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Velardo D, Antognozzi S, Rimoldi M, Pagliarani S, Cogiamanian F, Barbieri S, Corti S, Comi GP, Ronchi D. Case report: Clinical and molecular characterization of two siblings affected by Brody myopathy. Front Neurol 2023; 14:1170071. [PMID: 37332993 PMCID: PMC10272758 DOI: 10.3389/fneur.2023.1170071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Exercise-induced muscle stiffness is the hallmark of Brody disease, an autosomal recessive myopathy due to biallelic pathogenic variants in ATP2A1, encoding the sarcoplasmic/endoplasmic reticulum Ca2+ ATPase SERCA1. About 40 patients have been reported so far. Our knowledge about the natural history of this disorder, genotype-phenotype correlations and the effect of symptomatic treatment is partial. This results in incomplete recognition and underdiagnosis of the disease. Here, we report the clinical, instrumental, and molecular features of two siblings presenting childhood-onset exercise-induced muscle stiffness without pain. Both the probands display difficulty in climbing stairs and running, frequent falls, delayed muscle relaxation after exertion. Cold temperatures worsen these symptoms. No myotonic discharges were observed at electromyography. Whole Exome Sequencing analysis in the probands revealed the presence of two ATP2A1 variants: the previously reported frameshift microdeletion c.2464delC and the likely pathogenic novel splice-site variant c.324 + 1G > A, whose detrimental effect was demonstrated in ATP2A1 transcript analysis. The bi-allelic inheritance was verified by Sanger sequencing in the unaffected parents. This study expands the molecular defects associated with Brody myopathy.
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Affiliation(s)
- Daniele Velardo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Sara Antognozzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Martina Rimoldi
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Serena Pagliarani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Filippo Cogiamanian
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurophysiology Unit, Milan, Italy
| | - Sergio Barbieri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurophysiology Unit, Milan, Italy
| | - Stefania Corti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacomo Pietro Comi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Dario Ronchi
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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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] [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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Mussini JM, Magot A, Hantaï D, Sternberg D, Chevessier F, Péréon Y. Atypical nuclear abnormalities in a patient with Brody disease. Neuromuscul Disord 2015; 25:773-9. [PMID: 26248958 DOI: 10.1016/j.nmd.2015.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/09/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
Brody disease was first described as a benign pseudo-myotonic disorder with muscular stiffness, which increased with exercise. Biochemical and genetic studies have pointed out its close relationship to a functional defect of the fast-twitch sarcoplasmic reticulum Ca(++) ATPase pump (SERCA1) encoded by the ATP2A1 gene located on chromosome 16. The histopathological features in this form of myopathy were generally described as non-specific, i.e. moderate degree of type 2 fibre atrophy and excess of internal nuclei. We here present the clinical and histopathological features of a patient with Brody disease over a 19-year follow-up period. This patient had two heterozygous ATP2A1 mutations and complained about muscle stiffness immediately after effort. He had suffered from this since early childhood and exhibited clinical symptoms mimicking myotonia. Histological, ultrastructural and cytogenetic analyses revealed morphologically abnormal nuclei with polyploidy. In this report, we discuss the possible links between the consequences of the genetic abnormality and the peculiar aspect of the nuclei.
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Affiliation(s)
- Jean-Marie Mussini
- Laboratoire d'Anatomie Pathologique, CHU de Nantes, Nantes, France; Centre de Référence Maladies Neuromusculaires Nantes-Angers, CHU de Nantes, Nantes, France
| | - Armelle Magot
- Centre de Référence Maladies Neuromusculaires Nantes-Angers, CHU de Nantes, Nantes, France; Atlantic Gene Therapies - Biotherapy Institute for Rare Diseases, Nantes, France
| | - Daniel Hantaï
- Institut de Myologie, Hôpital de La Salpêtrière, Paris, France
| | - Damien Sternberg
- Institut de Myologie, Hôpital de La Salpêtrière, Paris, France; Laboratoire de Biochimie, Hôpital de La Salpêtrière, Paris, France
| | - Frédéric Chevessier
- Institut de Myologie, Hôpital de La Salpêtrière, Paris, France; Neuropathologisches Institut, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Yann Péréon
- Centre de Référence Maladies Neuromusculaires Nantes-Angers, CHU de Nantes, Nantes, France; Atlantic Gene Therapies - Biotherapy Institute for Rare Diseases, Nantes, France.
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5
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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] [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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