), ETZ, Tilburg; Department of Human Genetics (R.J.L., S.M.v.d.M.), Leiden University Medical Center; and Department of Neurology (E.v.d.K.), MCL, Leeuwarden, the Netherlands
| | - Nicol C Voermans
- From the Department of Neurology (M.W., C.G.H., B.G.v.E., G.W.P., N.C.V.), Donders Institute for Brain, Cognition and Behavior, and Radboud Institute for Health Sciences (M.J.), Radboud University Medical Center, Nijmegen; Department of Neurology (M.W.), ETZ, Tilburg; Department of Human Genetics (R.J.L., S.M.v.d.M.), Leiden University Medical Center; and Department of Neurology (E.v.d.K.), MCL, Leeuwarden, the Netherlands.
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14
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Goselink RJM, Schreuder THA, Mul K, Voermans NC, Pelsma M, de Groot IJM, van Alfen N, Franck B, Theelen T, Lemmers RJ, Mah JK, van der Maarel SM, van Engelen BG, Erasmus CE. Facioscapulohumeral dystrophy in children: design of a prospective, observational study on natural history, predictors and clinical impact (iFocus FSHD). BMC Neurol 2016; 16:138. [PMID: 27530735 PMCID: PMC4988042 DOI: 10.1186/s12883-016-0664-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022] Open
Abstract
Background Facioscapulohumeral muscular dystrophy (FSHD; OMIM 158900 & 158901) is a progressive skeletal muscle dystrophy, characterized by an autosomal dominant inheritance pattern. One of the major unsolved questions in FSHD is the marked clinical heterogeneity, ranging from asymptomatic individuals to severely affected patients with an early onset. An estimated 10 % of FSHD patients have an early onset (onset before 10 years of age) and are traditionally classified as infantile FSHD. This subgroup is regarded as severely affected and extra-muscular symptoms, such as hearing loss and retinopathy, are frequently described. However, information on the prevalence, natural history and clinical management of early onset FSHD is currently lacking, thereby hampering adequate patient counselling and management. Therefore, a population-based prospective cohort study on FSHD in children is highly needed. Methods/design This explorative study aims to recruit all children (aged 0–17 years) with a genetically confirmed diagnosis of FSHD in The Netherlands. The children will be assessed at baseline and at 2-year follow-up. The general aim of the study is the description of the clinical features and genetic characteristics of this paediatric cohort. The primary outcome is the motor function as measured by the Motor Function Measure. Secondary outcomes include quantitative and qualitative description of the clinical phenotype, muscle imaging, genotyping and prevalence estimations. The ultimate objective will be a thorough description of the natural history, predictors of disease severity and quality of life in children with FSHD. Discussion The results of this population-based study are vital for adequate patient management and clinical trial-readiness. Furthermore, this study is expected to provide additional insight in the epigenetic and environmental disease modifying factors. In addition to improve counselling, this could contribute to unravelling the aetiology of FSHD. Trial registration clinicaltrials.gov NCT02625662.
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Affiliation(s)
- Rianne J M Goselink
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Tim H A Schreuder
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maaike Pelsma
- Department of Rehabilitation, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas Franck
- Department of Clinical audiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas Theelen
- Department of Op Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard J Lemmers
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean K Mah
- Department of Paediatric Neurology, Alberta Children's Hospital, Calgary, Canada
| | | | - Baziel G van Engelen
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Winter JMD, Joureau B, Lee EJ, Kiss B, Yuen M, Gupta VA, Pappas CT, Gregorio CC, Stienen GJM, Edvardson S, Wallgren-Pettersson C, Lehtokari VL, Pelin K, Malfatti E, Romero NB, Engelen BGV, Voermans NC, Donkervoort S, Bönnemann CG, Clarke NF, Beggs AH, Granzier H, Ottenheijm CAC. Mutation-specific effects on thin filament length in thin filament myopathy. Ann Neurol 2016; 79:959-69. [PMID: 27074222 DOI: 10.1002/ana.24654] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Thin filament myopathies are among the most common nondystrophic congenital muscular disorders, and are caused by mutations in genes encoding proteins that are associated with the skeletal muscle thin filament. Mechanisms underlying muscle weakness are poorly understood, but might involve the length of the thin filament, an important determinant of force generation. METHODS We investigated the sarcomere length-dependence of force, a functional assay that provides insights into the contractile strength of muscle fibers as well as the length of the thin filaments, in muscle fibers from 51 patients with thin filament myopathy caused by mutations in NEB, ACTA1, TPM2, TPM3, TNNT1, KBTBD13, KLHL40, and KLHL41. RESULTS Lower force generation was observed in muscle fibers from patients of all genotypes. In a subset of patients who harbor mutations in NEB and ACTA1, the lower force was associated with downward shifted force-sarcomere length relations, indicative of shorter thin filaments. Confocal microscopy confirmed shorter thin filaments in muscle fibers of these patients. A conditional Neb knockout mouse model, which recapitulates thin filament myopathy, revealed a compensatory mechanism; the lower force generation that was associated with shorter thin filaments was compensated for by increasing the number of sarcomeres in series. This allowed muscle fibers to operate at a shorter sarcomere length and maintain optimal thin-thick filament overlap. INTERPRETATION These findings might provide a novel direction for the development of therapeutic strategies for thin filament myopathy patients with shortened thin filament lengths. Ann Neurol 2016;79:959-969.
