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Panadés-de Oliveira L, Bermejo-Guerrero L, de Fuenmayor-Fernández de la Hoz CP, Cantero Montenegro D, Hernández Lain A, Martí P, Muelas N, Vilchez JJ, Domínguez-González C. Persistent asymptomatic or mild symptomatic hyperCKemia due to mutations in ANO5: the mildest end of the anoctaminopathies spectrum. J Neurol 2020; 267:2546-2555. [PMID: 32367299 DOI: 10.1007/s00415-020-09872-7] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The ANO5 gene encodes for anoctamin-5, a chloride channel involved in muscle cell membrane repair. Recessive mutations in ANO5 are associated with muscular diseases termed anoctaminopathies, which are characterized by proximal or distal weakness, or isolated hyperCKemia. We present the largest series of patients with asymptomatic/paucisymptomatic anoctaminopathy reported so far, highlighting their clinical and radiological characteristics. METHODS Twenty subjects were recruited retrospectively from the Neuromuscular Disorders Units database of two national reference centers. All had a confirmed genetic diagnosis (mean age of diagnosis was 48 years) established between 2015 and 2019. Clinical and complementary data were evaluated through clinical records. RESULTS None of the patients complained about weakness or showed abnormal muscular balance. Among paucisymptomatic patients, the main complaints or findings were generalized myalgia, exercise intolerance and calf hypertrophy, occasionally associated with calf pain. All patients showed persistent hyperCKemia, ranging from mild-moderate to severe. Muscle biopsy revealed inflammatory changes in three cases. Muscle magnetic resonance imaging revealed typical signs (preferential involvement of adductor and gastrocnemius muscles) in all but one patient. In two cases, abnormal findings were detectable only in STIR sequences (not in T1). Three patients showed radiological progression despite remaining asymptomatic. Twelve different mutations in ANO5 were detected, of which seven are novel. CONCLUSIONS Recessive mutations in ANO5 are a frequent cause of undiagnosed asymptomatic/paucisymptomatic hyperCKemia. Patients with an apparent indolent phenotype may show muscle involvement in complementary tests (muscle biopsy and imaging), which may progress over time. Awareness of anoctaminopathy as the cause of nonspecific muscular complaints or of isolated hyperCKemia is essential to correctly diagnose affected patients.
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Affiliation(s)
- Luísa Panadés-de Oliveira
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, 28041, Madrid, Spain.
| | - Laura Bermejo-Guerrero
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, 28041, Madrid, Spain
| | - Carlos Pablo de Fuenmayor-Fernández de la Hoz
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, 28041, Madrid, Spain.,Department of Neurology, Neuromuscular Disorders Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Pilar Martí
- Department of Neurology and IIS La Fe, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Neuromuscular Reference Center ERN-EURO-NMD, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Nuria Muelas
- Department of Neurology and IIS La Fe, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Neuromuscular Reference Center ERN-EURO-NMD, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Juan J Vilchez
- Department of Neurology and IIS La Fe, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Neuromuscular Reference Center ERN-EURO-NMD, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Cristina Domínguez-González
- Department of Neurology, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, 28041, Madrid, Spain.,Department of Neurology, Neuromuscular Disorders Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Hospital 12 de Octubre Research Institute (imas12), Madrid, Spain
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