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Di Feo MF, Lillback V, Jokela M, McEntagart M, Homfray T, Giorgio E, Casalis Cavalchini GC, Brusco A, Iascone M, Spaccini L, D'Oria P, Savarese M, Udd B. The crucial role of titin in fetal development: recurrent miscarriages and bone, heart and muscle anomalies characterise the severe end of titinopathies spectrum. J Med Genet 2023; 60:866-873. [PMID: 36977548 DOI: 10.1136/jmg-2022-109018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/18/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Titin truncating variants (TTNtvs) have been associated with several forms of myopathies and/or cardiomyopathies. In homozygosity or in compound heterozygosity, they cause a wide spectrum of recessive phenotypes with a congenital or childhood onset. Most recessive phenotypes showing a congenital or childhood onset have been described in subjects carrying biallelic TTNtv in specific exons. Often karyotype or chromosomal microarray analyses are the only tests performed when prenatal anomalies are identified. Thereby, many cases caused by TTN defects might be missed in the diagnostic evaluations. In this study, we aimed to dissect the most severe end of the titinopathies spectrum. METHODS We performed a retrospective study analysing an international cohort of 93 published and 10 unpublished cases carrying biallelic TTNtv. RESULTS We identified recurrent clinical features showing a significant correlation with the genotype, including fetal akinesia (up to 62%), arthrogryposis (up to 85%), facial dysmorphisms (up to 73%), joint (up to 17%), bone (up to 22%) and heart anomalies (up to 27%) resembling complex, syndromic phenotypes. CONCLUSION We suggest TTN to be carefully evaluated in any diagnostic process involving patients with these prenatal signs. This step will be essential to improve diagnostic performance, expand our knowledge and optimise prenatal genetic counselling.
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Affiliation(s)
- Maria Francesca Di Feo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa, Genova, Italy
| | - Victoria Lillback
- Folkhälsan Research Center, Helsinki, Uusimaa, Finland
- University of Helsinki Department of Medical and Clinical Genetics, Helsinki, Uusimaa, Finland
| | - Manu Jokela
- Tampere University Hospital, Tampere, Pirkanmaa, Finland
- TYKS Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Meriel McEntagart
- Department of Medical Genetics, St George's University of London, London, London, UK
| | - Tessa Homfray
- St George's University of London, London, London, UK
| | - Elisa Giorgio
- Department of Molecular Medicine, University of Pavia, Pavia, Lombardia, Italy
- Fondazione Istituto Neurologico Nazionale C Mondino Istituto di Ricovero e Cura a Carattere Scientifico, Pavia, Lombardia, Italy
| | - Guido C Casalis Cavalchini
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Alfredo Brusco
- Department of Medical Sciences, University of Turin School of Medicine, Torino, Piemonte, Italy
| | - Maria Iascone
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, BG, Italy
| | - Luigina Spaccini
- Unità di Genetica Medica, UOC Ostetricia e Ginecologia, Ospedale dei Bambini Vittore Buzzi, Milano, Lombardia, Italy
| | - Patrizia D'Oria
- UOC Ostetrica e Ginecologia, Ospedale Bolognini di Seriate, Seriate, Lombardia, Italy
| | - Marco Savarese
- Folkhälsan Research Center, Helsinki, Uusimaa, Finland
- Department of Medical Genetics, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Bjarne Udd
- Folkhälsan Research Center, Helsinki, Uusimaa, Finland
- Tampere University Hospital Department of Musculoskeletal Diseases, Tampere, Pirkanmaa, Finland
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Cardone N, Moula M, Baelde RJ, Biquand A, Villanova M, Metay C, Fiorillo C, Baratto S, Merlini L, Sabatelli P, Romero NB, Relaix F, Authier FJ, Taglietti V, Savarese M, de Winter J, Ottenheijm C, Richard I, Malfatti E. Clinical and functional characterization of a long survivor congenital titinopathy patient with a novel metatranscript-only titin variant. Acta Neuropathol Commun 2023; 11:48. [PMID: 36945066 PMCID: PMC10031982 DOI: 10.1186/s40478-023-01539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023] Open
Abstract
Congenital titinopathies are an emerging group of a potentially severe form of congenital myopathies caused by biallelic mutations in titin, encoding the largest existing human protein involved in the formation and stability of sarcomeres. In this study we describe a patient with a congenital myopathy characterized by multiple contractures, a rigid spine, non progressive muscular weakness, and a novel homozygous TTN pathogenic variant in a metatranscript-only exon: the c.36400A > T, p.Lys12134*. Muscle biopsies showed increased internalized nuclei, variability in fiber size, mild fibrosis, type 1 fiber predominance, and a slight increase in the number of satellite cells. RNA studies revealed the retention of intron 170 and 171 in the open reading frame, and immunoflourescence and western blot studies, a normal titin content. Single fiber functional studies showed a slight decrease in absolute maximal force and a cross-sectional area with no decreases in tension, suggesting that weakness is not sarcomere-based but due to hypotrophy. Passive properties of single fibers were not affected, but the observed increased calcium sensitivity of force generation might contribute to the contractural phenotype and rigid spine of the patient. Our findings provide evidence for a pathogenic, causative role of a metatranscript-only titin variant in a long survivor congenital titinopathy patient with distal arthrogryposis and rigid spine.
