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Gu X, Yue D, Qiao K, Huang G, Zhu W, Xi J, Zhu H. NOTCH2NLC-related oculopharyngodistal myopathy type 3 with cardiomyopathy and nephropathy. Muscle Nerve 2023; 67:E18-E21. [PMID: 36840947 DOI: 10.1002/mus.27808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Affiliation(s)
- Xinyu Gu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongyue Yue
- Department of Neurology, Jing'an District Center Hospital of Shanghai, Shanghai, China
| | - Kai Qiao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Guoqian Huang
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenhua Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianying Xi
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hui Zhu
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
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2
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Shimizu T, Ishiura H, Hara M, Shibata S, Unuma A, Kubota A, Sakuishi K, Inoue K, Goto J, Takahashi Y, Shirota Y, Hamada M, Shimizu J, Tsuji S, Toda T. Expanded clinical spectrum of oculopharyngodistal myopathy type 1. Muscle Nerve 2022; 66:679-685. [PMID: 36052448 DOI: 10.1002/mus.27717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/09/2021] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS Heterozygous CGG repeat expansions in low-density lipoprotein receptor-related protein 12 (LRP12) have recently been identified as a cause of oculopharyngodistal myopathy (OPDM), and the disease is designated as OPDM type 1 (OPDM1). In contrast to broadening of our knowledge on the genetic background of OPDM, what we know of the clinical phenotype of genetically confirmed OPDM1 remains limited. METHODS This investigation was a single-center case series study of OPDM consisting of ten patients from seven families. Repeat-primed polymerase chain reaction and Southern blot analyses were performed to confirm the CGG repeat expansions in LRP12. Clinical findings were retrospectively reviewed. RESULTS Seven patients from five families were identified as having CGG repeat expansions in LRP12. We found a high prevalence of axial muscle involvement, such as neck muscle weakness (6/7) and fatty infiltration in the rectus abdominis muscle, as revealed by computed tomography (5/5). We identified patients with very subtle oculopharyngeal symptoms, mimicking isolated distal myopathy. Muscle specimens were collected from the biceps brachii and tibialis anterior muscles of three patients. Myopathic changes were more severe with more atrophic fibers forming clusters in the tibialis anterior than the biceps brachii muscles of these three patients. No rimmed vacuoles were observed in the biceps brachii muscles in two of the three patients. DISCUSSION This study shows the expanded clinical spectrum of OPDM1, highlighting the importance of axial muscle evaluation in OPDM1. Considering patients with very subtle oculopharyngeal symptoms, genetic analysis of LRP12 should be considered in patients with isolated distal myopathy.
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Affiliation(s)
- Takahiro Shimizu
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Manato Hara
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shota Shibata
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Atsushi Unuma
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kaori Sakuishi
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Neurology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kiyoharu Inoue
- Department of Neurology, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Jun Goto
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Neurology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Yuji Takahashi
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuichiro Shirota
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Jun Shimizu
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Molecular Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Institute of Medical Genomics, International University of Health and Welfare, Chiba, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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3
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Yu J, Shan J, Yu M, Di L, Xie Z, Zhang W, Lv H, Meng L, Zheng Y, Zhao Y, Gang Q, Guo X, Wang Y, Xi J, Zhu W, Da Y, Hong D, Yuan Y, Yan C, Wang Z, Deng J. The CGG repeat expansion in RILPL1 is associated with oculopharyngodistal myopathy type 4. Am J Hum Genet 2022; 109:533-541. [PMID: 35148830 DOI: 10.1016/j.ajhg.2022.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/20/2022] [Indexed: 12/13/2022] Open
Abstract
Recent studies indicate that CGG repeat expansions in LRP12, GIPC1, and NOTCH2NLC are associated with oculopharyngodistal myopathy (OPDM) types 1, 2, and 3, respectively. However, some clinicopathologically confirmed OPDM cases continue to have unknown genetic causes. Here, through a combination of long-read whole-genome sequencing (LRS), repeat-primed polymerase chain reaction (RP-PCR), and fluorescence amplicon length analysis PCR (AL-PCR), we found that a CGG repeat expansion in the 5' UTR of RILPL1 is associated with familial and simplex OPDM type 4 (OPDM4). The number of repeats ranged from 139 to 197. Methylation analysis indicates that the methylation levels in RILPL1 were unaltered in OPDM4 individuals. Analyses of muscle biopsies suggested that the expanded CGG repeat might be translated into a toxic poly-glycine protein that co-localizes with p62 in intranuclear inclusions. Moreover, analyses suggest that the toxic RNA gain-of-function effects also contributed to the pathogenesis of this disease. Intriguingly, all four types of OPDM have been found to be associated with the CGG repeat expansions located in 5' UTRs. This finding suggests that a common pathogenic mechanism, driven by the CGG repeat expansion, might underlie all cases of OPDM.