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Affiliation(s)
- Josine M de Winter
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Barbara Joureau
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Eun-Jeong Lee
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Balázs Kiss
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Michaela Yuen
- Institute for Neuroscience and Muscle Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Vandana A Gupta
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Christopher T Pappas
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Carol C Gregorio
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Ger J M Stienen
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Physics and Astronomy, VU University, Amsterdam, the Netherlands
| | - Simon Edvardson
- Pediatric Neurology Unit, Hadassah University Hospital, Jerusalem, Israel
| | - Carina Wallgren-Pettersson
- Department of Medical and Clinical Genetics, Haartman Institute, University of Helsinki, Helsinki, Finland.,Folkhaelsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland
| | - Vilma-Lotta Lehtokari
- Department of Medical and Clinical Genetics, Haartman Institute, University of Helsinki, Helsinki, Finland.,Folkhaelsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland
| | - Katarina Pelin
- Folkhaelsan Institute of Genetics, Biomedicum Helsinki, Helsinki, Finland.,Division of Genetics, Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Edoardo Malfatti
- Center for Research in Myology, Pitié-Salpêtrière Hospital Group, Paris, France
| | - Norma B Romero
- Center for Research in Myology, Pitié-Salpêtrière Hospital Group, Paris, France
| | - Baziel G van Engelen
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicol C Voermans
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sandra Donkervoort
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institutes of Health, Bethesda, MD
| | - C G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institutes of Health, Bethesda, MD
| | - Nigel F Clarke
- Institute for Neuroscience and Muscle Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alan H Beggs
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Henk Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Coen A C Ottenheijm
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
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16
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Rijken NH, van Engelen BG, Weerdesteyn V, Geurts AC. Clinical Functional Capacity Testing in Patients With Facioscapulohumeral Muscular Dystrophy: Construct Validity and Interrater Reliability of Antigravity Tests. Arch Phys Med Rehabil 2015; 96:2201-6. [PMID: 26363336 DOI: 10.1016/j.apmr.2015.08.429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/24/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the construct validity and interrater reliability of 4 simple antigravity tests in a small group of patients with facioscapulohumeral muscular dystrophy (FSHD). DESIGN Case-control study. SETTING University medical center. PARTICIPANTS Patients with various severity levels of FSHD (n=9) and healthy control subjects (n=10) were included (N=19). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A 4-point ordinal scale was designed to grade performance on the following 4 antigravity tests: sit to stance, stance to sit, step up, and step down. In addition, the 6-minute walk test, 10-m walking test, Berg Balance Scale, and timed Up and Go test were administered as conventional tests. Construct validity was determined by linear regression analysis using the Clinical Severity Score (CSS) as the dependent variable. Interrater agreement was tested using a κ analysis. RESULTS Patients with FSHD performed worse on all 4 antigravity tests compared with the controls. Stronger correlations were found within than between test categories (antigravity vs conventional). The antigravity tests revealed the highest explained variance with regard to the CSS (R(2)=.86, P=.014). Interrater agreement was generally good. CONCLUSIONS The results of this exploratory study support the construct validity and interrater reliability of the proposed antigravity tests for the assessment of functional capacity in patients with FSHD taking into account the use of compensatory strategies. Future research should further validate these results in a larger sample of patients with FSHD.
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Affiliation(s)
- Noortje H Rijken
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Baziel G van Engelen
- Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alexander C Geurts
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.
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17
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Herbert MK, Stammen-Vogelzangs J, Verbeek MM, Rietveld A, Lundberg IE, Chinoy H, Lamb JA, Cooper RG, Roberts M, Badrising UA, De Bleecker JL, Machado PM, Hanna MG, Plestilova L, Vencovsky J, van Engelen BG, Pruijn GJM. Disease specificity of autoantibodies to cytosolic 5'-nucleotidase 1A in sporadic inclusion body myositis versus known autoimmune diseases. Ann Rheum Dis 2015; 75:696-701. [PMID: 25714931 DOI: 10.1136/annrheumdis-2014-206691] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/08/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The diagnosis of inclusion body myositis (IBM) can be challenging as it can be difficult to clinically distinguish from other forms of myositis, particularly polymyositis (PM). Recent studies have shown frequent presence of autoantibodies directed against cytosolic 5'-nucleotidase 1A (cN-1A) in patients with IBM. We therefore, examined the autoantigenicity and disease specificity of major epitopes of cN-1A in patients with sporadic IBM compared with healthy and disease controls. METHODS Serum samples obtained from patients with IBM (n=238), PM and dermatomyositis (DM) (n=185), other autoimmune diseases (n=246), other neuromuscular diseases (n=93) and healthy controls (n=35) were analysed for the presence of autoantibodies using immunodominant cN-1A peptide ELISAs. RESULTS Autoantibodies directed against major epitopes of cN-1A were frequent in patients with IBM (37%) but not in PM, DM or non-autoimmune neuromuscular diseases (<5%). Anti-cN-1A reactivity was also observed in some other autoimmune diseases, particularly Sjögren's syndrome (SjS; 36%) and systemic lupus erythematosus (SLE; 20%). CONCLUSIONS In summary, we found frequent anti-cN-1A autoantibodies in sera from patients with IBM. Heterogeneity in reactivity with the three immunodominant epitopes indicates that serological assays should not be limited to a distinct epitope region. The similar reactivities observed for SjS and SLE demonstrate the need to further investigate whether distinct IBM-specific epitopes exist.