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Affiliation(s)
- Nastasia Cardone
- Univ Paris-Est Créteil, INSERM, U955 IMRB, F-94010, Créteil, France
| | - Melissa Moula
- Univ Paris-Est Créteil, INSERM, U955 IMRB, F-94010, Créteil, France
| | - Rianne J Baelde
- Amsterdam UMC location Vrije Universiteit Amsterdam, Physiology, De Boelelaan 1117, Amsterdam, Netherlands
| | | | - Marcello Villanova
- Neuromuscular Unit, Presidio Ospedaliero Accreditato Villa Bellombra, Bologna, Italy
| | - Corinne Metay
- Unité Fonctionnelle de Cardiogénétique et Myogénétique moléculaire et cellulaire. Centre de Génétique Moléculaire et Chromosomique et INSERM UMRS 974, Institut de Myologie. Groupe Hospitalier La Pitié-Salpêtrière-Charles Foix, Paris, INSERM UMRS1166, Sorbonne Université, Paris, France
| | - Chiara Fiorillo
- Neurologia Pediatrica e Malattie Muscolari, Istituto G.Gaslini, Genoa, Italy
| | - Serena Baratto
- Neurologia Pediatrica e Malattie Muscolari, Istituto G.Gaslini, Genoa, Italy
| | - Luciano Merlini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126, Bologna, Italy
| | - Patrizia Sabatelli
- CNR, Institute of Molecular Genetics "Luigi Luca Cavalli Sforza" -Unit of Bologna, Bologna, Italy
- IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Norma B Romero
- Neuromuscular Morphology Unit, Myology Institute, GHU Pitié-Salpêtrière, Paris, France
| | - Frederic Relaix
- Univ Paris-Est Créteil, INSERM, U955 IMRB, F-94010, Créteil, France
| | - François Jérôme Authier
- Univ Paris-Est Créteil, INSERM, U955 IMRB, F-94010, Créteil, France
- APHP, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, Créteil, France
| | | | | | - Josine de Winter
- Amsterdam UMC location Vrije Universiteit Amsterdam, Physiology, De Boelelaan 1117, Amsterdam, Netherlands
| | - Coen Ottenheijm
- Amsterdam UMC location Vrije Universiteit Amsterdam, Physiology, De Boelelaan 1117, Amsterdam, Netherlands
| | | | - Edoardo Malfatti
- Univ Paris-Est Créteil, INSERM, U955 IMRB, F-94010, Créteil, France.
- APHP, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, Créteil, France.
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Abstract
Symmetry of the face is one of the most important features for the perception of attractiveness. Asymmetry of the face means that the right and left sides of the face are not identical. Subclinical facial asymmetry is very common in the general population. Most people have some slight facial asymmetry, and this is the normal biological situation in humans. Abnormalities from soft tissue, dental, and skeletal elements lead to facial asymmetry. Asymmetry has many causal factors, and its aetiology includes both congenital and acquired conditions. Neurological facial asymmetry is scarcely addressed in the dental literature. In this narrative review, we focus on the most common neurological causes of facial asymmetry. From a neurological point of view, facial asymmetry can result from disturbances of the cranial nerves, developmental disorders, or myopathies. In the broad range of differential diagnostics of facial asymmetry, neurological abnormalities should be taken into consideration. The treatment must be related to the underlying cause. Complete knowledge of the aetiological factors and the character of the asymmetry plays a crucial role in formulating a treatment plan.