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4
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Xi J, Wang X, Yue D, Dou T, Wu Q, Lu J, Liu Y, Yu W, Qiao K, Lin J, Luo S, Li J, Du A, Dong J, Chen Y, Luo L, Yang J, Niu Z, Liang Z, Zhao C, Lu J, Zhu W, Zhou Y. 5' UTR CGG repeat expansion in GIPC1 is associated with oculopharyngodistal myopathy. Brain 2021; 144:601-614. [PMID: 33374016 DOI: 10.1093/brain/awaa426] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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: 05/13/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 11/14/2022] Open
Abstract
Oculopharyngodistal myopathy is a late-onset degenerative muscle disorder characterized by ptosis and weakness of the facial, pharyngeal, and distal limb muscles. A recent report suggested a non-coding trinucleotide repeat expansion in LRP12 to be associated with the disease. Here we report a genetic study in a Chinese cohort of 41 patients with the clinical diagnosis of oculopharyngodistal myopathy (21 cases from seven families and 20 sporadic cases). In a large family with 12 affected individuals, combined haplotype and linkage analysis revealed a maximum two-point logarithm of the odds (LOD) score of 3.3 in chromosomal region chr19p13.11-p13.2 and narrowed the candidate region to an interval of 4.5 Mb. Using a comprehensive strategy combining whole-exome sequencing, long-read sequencing, repeat-primed polymerase chain reaction and GC-rich polymerase chain reaction, we identified an abnormal CGG repeat expansion in the 5' UTR of the GIPC1 gene that co-segregated with disease. Overall, the repeat expansion in GIPC1 was identified in 51.9% independent pedigrees (4/7 families and 10/20 sporadic cases), while the repeat expansion in LRP12 was only identified in one sporadic case (3.7%) in our cohort. The number of CGG repeats was <30 in controls but >60 in affected individuals. There was a slight correlation between repeat size and the age at onset. Both repeat expansion and retraction were observed during transmission but somatic instability was not evident. These results further support that non-coding CGG repeat expansion plays an essential role in the pathogenesis of oculopharyngodistal myopathy.
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Affiliation(s)
- Jianying Xi
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xilu Wang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200438, China
| | - Dongyue Yue
- Department of Neurology, Jing'an District Center Hospital of Shanghai, Shanghai, 200040, China
| | - Tonghai Dou
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200438, China
| | - Qunfeng Wu
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200438, China
| | - Jun Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yiqi Liu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Wenbo Yu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Kai Qiao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jie Lin
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Sushan Luo
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jing Li
- Department of Radiology, Jing'an District Center Hospital of Shanghai, Shanghai, 200040, China
| | - Ailian Du
- Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China
| | - Jihong Dong
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yan Chen
- Department of Neurology, Tongji Hospital, Tongji University, Shanghai, 200065, China
| | - Lijun Luo
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, 430021, China
| | - Jie Yang
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, 430021, China
| | - Zhenmin Niu
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, 201203, China
| | - Zonghui Liang
- Department of Radiology, Jing'an District Center Hospital of Shanghai, Shanghai, 200040, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Wenhua Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yan Zhou
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200438, China.,Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai, Shanghai, 201203, China
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5
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Yu J, Deng J, Guo X, Shan J, Luan X, Cao L, Zhao J, Yu M, Zhang W, Lv H, Xie Z, Meng L, Zheng Y, Zhao Y, Gang Q, Wang Q, Liu J, Zhu M, Zhou B, Li P, Liu Y, Wang Y, Yan C, Hong D, Yuan Y, Wang Z. The GGC repeat expansion in NOTCH2NLC is associated with oculopharyngodistal myopathy type 3. Brain 2021; 144:1819-1832. [PMID: 33693509 PMCID: PMC8320266 DOI: 10.1093/brain/awab077] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [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: 06/01/2020] [Revised: 11/12/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
Oculopharyngodistal myopathy (OPDM) is an adult-onset neuromuscular disease characterized
by progressive ocular, facial, pharyngeal and distal limb muscle involvement.