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Affiliation(s)
- Megan K Herbert
- Department of Biomolecular Chemistry, Radboud Institute for Molecular Life Sciences and Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - Judith Stammen-Vogelzangs
- Department of Biomolecular Chemistry, Radboud Institute for Molecular Life Sciences and Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - Marcel M Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anke Rietveld
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ingrid E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden
| | - Hector Chinoy
- Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Janine A Lamb
- Centre for Integrated Genomic Medical Research, The University of Manchester, Manchester, UK
| | - Robert G Cooper
- Faculty of Health & Life Sciences, MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Mark Roberts
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - Umesh A Badrising
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan L De Bleecker
- Department of Neurology, Neuromuscular Reference Centre, Ghent University Hospital, Ghent, Belgium
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | - Lenka Plestilova
- Department of Rheumatology, First Faculty of Medicine, Institute of Rheumatology, Charles University, Prague, Czech Republic
| | - Jiri Vencovsky
- Department of Rheumatology, First Faculty of Medicine, Institute of Rheumatology, Charles University, Prague, Czech Republic
| | - Baziel G van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ger J M Pruijn
- Department of Biomolecular Chemistry, Radboud Institute for Molecular Life Sciences and Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
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18
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Voermans NC, Benveniste O, Minnema MC, Lokhorst H, Lammens M, Meersseman W, Delforge M, Kuntzer T, Novy J, Pabst T, Bouhour F, Romero N, Leblond V, Bergh PVD, Vekemans MC, van Engelen BG, Eymard B. Sporadic late-onset nemaline myopathy with MGUS: long-term follow-up after melphalan and SCT. Neurology 2014; 83:2133-9. [PMID: 25378674 DOI: 10.1212/wnl.0000000000001047] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Sporadic late-onset nemaline myopathy (SLONM) is a rare, late-onset myopathy that progresses subacutely. If associated with a monoclonal gammopathy of unknown significance (MGUS), the outcome is unfavorable: the majority of these patients die within 1 to 5 years of respiratory failure. This study aims to qualitatively assess the long-term treatment effect of high-dose melphalan (HDM) followed by autologous stem cell transplantation (SCT) in a series of 8 patients with SLONM-MGUS. METHODS We performed a retrospective case series study (n = 8) on the long-term (1-8 years) treatment effect of HDM followed by autologous SCT (HDM-SCT) on survival, muscle strength, and functional capacities. RESULTS Seven patients showed a lasting moderate-good clinical response, 2 of them after the second HDM-SCT. All of them had a complete, a very good partial, or a partial hematologic response. One patient showed no clinical or hematologic response and died. CONCLUSIONS This case series shows the positive effect of HDM-SCT in this rare disorder. Factors that may portend an unfavorable outcome are a long disease course before the hematologic treatment and a poor hematologic response. Age at onset, level and type of M protein (κ vs λ), and severity of muscle weakness were not associated with a specific outcome. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with SLONM-MGUS, HDM-SCT increases the probability of survival and functional improvement.
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Affiliation(s)
- Nicol C Voermans
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium.
| | - Olivier Benveniste
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Monique C Minnema
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Henk Lokhorst
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Martin Lammens
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Wouter Meersseman
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Michel Delforge
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Thierry Kuntzer
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Jan Novy
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Thomas Pabst
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Françoise Bouhour
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Norma Romero
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Veronique Leblond
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Peter van den Bergh
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Marie-Christiane Vekemans
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Baziel G van Engelen
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
| | - Bruno Eymard
- From the Departments of Neurology (N.C.V., B.G.v.E.) and Pathology (M.L.), Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Internal Medicine (O.B.), Hôpital Pitié Salpêtrière, UPMC, U974, DHU I2B, Paris, France; Department of Hematology (M.C.M., H.L.), University Medical Center Utrecht, the Netherlands; Department of Pathology (M.L.), Antwerp University Hospital, University of Antwerp, Edegem; Departments of Internal Medicine (W.M.) and Hematology (M.D.), University Hospital Leuven, Belgium; Neurology Service (T.K., J.N.), Lausanne University Hospital CHUV, Lausanne; Department of Medical Oncology (T.P.), University Hospital Bern, Switzerland; Electromyography and Neuromuscular Pathologies Department Lyon Est (F.B.), Bron Hospitals, France; Departments of Pathology (N.R.) and Neurology (B.E.), Hôpital Pitié Salpêtrière, Myology Institute, Paris; Department of Hematology (V.L., P.v.d.B.), Hôpital Pitié Salpêtrière, UPMC Univ Paris 6 GRC 11 GRECHY, Paris, France; Neuromuscular Reference Centre, Department of Neurology (V.L., P.v.d.B.), and Department of Hematology (M.C.V.), Cliniques Universitaires Saint-Luc, University of Louvain, Brussels, Belgium
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Voermans NC, Gerrits K, van Engelen BG, de Haan A. Compound heterozygous mutations of the TNXB gene cause primary myopathy. Neuromuscul Disord 2014; 24:88-9. [DOI: 10.1016/j.nmd.2013.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 09/19/2013] [Accepted: 10/25/2013] [Indexed: 12/19/2022]
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Voermans NC, Jungbluth H, Brusse E, van Engelen BG, Lafôret P. Exertional hyperckemia might be the first manifestation of a genetic disorder. Muscle Nerve 2013; 48:461-2. [DOI: 10.1002/mus.23826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 02/05/2013] [Accepted: 02/13/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Nicol C. Voermans
- Department of Neurology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Heinz Jungbluth
- Clinical Neuroscience Division; IOP, King's College; London; UK
| | - Esther Brusse
- Department of Neurology; Erasmus MC University Medical Center Rotterdam; Rotterdam; The Netherlands
| | - Baziel G. van Engelen
- Department of Neurology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Pascal Lafôret
- Institut de Myologie; GH Pitié Salpêtrìre; Paris; France
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Guglielmi V, Vattemi G, Gualandi F, Voermans NC, Marini M, Scotton C, Pegoraro E, Oosterhof A, Kósa M, Zádor E, Valente EM, De Grandis D, Neri M, Codemo V, Novelli A, van Kuppevelt TH, Dallapiccola B, van Engelen BG, Ferlini A, Tomelleri G. SERCA1 protein expression in muscle of patients with Brody disease and Brody syndrome and in cultured human muscle fibers. Mol Genet Metab 2013; 110:162-9. [PMID: 23911890 DOI: 10.1016/j.ymgme.2013.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/14/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
Brody disease is an inherited myopathy associated with a defective function of sarcoplasmic/endoplasmic reticulum Ca(2+)-ATPase 1 (SERCA1) protein. Mutations in the ATP2A1 gene have been reported only in some patients. Therefore it has been proposed to distinguish patients with ATP2A1 mutations, Brody disease (BD), from patients without mutations, Brody syndrome (BS). We performed a detailed study of SERCA1 protein expression in muscle of patients with BD and BS, and evaluated the alternative splicing of SERCA1 in primary cultures of normal human muscle and in infant muscle. SERCA1 reactivity was observed in type 2 muscle fibers of patients with and without ATP2A1 mutations and staining intensity was similar in patients and controls. Immunoblot analysis showed a significant reduction of SERCA1 band in muscle of BD patients. In addition we demonstrated that the wild type and mutated protein exhibits similar solubility properties and that RIPA buffer improves the recovery of the wild type and mutated SERCA1 protein. We found that SERCA1b, the SERCA1 neonatal form, is the main protein isoform expressed in cultured human muscle fibers and infant muscle. Finally, we identified two novel heterozygous mutations within exon 3 of the ATP2A1 gene from a previously described patient with BD.