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El Kadiri Y, Ratbi I, Sefiani A, Lyahyai J. Clinical and molecular genetic analysis of early-onset myopathy with fatal cardiomyopathy: Novel biallelic M-line TTN mutation and review of the literature. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2022.101587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Salih MA, Hamad MH, Savarese M, Alorainy IA, Al-Jarallah AS, Alkhalidi H, AlQudairy H, Albader A, Alotaibi AJ, Alsagob M, Al-Bakheet A, Colak D, Udd B, Kaya N. Exome Sequencing Reveals Novel TTN Variants in Saudi Patients with Congenital Titinopathies. Genet Test Mol Biomarkers 2021; 25:757-764. [DOI: 10.1089/gtmb.2021.0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Mustafa A. Salih
- Division of Pediatric Neurology, Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Muddathir H. Hamad
- Division of Pediatric Neurology, Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Marco Savarese
- The Folkhälsan Institute of Genetics and the Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Ibrahim A. Alorainy
- Department of Radiology and Diagnostic Imaging, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah S. Al-Jarallah
- Pediatric Cardiology Division, Cardiac Science Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hisham Alkhalidi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hanan AlQudairy
- Translational Genomics Department, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, MBC: 03, Riyadh, Saudi Arabia
| | - Anoud Albader
- Translational Genomics Department, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, MBC: 03, Riyadh, Saudi Arabia
| | - Amal Jahz Alotaibi
- Translational Genomics Department, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, MBC: 03, Riyadh, Saudi Arabia
| | - Maysoon Alsagob
- Translational Genomics Department, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, MBC: 03, Riyadh, Saudi Arabia
| | - Albandary Al-Bakheet
- Translational Genomics Department, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, MBC: 03, Riyadh, Saudi Arabia
| | - Dilek Colak
- Biostatistics, Epidemiology, and Scientific Computing Department, MBC: 03, Riyadh, Saudi Arabia
| | - Bjarne Udd
- Tampere Neuromuscular Research Unit, The Folkhälsan Institute of Genetics and the Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Namik Kaya
- Translational Genomics Department, Center for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, MBC: 03, Riyadh, Saudi Arabia
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Skeletal muscle immunohistochemistry of acquired and hereditary myopathies. Curr Opin Rheumatol 2021; 33:529-536. [PMID: 34431810 DOI: 10.1097/bor.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The continued development in the field of immunohistochemistry (IHC) has improved the ability to diagnose muscle diseases. Many hereditary diseases are diagnosed by the absence or abnormal localization of proteins. Detection of secondary pathological protein expression is also used in diagnostics, and to study disease processes. We relate and discuss recent reports, where IHC has been an important tool in the investigation of muscle diseases. RECENT FINDINGS In idiopathic inflammatory myopathies, IHC has extended its role to diagnose subgroups. This is most evident concerning immune-mediated necrotizing myopathy and antisynthetase syndrome. The availability of new antibodies has increased the sensitivity of a muscle biopsy to diagnose several hereditary myopathies. The introduction of protein restoration therapies in muscular dystrophies also comes with the need to detect and measure protein levels. For the study of disease processes at the protein level, in both acquired and hereditary myopathies IHC, often combined with gene studies, PCR-based methods, western blotting and electron microscopy, continues to bring forth interesting results. SUMMARY IHC is an integrated tool in muscle pathology, where recent studies contribute to improved diagnostic skills and increased insights into disease processes.
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Perrin A, Juntas Morales R, Chapon F, Thèze C, Lacourt D, Pégeot H, Uro‐Coste E, Giovannini D, Leboucq N, Mallaret M, Lagrange E, Rigau V, Gaudon K, Richard P, Koenig M, Métay C, Cossée M. Novel dominant distal titinopathy phenotype associated with copy number variation. Ann Clin Transl Neurol 2021; 8:1906-1912. [PMID: 34312993 PMCID: PMC8419403 DOI: 10.1002/acn3.51434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to analyze patients from two distinct families with a novel distal titinopathy phenotype associated with exactly the same CNV in the TTN gene. We used an integrated strategy combining deep phenotyping and complete molecular analyses in patients. The CNV is the most proximal out-of-frame TTN variant reported and leads to aberrant splicing transcripts leading to a frameshift. In this case, the dominant effect would be due to dominant-negative and/or haploinsufficiency. Few CNV in TTN have been reported to date. Our data represent a novel phenotype-genotype association and provides hypotheses for its dominant effects.