Trinucleotide repeat expansions in LRP12 or GIPC1 were
recently reported to be associated with OPDM. However, a significant portion of OPDM
patients have unknown genetic causes. In this study, long-read whole-genome sequencing and
repeat-primed PCR were performed and we identified GGC repeat expansions in the
NOTCH2NLC gene in 16.7% (4/24) of a cohort of Chinese OPDM patients,
designated as OPDM type 3 (OPDM3). Methylation analysis indicated that methylation levels
of the NOTCH2NLC gene were unaltered in OPDM3 patients, but increased
significantly in asymptomatic carriers. Quantitative real-time PCR analysis indicated that
NOTCH2NLC mRNA levels were increased in muscle but not in blood of
OPDM3 patients. Immunofluorescence on OPDM muscle samples and expressing mutant NOTCH2NLC
with (GGC)69 repeat expansions in HEK293 cells indicated that mutant
NOTCH2NLC-polyglycine protein might be a major component of intranuclear inclusions, and
contribute to toxicity in cultured cells. In addition, two RNA-binding proteins, hnRNP A/B
and MBNL1, were both co-localized with p62 in intranuclear inclusions in OPDM muscle
samples. These results indicated that a toxic protein gain-of-function mechanism and RNA
gain-of-function mechanism may both play a vital role in the pathogenic processes of
OPDM3. This study extended the spectrum of NOTCH2NLC repeat expansion-related diseases to
a predominant myopathy phenotype presenting as OPDM, and provided evidence for possible
pathogenesis of these diseases.
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Affiliation(s)
- Jiaxi Yu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Xueyu Guo
- Grandomics Biosciences, Beijing 100176, China
| | - Jingli Shan
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Shandong University, Jinan 250000, Shandong, China.,Mitochondrial Medicine Laboratory, Qilu Hospital (Qingdao), Shandong University, Qingdao 266035, Shandong, China.,Brain Science Research Institute, Shandong University, Jinan 250000, Shandong, China
| | - Xinghua Luan
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
| | - Li Cao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
| | - Juan Zhao
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - He Lv
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Zhiying Xie
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - LingChao Meng
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Yiming Zheng
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Yawen Zhao
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Qiang Gang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Qingqing Wang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Jing Liu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Min Zhu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Binbin Zhou
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Pidong Li
- Grandomics Biosciences, Beijing 100176, China
| | - Yinzhe Liu
- Grandomics Biosciences, Beijing 100176, China
| | - Yang Wang
- Grandomics Biosciences, Beijing 100176, China
| | - Chuanzhu Yan
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Shandong University, Jinan 250000, Shandong, China.,Mitochondrial Medicine Laboratory, Qilu Hospital (Qingdao), Shandong University, Qingdao 266035, Shandong, China.,Brain Science Research Institute, Shandong University, Jinan 250000, Shandong, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China.,Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing 100034, China
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6
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Deng J, Yu J, Li P, Luan X, Cao L, Zhao J, Yu M, Zhang W, Lv H, Xie Z, Meng L, Zheng Y, Zhao Y, Gang Q, Wang Q, Liu J, Zhu M, Guo X, Su Y, Liang Y, Liang F, Hayashi T, Maeda MH, Sato T, Ura S, Oya Y, Ogasawara M, Iida A, Nishino I, Zhou C, Yan C, Yuan Y, Hong D, Wang Z. Expansion of GGC Repeat in GIPC1 Is Associated with Oculopharyngodistal Myopathy. Am J Hum Genet 2020; 106:793-804. [PMID: 32413282 DOI: 10.1016/j.ajhg.2020.04.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/15/2020] [Indexed: 11/27/2022] Open