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Affiliation(s)
- Valeria Guglielmi
- Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy
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Pluk H, van Hoeve BJA, van Dooren SHJ, Stammen-Vogelzangs J, van der Heijden A, Schelhaas HJ, Verbeek MM, Badrising UA, Arnardottir S, Gheorghe K, Lundberg IE, Boelens WC, van Engelen BG, Pruijn GJM. Autoantibodies to cytosolic 5'-nucleotidase 1A in inclusion body myositis. Ann Neurol 2013; 73:397-407. [PMID: 23460448 DOI: 10.1002/ana.23822] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/20/2012] [Accepted: 11/21/2012] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Sporadic inclusion body myositis (sIBM) is an inflammatory myopathy characterized by both degenerative and autoimmune features. In contrast to other inflammatory myopathies, myositis-specific autoantibodies had not been found in sIBM patients until recently. We used human skeletal muscle extracts as a source of antigens to detect autoantibodies in sIBM and to characterize the corresponding antigen. METHODS Autoantibodies to skeletal muscle antigens were detected by immunoblotting. The target antigen was immunoaffinity-purified from skeletal muscle extracts and characterized by mass spectrometry. A cDNA encoding this protein was cloned and expressed in vitro, and its recognition by patient sera was analyzed in an immunoprecipitation assay. Epitopes were mapped using microarrays of overlapping peptides. RESULTS An Mr 44,000 polypeptide (Mup44) was frequently targeted by sIBM autoantibodies. The target protein was purified, and subsequent mass spectrometry analysis revealed that Mup44 is the cytosolic 5'-nucleotidase 1A (cN1A). By immunoprecipitation of recombinant cN1A, high concentrations of anti-Mup44 autoantibodies were detected in 33% of sIBM patient sera, whereas their prevalence in dermatomyositis, polymyositis, and other neuromuscular disorders appeared to be rare (4.2%, 4.5%, and 3.2%, respectively). Low concentrations of anti-Mup44 antibodies were found in myositis as well as other neuromuscular disorders, but not in healthy controls. Three major autoepitope regions of cN1A were mapped by using microarrays containing a set of overlapping peptides covering the complete cN1A amino acid sequence. INTERPRETATION Anti-Mup44 autoantibodies, which are targeted to cN1A, represent the first serological biomarker for sIBM and may facilitate the diagnosis of this type of myositis.
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Affiliation(s)
- Helma Pluk
- Department of Biomolecular Chemistry, Institute for Molecules and Materials and Nijmegen Center for Molecular Life Sciences, Radboud University Nijmegen, Nijmegen, the Netherlands
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Gerrits KH, Voermans NC, de Haan A, van Engelen BG. Neuromuscular properties of the thigh muscles in patients with ehlers-danlos syndrome. Muscle Nerve 2012; 47:96-104. [DOI: 10.1002/mus.23482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 12/16/2022]
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Voermans NC, Kleefstra T, Gabreëls-Festen AA, Faas BHW, Kamsteeg EJ, Houlden H, Laurá M, Polke JM, Pandraud A, van Ruissen F, van Engelen BG, Reilly MM. Severe Dejerine-Sottas disease with respiratory failure and dysmorphic features in association with a PMP22 point mutation and a 3q23 microdeletion. J Peripher Nerv Syst 2012; 17:223-5. [PMID: 22734911 DOI: 10.1111/j.1529-8027.2012.00402.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Minis MA, Cup EH, Heerkens YF, Engels JA, van Engelen BG, Oostendorp RA. Exploring employment in consultation reports of patients with neuromuscular diseases. Arch Phys Med Rehabil 2012; 93:2276-80. [PMID: 22543016 DOI: 10.1016/j.apmr.2012.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/12/2012] [Accepted: 04/15/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore consultation reports for patient and employment characteristics and recommendations on employment regarding patients with neuromuscular diseases (NMDs). DESIGN Retrospective study of multidisciplinary reports. SETTING An outpatient neuromuscular clinic at a university hospital. PARTICIPANTS Reports (N=102) of patients with NMDs. INTERVENTIONS Based on one-off consultations by occupational therapists, physical therapists, and speech therapists and a multidisciplinary meeting, recommendations were developed regarding therapy content and volume in primary care or rehabilitation settings. MAIN OUTCOME MEASURES A checklist has been developed to examine employment characteristics. A general questionnaire has been used including demographic variables and data on employment. RESULTS Of the 102 reports available, 86 were included for analysis. Sixty-nine reports contained information on employment. Thirty-seven patients (43%) with NMD were employed, most in white-collar or moderately strenuous jobs. Of the 37 employed patients, 28 (76%) worked using adaptations. Thirty-two (87%) had employment problems; of these, 15 (40%) needed improvement in 1 or more environmental factors. Twenty patients (54%) needed advice regarding participation in employment, of whom 19 were referred to primary care or rehabilitation settings for treatment to enhance employment participation. CONCLUSIONS Eighty percent of the included consultation reports contained information on employment. Less than half the patients with NMD were employed, most in office-related jobs, using some kind of adaptations. Nineteen of 20 patients who agreed to recommendations regarding therapy were adequately referred by occupational therapists and physical therapists for treatment of employment problems.
