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Dabaj I, Carlier RY, Dieterich K, Desguerre I, Faure J, Romero NB, Trang W, Quijano-Roy S, Germain DP. Diagnostic work-up and phenotypic characteristics of a family with variable severity of distal arthrogryposis type 2B (Sheldon-Hall syndrome) and TNNT3 pathogenic variant. Front Genet 2023; 13:955041. [PMID: 36968005 PMCID: PMC10034368 DOI: 10.3389/fgene.2022.955041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/30/2022] [Indexed: 03/11/2023] Open
Abstract
Background: Sheldon–Hall syndrome (SHS) or distal arthrogryposis 2B (DA2B) is a rare clinically and genetically heterogeneous multiple congenital contracture syndrome characterized by contractures of the distal joints of the limbs and mild facial involvement, due to pathogenic variants in genes encoding the fast-twitch skeletal muscle contractile myofiber complex (TNNT3, TNNI2, TMP2, and MYH3 genes).Patients and methods: A 16-year-old boy with a history of congenital distal arthrogryposis developed severe kyphoscoliosis and respiratory insufficiency. His mother and younger sister had phenotypes compatible with SHS but to a much lesser extent. Diagnostic work-up included physical examination and whole-body muscular MRI (WBMRI) in all three patients and electroneuromyography (ENMG) and paravertebral muscle biopsy in the proband. DNA sequencing was used to confirm the diagnosis.Results: Physical examination suggested the diagnosis of SHS. No muscle signal abnormalities were found in WBMRI. Large motor unit potentials and reduced recruitment suggestive of neurogenic changes were observed on needle EMG in distal and paravertebral muscles in the proband. DNA sequencing revealed a pathogenic variant in TNNT3 (c.187C>T), which segregated as a dominant trait with the phenotype.Discussion: This is the first report on neurogenic features in a patient with DA2B and a pathogenic variant in TNNT3 encoding the fast-twitch skeletal muscle contractile myofiber complex. A superimposed length-dependent motor nerve involvement was unexpected. Whether developmental disarrangements in number, distribution, or innervation of the motor unit in fetal life might lead to pseudo-neurogenic EMG features warrants further studies, as well as the role of genetic modifiers in SHS variability.
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Affiliation(s)
- Ivana Dabaj
- APHP Université Paris-Saclay, Neuromuscular Unit, Department of Pediatric Neurology and ICU, Raymond Poincaré University Hospital (UVSQ), Garches, France
- Department of Neonatal and Pediatric Intensive Care, Charles Nicolle University Hospital, INSERM 1245, Rouen University, Rouen, France
- Nord-Est Ile de France National Neuromuscular Center, French Network (FILNEMUS) and European Reference Network (Euro-NMD), Paris, France
| | - Robert Y. Carlier
- Nord-Est Ile de France National Neuromuscular Center, French Network (FILNEMUS) and European Reference Network (Euro-NMD), Paris, France
- APHP Université Paris-Saclay, Medical Imaging Department, Raymond Poincaré Universiy Hospital (UVSQ), Garches, France
| | - Klaus Dieterich
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Medical Genetics, Grenoble Institute of Neurosciences, Grenoble, France
| | - Isabelle Desguerre
- Assistance Publique-Hôpitaux de Paris, Paediatric Neurology Department - CHU Necker-Enfants-Malades, Paris, France
| | - Julien Faure
- University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Medical Genetics, Grenoble Institute of Neurosciences, Grenoble, France
| | - Norma B. Romero
- Sorbonne Universités, UPMC University, INSERM UMRS974, CNRS FRE3617, Center for Research in Myology, Institut de Myologie, APHP GHU Pitié-Salpêtrière, Paris, France
| | - Wenting Trang
- AnDDI-RARE Paris Referral Center for Birth Defects, Division of Medical Genetics, APHP Paris Saclay University, Paris, France
| | - Susana Quijano-Roy
- APHP Université Paris-Saclay, Neuromuscular Unit, Department of Pediatric Neurology and ICU, Raymond Poincaré University Hospital (UVSQ), Garches, France
- Nord-Est Ile de France National Neuromuscular Center, French Network (FILNEMUS) and European Reference Network (Euro-NMD), Paris, France
| | - Dominique P. Germain
- AnDDI-RARE Paris Referral Center for Birth Defects, Division of Medical Genetics, APHP Paris Saclay University, Paris, France
- University of Versailles, Division of Medical Genetics, Montigny, France
- *Correspondence: Dominique P. Germain,
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Frasquet M, Sevilla T. Hereditary motor neuropathies. Curr Opin Neurol 2022; 35:562-570. [PMID: 35942667 DOI: 10.1097/wco.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Distal hereditary motor neuropathies (dHMN) are a clinically and genetically diverse group of disorders that are characterized by length-dependent axonal degeneration of lower motor neurons. In this review, we will provide an overview of dHMN, and we will correlate the distinct clinical subtypes with their causative genes, focusing on the most recent advances in the field. RECENT FINDINGS Despite the massive use of new-generation sequencing (NGS) and the discovery of new genes, only a third of dHMN patients receive a molecular diagnosis. Thanks to international cooperation between researchers, new genes have been implicated in dHMN, such as SORD and VWA1 . Mutations in SORD are the most frequent cause of autosomal recessive forms of dHMN. As a result of these findings, the potential benefits of some pharmacological compounds are being studied in cell and animal models, mainly targeting axonal transport and metabolic pathways. SUMMARY Despite the wide use of NGS, the diagnosis of dHMN remains a challenge. The low prevalence of dHMN makes international cooperation necessary in order to discover new genes and causal mechanisms. Genetic diagnosis of patients and identification of new pathomechanism are essential for the development of therapeutical clinical trials.
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Affiliation(s)
- Marina Frasquet
- Department of Neurology, Hospital Universitari Doctor Peset
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Spain
| | - Teresa Sevilla
- Neuromuscular Diseases Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Spain
- Universitat de València, Valencia, Spain
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