Abstract
Oculopharyngodistal myopathy (OPDM) is an adult-onset inherited neuromuscular disorder characterized by progressive ptosis, external ophthalmoplegia, and weakness of the masseter, facial, pharyngeal, and distal limb muscles. The myopathological features are presence of rimmed vacuoles (RVs) in the muscle fibers and myopathic changes of differing severity. Inheritance is variable, with either putative autosomal-dominant or autosomal-recessive pattern. Here, using a comprehensive strategy combining whole-genome sequencing (WGS), long-read whole-genome sequencing (LRS), linkage analysis, repeat-primed polymerase chain reaction (RP-PCR), and fluorescence amplicon length analysis polymerase chain reaction (AL-PCR), we identified an abnormal GGC repeat expansion in the 5' UTR of GIPC1 in one out of four families and three sporadic case subjects from a Chinese OPDM cohort. Expanded GGC repeats were further confirmed as the cause of OPDM in an additional 2 out of 4 families and 6 out of 13 sporadic Chinese individuals with OPDM, as well as 7 out of 194 unrelated Japanese individuals with OPDM. Methylation, qRT-PCR, and western blot analysis indicated that GIPC1 mRNA levels were increased while protein levels were unaltered in OPDM-affected individuals. RNA sequencing indicated p53 signaling, vascular smooth muscle contraction, ubiquitin-mediated proteolysis, and ribosome pathways were involved in the pathogenic mechanisms of OPDM-affected individuals with GGC repeat expansion in GIPC1. This study provides further evidence that OPDM is associated with GGC repeat expansions in distinct genes and highly suggests that expanded GGC repeat units are essential in the pathogenesis of OPDM, regardless of the genes in which the expanded repeats are located.
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Cabrera-Serrano M, Fabian VA, Boutilier J, Wise C, Faiz F, Lamont PJ, Laing NG. Adult onset distal and proximal myopathy with complete ophthalmoplegia associated with a novel de novo p.(Leu1877Pro) mutation in MYH2. Clin Genet 2015; 88:573-8. [PMID: 25529940 DOI: 10.1111/cge.12552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 07/14/2014] [Revised: 11/19/2014] [Accepted: 12/10/2014] [Indexed: 11/29/2022]
Abstract
An MYH2 mutation p.(Glu706Lys) was originally described in a family with autosomal dominant inheritance, where the affected family members presented with multiple congenital contractures and ophthalmoplegia, progressing to a proximal myopathy in adulthood. Another patient with a dominant mutation p.(Leu1870Pro) was described, presenting as a congenital myopathy with ophthalmoplegia. Here, we present a patient with symptoms beginning at age 16 years, of prominent distal but also proximal weakness, bulbar involvement and ophthalmoplegia. Initially, clinically classified as oculopharyngodistal myopathy, the patient was found to carry a novel, de novo MYH2 mutation c.5630T>C p.(Leu1877Pro). This expands the phenotype of dominant MYH2 myopathies with the clinical phenotype overlapping the oculopharyngodistal myopathy spectrum.
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Affiliation(s)
- M Cabrera-Serrano
- Centre for Medical Research, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.,Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - V A Fabian
- Section of Neuropathology, Department of Anatomical Pathology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - J Boutilier
- Centre for Medical Research, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - C Wise
- Department of Diagnostic Genomics, Pathwest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - F Faiz
- Department of Diagnostic Genomics, Pathwest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - P J Lamont
- Neurogenetic Unit, Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - N G Laing
- Centre for Medical Research, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
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