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Affiliation(s)
- Marie-Antoinette Minis
- HAN University of Applied Sciences, Department Occupational Health, Prevention and Reintegration, Nijmegen, The Netherlands.
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Ottenheijm CAC, Voermans NC, Hudson BD, Irving T, Stienen GJM, van Engelen BG, Granzier H. Titin-based stiffening of muscle fibers in Ehlers-Danlos Syndrome. J Appl Physiol (1985) 2012; 112:1157-65. [PMID: 22223454 DOI: 10.1152/japplphysiol.01166.2011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE tenascin-X (TNX) is an extracellular matrix glycoprotein whose absence leads to Ehlers-Danlos Syndrome (EDS). TNX-deficient EDS patients present with joint hypermobility and muscle weakness attributable to increased compliance of the extracellular matrix. We hypothesized that in response to the increased compliance of the extracellular matrix in TNX-deficient EDS patients, intracellular adaptations take place in the elastic properties of the giant muscle protein titin. METHODS we performed extensive single muscle fiber mechanical studies to determine active and passive properties in TNX-deficient EDS patients. Gel-electrophoresis, Western blotting, and microarray studies were used to evaluate titin expression and phosphorylation. X-ray diffraction was used to measure myofilament lattice spacing. RESULTS passive tension of muscle fibers from TNX-deficient EDS patients was markedly increased. Myofilament extraction experiments indicated that the increased passive tension is attributable to changes in the properties of the sarcomeric protein titin. Transcript and protein data indicated no changes in titin isoform expression. Instead, differences in posttranslational modifications within titin's elastic region were found. In patients, active tension was not different at maximal activation level, but at submaximal activation level it was augmented attributable to increased calcium sensitivity. This increased calcium sensitivity might be attributable to stiffer titin molecules. CONCLUSION in response to the increased compliance of the extracellular matrix in muscle of TNX-deficient EDS patients, a marked intracellular stiffening occurs of the giant protein titin. The stiffening of titin partly compensates for the muscle weakness in these patients by augmenting submaximal active tension generation.
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Affiliation(s)
- Coen A C Ottenheijm
- Laboratory for Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam.
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Voermans NC, Knoop H, van Engelen BG. High frequency of neuropathic pain in Ehlers-Danlos syndrome: an association with axonal polyneuropathy and compression neuropathy? J Pain Symptom Manage 2011; 41:e4-6; author reply e6-7. [PMID: 21458218 DOI: 10.1016/j.jpainsymman.2011.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/07/2011] [Indexed: 11/29/2022]
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Voermans NC, Knoop H, van de Kamp N, Hamel BC, Bleijenberg G, van Engelen BG. Fatigue Is a Frequent and Clinically Relevant Problem in Ehlers-Danlos Syndrome. Semin Arthritis Rheum 2010; 40:267-74. [DOI: 10.1016/j.semarthrit.2009.08.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 08/16/2009] [Accepted: 08/24/2009] [Indexed: 12/01/2022]
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Kuiperij HB, Abdo WF, van Engelen BG, Schelhaas HJ, Verbeek MM. TDP-43 plasma levels do not differentiate sporadic inclusion body myositis from other inflammatory myopathies. Acta Neuropathol 2010; 120:825-6. [PMID: 21046407 DOI: 10.1007/s00401-010-0769-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 10/25/2010] [Indexed: 12/12/2022]
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Voermans NC, Knoop H, Bleijenberg G, van Engelen BG. Pain in ehlers-danlos syndrome is common, severe, and associated with functional impairment. J Pain Symptom Manage 2010; 40:370-8. [PMID: 20579833 DOI: 10.1016/j.jpainsymman.2009.12.026] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 11/27/2009] [Accepted: 01/19/2010] [Indexed: 11/30/2022]
Abstract
CONTEXT The Ehlers-Danlos Syndrome (EDS) is a clinically and genetically heterogeneous group of heritable connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Musculoskeletal pain is mentioned in the diagnostic criteria and described as early in onset, chronic, and debilitating. However, systematic research on pain in EDS is scarce. OBJECTIVES We investigated prevalence and impact of pain and associated features in a large group of EDS patients. METHODS We performed a study among members of the Dutch EDS patient organization (n=273) and included the McGill Pain Questionnaire to investigate various aspects of pain, the Sickness Impact Profile to study functional impairment, the Symptom Checklist subscale sleep to evaluate sleep disturbances, and the Checklist Individual Strength subscale fatigue to determine fatigue severity. RESULTS The results of this study show that 1) chronic pain in EDS is highly prevalent and associated with regular use of analgesics; 2) pain is more prevalent and more severe in the hypermobility type than in the classic type; 3) pain severity is correlated with hypermobility, dislocations, and previous surgery; 4) pain is correlated with low nocturnal sleep quality; and 5) pain contributes to functional impairment in daily life, independent of the level of fatigue. CONCLUSION From this large cohort of EDS patients, we conclude that pain is common and severe in EDS. Pain is related to hypermobility, dislocations, and previous surgery and associated with moderate to severe impairment in daily functioning. Therefore, treatment of pain should be a prominent aspect of symptomatic management of EDS.