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Affiliation(s)
- Aurélien Perrin
- Laboratoire de Génétique MoléculaireCentre Hospitalier Universitaire de MontpellierMontpellierFrance
- PhyMedExpUniversité de MontpellierINSERMCNRSMontpellierFrance
| | - Raul Juntas Morales
- Laboratoire de Génétique MoléculaireCentre Hospitalier Universitaire de MontpellierMontpellierFrance
- Service de NeurologieCentre de Référence des Maladies Neuromusculaires AOC (Atlantique‐Occitanie‐Caraïbe) Centre Hospitalier Universitaire de MontpellierMontpellierFrance
| | - Françoise Chapon
- Département de pathologieCentre de Compétence des Maladies NeuromusculairesCentre Hospitalier Universitaire de CaenCaenFrance
| | - Corinne Thèze
- Laboratoire de Génétique MoléculaireCentre Hospitalier Universitaire de MontpellierMontpellierFrance
| | - Delphine Lacourt
- Laboratoire de Génétique MoléculaireCentre Hospitalier Universitaire de MontpellierMontpellierFrance
| | - Henri Pégeot
- Laboratoire de Génétique MoléculaireCentre Hospitalier Universitaire de MontpellierMontpellierFrance
| | - Emmanuelle Uro‐Coste
- Département d’Anatomie et Cytologie PathologiquesCentre Hospitalier Universitaire ToulouseToulouseFrance
| | - Diane Giovannini
- Service d’Anatomie et de Cytologie PathologiquesCHU Grenoble‐AlpesGrenobleFrance
| | - Nicolas Leboucq
- Service de NeuroradiologieCentre Hospitalier Universitaire de MontpellierMontpellier34090France
| | - Martial Mallaret
- Centre de Compétences des Maladies Neuro MusculairesCentre Hospitalier Universitaire Grenoble AlpesGrenobleFrance
| | - Emmeline Lagrange
- Centre de Compétences des Maladies Neuro MusculairesCentre Hospitalier Universitaire Grenoble AlpesGrenobleFrance
| | - Valérie Rigau
- Département de PathologieCentre Hospitalier Universitaire MontpellierMontpellierFrance
| | - Karen Gaudon
- Unité Fonctionnelle de Cardiogénétique et Myogénétique moleculaire et cellulaireCentre de Génétique Moléculaire et Chromosomique et INSERM UMRS 974Institut de MyologieGroupe Hospitalier La Pitié‐Salpêtrière‐Charles FoixParisINSERMUMRS1166UPMC Paris 6ParisFrance
| | - Pascale Richard
- Unité Fonctionnelle de Cardiogénétique et Myogénétique moleculaire et cellulaireCentre de Génétique Moléculaire et Chromosomique et INSERM UMRS 974Institut de MyologieGroupe Hospitalier La Pitié‐Salpêtrière‐Charles FoixParisINSERMUMRS1166UPMC Paris 6ParisFrance
| | - Michel Koenig
- Laboratoire de Génétique MoléculaireCentre Hospitalier Universitaire de MontpellierMontpellierFrance
- PhyMedExpUniversité de MontpellierINSERMCNRSMontpellierFrance
| | - Corinne Métay
- Unité Fonctionnelle de Cardiogénétique et Myogénétique moleculaire et cellulaireCentre de Génétique Moléculaire et Chromosomique et INSERM UMRS 974Institut de MyologieGroupe Hospitalier La Pitié‐Salpêtrière‐Charles FoixParisINSERMUMRS1166UPMC Paris 6ParisFrance
| | - Mireille Cossée
- Laboratoire de Génétique MoléculaireCentre Hospitalier Universitaire de MontpellierMontpellierFrance
- PhyMedExpUniversité de MontpellierINSERMCNRSMontpellierFrance
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