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Affiliation(s)
- Nicol C Voermans
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Leen WG, Klepper J, Verbeek MM, Leferink M, Hofste T, van Engelen BG, Wevers RA, Arthur T, Bahi-Buisson N, Ballhausen D, Bekhof J, van Bogaert P, Carrilho I, Chabrol B, Champion MP, Coldwell J, Clayton P, Donner E, Evangeliou A, Ebinger F, Farrell K, Forsyth RJ, de Goede CGEL, Gross S, Grunewald S, Holthausen H, Jayawant S, Lachlan K, Laugel V, Leppig K, Lim MJ, Mancini G, Marina AD, Martorell L, McMenamin J, Meuwissen MEC, Mundy H, Nilsson NO, Panzer A, Poll-The BT, Rauscher C, Rouselle CMR, Sandvig I, Scheffner T, Sheridan E, Simpson N, Sykora P, Tomlinson R, Trounce J, Webb D, Weschke B, Scheffer H, Willemsen MA. Glucose transporter-1 deficiency syndrome: the expanding clinical and genetic spectrum of a treatable disorder. Brain 2010; 133:655-70. [PMID: 20129935 DOI: 10.1093/brain/awp336] [Citation(s) in RCA: 237] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Glucose transporter-1 deficiency syndrome is caused by mutations in the SLC2A1 gene in the majority of patients and results in impaired glucose transport into the brain. From 2004-2008, 132 requests for mutational analysis of the SLC2A1 gene were studied by automated Sanger sequencing and multiplex ligation-dependent probe amplification. Mutations in the SLC2A1 gene were detected in 54 patients (41%) and subsequently in three clinically affected family members. In these 57 patients we identified 49 different mutations, including six multiple exon deletions, six known mutations and 37 novel mutations (13 missense, five nonsense, 13 frame shift, four splice site and two translation initiation mutations). Clinical data were retrospectively collected from referring physicians by means of a questionnaire. Three different phenotypes were recognized: (i) the classical phenotype (84%), subdivided into early-onset (<2 years) (65%) and late-onset (18%); (ii) a non-classical phenotype, with mental retardation and movement disorder, without epilepsy (15%); and (iii) one adult case of glucose transporter-1 deficiency syndrome with minimal symptoms. Recognizing glucose transporter-1 deficiency syndrome is important, since a ketogenic diet was effective in most of the patients with epilepsy (86%) and also reduced movement disorders in 48% of the patients with a classical phenotype and 71% of the patients with a non-classical phenotype. The average delay in diagnosing classical glucose transporter-1 deficiency syndrome was 6.6 years (range 1 month-16 years). Cerebrospinal fluid glucose was below 2.5 mmol/l (range 0.9-2.4 mmol/l) in all patients and cerebrospinal fluid : blood glucose ratio was below 0.50 in all but one patient (range 0.19-0.52). Cerebrospinal fluid lactate was low to normal in all patients. Our relatively large series of 57 patients with glucose transporter-1 deficiency syndrome allowed us to identify correlations between genotype, phenotype and biochemical data. Type of mutation was related to the severity of mental retardation and the presence of complex movement disorders. Cerebrospinal fluid : blood glucose ratio was related to type of mutation and phenotype. In conclusion, a substantial number of the patients with glucose transporter-1 deficiency syndrome do not have epilepsy. Our study demonstrates that a lumbar puncture provides the diagnostic clue to glucose transporter-1 deficiency syndrome and can thereby dramatically reduce diagnostic delay to allow early start of the ketogenic diet.
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Affiliation(s)
- Wilhelmina G Leen
- Department of Neurology, Radboud University Nijmegen Medical Centre, 935 Neurology, PO BOX 9101, 6500 HB Nijmegen, The Netherlands.
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Voermans NC, van Alfen N, Pillen S, Lammens M, Schalkwijk J, Zwarts MJ, van Rooij IA, Hamel BCJ, van Engelen BG. Neuromuscular involvement in various types of Ehlers-Danlos syndrome. Ann Neurol 2009; 65:687-97. [DOI: 10.1002/ana.21643] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Cup EH, Pieterse AJ, ten Broek-Pastoor JM, Munneke M, van Engelen BG, Hendricks HT, van der Wilt GJ, Oostendorp RA. Exercise Therapy and Other Types of Physical Therapy for Patients With Neuromuscular Diseases: A Systematic Review. Arch Phys Med Rehabil 2007; 88:1452-64. [DOI: 10.1016/j.apmr.2007.07.024] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 07/24/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
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Affiliation(s)
- Martijn M Molema
- Neuromuscular Centre Nijmegen, Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Abstract
Several proteomics approaches to study different aspects of genetic and metabolic diseases are presented. The choice of technique is strongly dependent on the biological question to be addressed and the availability and amount of sample. In general, there are three approaches that may be used to study genetic and metabolic diseases: protein profiling of complex biological samples, identification of affected proteins, or a functional proteomics approach to study protein interactions and function.
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Affiliation(s)
- Jolein Gloerich
- Laboratory for Pediatrics and Neurology, Nijmegen Centre for Mitochondrial Disorders, Department of Pediatrics, Neuromuscular Center Nijmegen, 6500 HB Nijmegen, The Netherlands
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Ruiter EM, Siers MH, van den Elzen C, van Engelen BG, Smeitink JAM, Rodenburg RJ, Hol FA. The mitochondrial 13513G > A mutation is most frequent in Leigh syndrome combined with reduced complex I activity, optic atrophy and/or Wolff-Parkinson-White. Eur J Hum Genet 2006; 15:155-61. [PMID: 17106447 DOI: 10.1038/sj.ejhg.5201735] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The m.13513G > A transition in the mitochondrial gene encoding the ND5 subunit of respiratory chain complex I, can cause mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) and has been reported to be a frequent cause of Leigh syndrome (LS). We determined the frequency of the mutation in a cohort of 123 patients with reduced complex I activity in muscle (n = 113) or fibroblast (n = 10) tissue. We describe a Pyrosequencing assay for rapid detection and quantification of the m.13513G > A mutation. Two patients with the mutation were identified; both had LS, optical atrophy and a Wolff-Parkinson-White Syndrome (WPWS)-like cardiac conduction defect. The clinical presentation of the m.13513G > A mutation is discussed. We conclude that the m.13513G > A mutation seems not as frequent as previously suggested and is most likely to be present in patients with Leigh (-like) syndrome combined with a complex I deficiency, optic atrophy and/ or WPWS. In addition, we confirmed that the adjacent m.13514A > G mutation is a rare cause of LS or MELAS since no cases with this transition were found.
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Affiliation(s)
- E Mariken Ruiter
- Radboud University Nijmegen Medical Centre, Department of Human Genetics, Nijmegen, The Netherlands.
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Muchir A, Massart C, van Engelen BG, Lammens M, Bonne G, Worman HJ. Proteasome-mediated degradation of integral inner nuclear membrane protein emerin in fibroblasts lacking A-type lamins. Biochem Biophys Res Commun 2006; 351:1011-7. [PMID: 17097067 PMCID: PMC1771114 DOI: 10.1016/j.bbrc.2006.10.147] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 10/26/2006] [Indexed: 11/18/2022]
Abstract
We previously identified and characterized a homozygous LMNA nonsense mutation leading to the absence of A-type lamins in a premature neonate who died at birth. We show here that the absence of A-type lamins is due to degradation of the aberrant mRNA transcript with a premature termination codon. In cultured fibroblasts from the subject with the homozygous LMNA nonsense mutation, there was a decreased steady-state expression of the integral inner nuclear membrane proteins emerin and nesprin-1alpha associated with their mislocalization to the bulk endoplasmic reticulum and a hyperphosphorylation of emerin. To determine if decreased emerin expression occurred post-translationally, we treated cells with a selective proteasome inhibitor and observed an increase in expression. Our results show that mislocalization of integral inner nuclear membrane proteins to the endoplasmic reticulum in human cells lacking A-type lamins leads to their degradation and provides the first evidence that their degradation is mediated by the proteasome.
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Affiliation(s)
- Antoine Muchir
- Departments of Medicine and Anatomy and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Voermans NC, Crul BJ, van Engelen BG. Safety of the Posterior Approach to the Brachial Plexus. Anesth Analg 2006. [DOI: 10.1213/01.ane.0000239016.73407.f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Voermans NC, van Engelen BG, Kluijtmans LA, Stikkelbroeck NM, Hermus AR. Rhabdomyolysis caused by an inherited metabolic disease: very long-chain acyl-CoA dehydrogenase deficiency. Am J Med 2006; 119:176-9. [PMID: 16443431 DOI: 10.1016/j.amjmed.2005.07.064] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Accepted: 07/29/2005] [Indexed: 01/07/2023]
Affiliation(s)
- Nicol C Voermans
- Neuromuscular Center Nijmegen, Department of Neurology, Radboud University Nijmegen Medical Center, The Netherlands.
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Farhoud MH, Wessels HJCT, Wevers RA, van Engelen BG, van den Heuvel LP, Smeitink JA. Serial Isoelectric Focusing as an Effective and Economic Way to Obtain Maximal Resolution and High-Throughput in 2D-Based Comparative Proteomics of Scarce Samples: Proof-of-Principle. J Proteome Res 2005; 4:2364-8. [PMID: 16335987 DOI: 10.1021/pr050231a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2D-based comparative proteomics of scarce samples, such as limited patient material, established methods for prefractionation and subsequent use of different narrow range IPG strips to increase overall resolution are difficult to apply. Also, a high number of samples, a prerequisite for drawing meaningful conclusions when pathological and control samples are considered, will increase the associated amount of work almost exponentially. Here, we introduce a novel, effective, and economic method designed to obtain maximum 2D resolution while maintaining the high throughput necessary to perform large-scale comparative proteomics studies. The method is based on connecting different IPG strips serially head-to-tail so that a complete line of different IPG strips with sequential pH regions can be focused in the same experiment. We show that when 3 IPG strips (covering together the pH range of 3-11) are connected head-to-tail an optimal resolution is achieved along the whole pH range. Sample consumption, time required, and associated costs are reduced by almost 70%, and the workload is reduced significantly.
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Affiliation(s)
- Murtada H Farhoud
- Nijmegen Center for Mitochondrial Disorders, Department of Pediatrics, Radboud University Nijmegen Medical Centre, The Netherlands.
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Farhoud MH, Wessels HJCT, Steenbakkers PJM, Mattijssen S, Wevers RA, van Engelen BG, Jetten MSM, Smeitink JA, van den Heuvel LP, Keltjens JT. Protein complexes in the archaeon Methanothermobacter thermautotrophicus analyzed by blue native/SDS-PAGE and mass spectrometry. Mol Cell Proteomics 2005; 4:1653-63. [PMID: 16037073 DOI: 10.1074/mcp.m500171-mcp200] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Methanothermobacter thermautotrophicus is a thermophilic archaeon that produces methane as the end product of its primary metabolism. The biochemistry of methane formation has been extensively studied and is catalyzed by individual enzymes and proteins that are organized in protein complexes. Although much is known of the protein complexes involved in methanogenesis, only limited information is available on the associations of proteins involved in other cell processes of M. thermautotrophicus. To visualize and identify interacting and individual proteins of M. thermautotrophicus on a proteome-wide scale, protein preparations were separated using blue native electrophoresis followed by SDS-PAGE. A total of 361 proteins, corresponding to almost 20% of the predicted proteome, was identified using peptide mass fingerprinting after MALDI-TOF MS. All previously characterized complexes involved in energy generation could be visualized. Furthermore the expression and association of the heterodisulfide reductase and methylviologen-reducing hydrogenase complexes depended on culture conditions. Also homomeric supercomplexes of the ATP synthase stalk subcomplex and the N5-methyl-5,6,7,8-tetrahydromethanopterin:coenzyme M methyltransferase complex were separated. Chemical cross-linking experiments confirmed that the multimerization of both complexes was not experimentally induced. A considerable number of previously uncharacterized protein complexes were reproducibly visualized. These included an exosome-like complex consisting of four exosome core subunits, which associated with a tRNA-intron endonuclease, thereby expanding the constituency of archaeal exosomes. The results presented show the presence of novel complexes and demonstrate the added value of including blue native gel electrophoresis followed by SDS-PAGE in discovering protein complexes that are involved in catabolic, anabolic, and general cell processes.
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Affiliation(s)
- Murtada H Farhoud
- Nijmegen Center for Mitochondrial and Metabolic Disorders, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6500 HB Nijmegen
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Muchir A, van Engelen BG, Lammens M, Mislow JM, McNally E, Schwartz K, Bonne G. Nuclear envelope alterations in fibroblasts from LGMD1B patients carrying nonsense Y259X heterozygous or homozygous mutation in lamin A/C gene. Exp Cell Res 2003; 291:352-62. [PMID: 14644157 DOI: 10.1016/j.yexcr.2003.07.002] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mutations in the LMNA gene encoding nuclear lamins A and C are responsible for seven inherited disorders affecting specific tissues. We have analyzed skin fibroblasts from a patient with type 1B limb-girdle muscular dystrophy and from her deceased newborn grandchild carrying, respectively, a heterozygous (+/mut) and a homozygous (mut/mut) nonsense Y259X mutation. In fibroblasts(+/mut), the presence of only 50% lamins A and C promotes no detectable abnormality, whereas in fibroblasts(mut/mut) the complete absence of lamins A and C leads to abnormally shaped nuclei with lobules in which none of the analyzed nuclear proteins were detected, i.e., B-type lamins, emerin, nesprin-1alpha, LAP2beta, and Nup153. These lobules perturb cell division as fibroblast(mut/mut) cultures with large proportions of cells with dysmorphic nuclei grow more slowly than controls and the cell proliferation normalizes when the number of these abnormally shaped nuclei declines. In all fibroblasts(mut/mut), nesprin-1alpha-like emerin exhibited aberrant localization in the endoplasmic reticulum. Transfection of wild-type lamin A or C cDNAs restored the correct localization of both emerin and nesprin-1alpha. These data demonstrate that lamin C, like lamin A, interacts in vivo directly with nesprin-1alpha and with emerin and that lamin A or C is sufficient for the correct anchorage of emerin and nesprin-1alpha at the nuclear envelope in human cells.
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Affiliation(s)
- Antoine Muchir
- INSERM U582, Institut de Myologie, Groupe Hospitalier Pitié-Salpétrière, 75013, Paris, France
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Horstink MWIM, van Engelen BG. The effect of coenzyme Q10 therapy in Parkinson disease could be symptomatic. Arch Neurol 2003; 60:1170-2; author reply 1172-3. [PMID: 12925381 DOI: 10.1001/archneur.60.8.1170-b] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Pouwels MJJ, Span PN, Tack CJ, Olthaar AJ, Sweep CGJF, van Engelen BG, de Jong JG, Lutterman JA, Hermus AR. Muscle uridine diphosphate-hexosamines do not decrease despite correction of hyperglycemia-induced insulin resistance in type 2 diabetes. J Clin Endocrinol Metab 2002; 87:5179-84. [PMID: 12414889 DOI: 10.1210/jc.2002-020440] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Animal studies suggest that overactivity of the hexosamine pathway, resulting in increased UDP-hexosamines [UDP-N-acetylglucosamine (UDP-GlcNAc) and UDP-N-acetylgalactosamine (UDP-GalNAc)] is an important mechanism by which hyperglycemia causes insulin resistance. This study was performed to test this hypothesis in patients with type 2 diabetes mellitus (DM). Eight obese patients with uncontrolled DM type 2 and severe insulin resistance were treated with iv insulin for 28 +/- 6 d aimed at euglycemia. Before and after iv insulin treatment, insulin sensitivity was measured using a hyperinsulinemic euglycemic clamp, and a muscle biopsy was taken for measurement of UDP-GlcNAc, UDP-GalNAc, UDP-glucose, and UDP-galactose levels. Also, isoelectric focusing patterns of serum transferrin and the urinary excretion of glycosaminoglycans as measures of final products of the hexosamine pathway were examined. After euglycemia, insulin resistance improved, as demonstrated by an increase in the glucose infusion rate during the clamp from 12.7 +/- 5.6 to 22.4 +/- 8.8 micro mol/kg.min (P < 0.0005) and a decrease in insulin requirement from 1.7 +/- 0.9 to 1.1 +/- 0.6 U/kg.d (P < 0.005), whereas metabolic control improved. Surprisingly, both UDP-GlcNAc, from 8.81 +/- 1.21 to 12.31 +/- 2.52 nmol/g tissue (P < 0.005), and UDP-GalNAc concentrations, from 4.49 +/- 0.85 to 5.89 +/- 1.55 nmol/g tissue (P < 0.05) increased. Isoelectric focusing patterns of serum transferrin and excretion of glycosaminoglycans were similar before and after euglycemia. In conclusion, after amelioration of hyperglycemia- induced insulin resistance, UDP-hexosamines increased in skeletal muscle of patients with type 2 DM. These results do not support the hypothesis that accumulation of products of the hexosamine pathway plays a major role in hyperglycemia-induced insulin resistance.
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Affiliation(s)
- Marie-Jose J Pouwels
- Division of General Internal Medicine, Department of Medicine, University Medical Center, 6500 HB Nijmegen, The Netherlands.
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Snoeck MM, Oosterhof A, Tangerman A, Veerkamp JH, van Engelen BG, Gielen MJ. Halothane-induced calcium release in cultured human skeletal muscle cells from a family susceptible to malignant hyperthermia with an unidentified mutation in chromosome 19. Anesthesiology 2002; 97:272-4. [PMID: 12131133 DOI: 10.1097/00000542-200207000-00038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marc M Snoeck
- Department of Anesthesiology, University of Nijmegen, Nijmegen, The Netherlands.
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