1
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Ning S, Han M, Qiu R, Hong X, Xia Z, Liu L, Liu C. Novel pathogenic variant in LMNA gene identified in a six-generation family causing atrial cardiomyopathy and associated right atrial conduction arrhythmias. Front Cardiovasc Med 2023; 10:1109008. [PMID: 37465451 PMCID: PMC10350631 DOI: 10.3389/fcvm.2023.1109008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Abstract
Objective To characterize the cardiac phenotype associated with the novel pathogenic variant (c.1526del) of LMNA gene, which we identified in a large, six-generation family. Methods and Results A family tree was constructed. The clinical data of living and deceased family members were collected. DNA samples from 7 family members were analyzed for LMNA mutations using whole-exome high-throughput sequencing technology. The clinical presentation of pathogenic variant carriers was evaluated. In this six-generation family (n = 67), one member experienced sudden death at the age of 40-years-old. Three pathogenic variant carriers were identified to possess a novel heterozygous deletion mutation in LMNA gene (HGVS: NM_170707.4, c.1526del) located at exon 9 of LMNA chr1:156137145, which creates a premature translational stop signal (p.Pro509Leufs*39) in the LMNA gene and results in an mutant lamin A protein product. The main symptoms of the pathogenic variant carriers were palpitation, fatigue, and syncope, which typically occurred around 20-years-old. AV-conduction block and non-sustained ventricular tachycardia were the first signs of disease and would rapidly progress to atrial standstill around 30-years-old. Significant right atrial enlargement and bicuspid aortic valve malformation was also commonly seen in patients who carried this pathogenic variant. Conclusion The pathogenic variant of c.1526del p.P509Lfs*39 was a frameshift deletion located at exon 9 of LMNA chr1:156137145 and causes severe right atrial enlargement, sick sinus syndrome, atrial standstill, ventricular tachycardia, and bicuspid aortic valve malformation. Our findings expand the phenotypic spectrum of novel LMNA gene mutations.
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Affiliation(s)
| | | | | | | | | | - Li Liu
- Correspondence: Li Liu Chengwei Liu
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2
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Bădilă E, Lungu II, Grumezescu AM, Scafa Udriște A. Diagnosis of Cardiac Abnormalities in Muscular Dystrophies. ACTA ACUST UNITED AC 2021; 57:medicina57050488. [PMID: 34066119 PMCID: PMC8151418 DOI: 10.3390/medicina57050488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 01/14/2023]
Abstract
Muscular disorders are mainly characterized by progressive skeletal muscle weakness. There are several aspects that can be monitored, which are used to differentiate between the types of muscular disorders, ranging from the targeted muscle up to the mutated gene. An aspect that holds critical importance when managing muscular dystrophies is that most of them exhibit cardiac abnormalities. Therefore, cardiac imaging is an essential part of muscular disorder monitoring and management. In the first section of the review, several cardiac abnormalities are introduced; afterward, different muscular dystrophies' pathogenesis is presented. Not all muscular dystrophies necessarily present cardiac involvement; however, the ones that do are linked with the cardiac abnormalities described in the first section. Moreover, studies from the last 3 years on muscular disorders are presented alongside imaging techniques used to determine cardiac abnormalities.
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Affiliation(s)
- Elisabeta Bădilă
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (A.S.U.)
- Internal Medicine Department, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Iulia Ioana Lungu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 011061 Bucharest, Romania;
- Correspondence: ; Tel.: +40-21-402-39-97
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 011061 Bucharest, Romania;
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
| | - Alexandru Scafa Udriște
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (A.S.U.)
- Cardiology Department, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
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3
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Kovalchuk T, Yakovleva E, Fetisova S, Vershinina T, Lebedeva V, Lyubimtseva T, Lebedev D, Mitrofanova L, Ryzhkov A, Sokolnikova P, Fomicheva Y, Kozyreva A, Zhuk S, Smolina N, Zlotina A, Pervunina T, Kostareva A, Vasichkina E. Case Reports: Emery-Dreifuss Muscular Dystrophy Presenting as a Heart Rhythm Disorders in Children. Front Cardiovasc Med 2021; 8:668231. [PMID: 34026875 PMCID: PMC8137911 DOI: 10.3389/fcvm.2021.668231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/07/2021] [Indexed: 01/06/2023] Open
Abstract
Emery-Dreifuss muscular dystrophy (EDMD) is inherited muscle dystrophy often accompanied by cardiac abnormalities in the form of supraventricular arrhythmias, conduction defects and sinus node dysfunction. Cardiac phenotype typically arises years after skeletal muscle presentation, though, could be severe and life-threatening. The defined clinical manifestation with joint contractures, progressive muscle weakness and atrophy, as well as cardiac symptoms are observed by the third decade of life. Still, clinical course and sequence of muscle and cardiac signs may be variable and depends on the genotype. Cardiac abnormalities in patients with EDMD in pediatric age are not commonly seen. Here we describe five patients with different forms of EDMD (X-linked and autosomal-dominant) caused by the mutations in EMD and LMNA genes, presented with early onset of cardiac abnormalities and no prominent skeletal muscle phenotype. The predominant forms of cardiac pathology were atrial arrhythmias and conduction disturbances that progress over time. The presented cases discussed in the light of therapeutic strategy, including radiofrequency ablation and antiarrhythmic devices implantation, and the importance of thorough neurological and genetic screening in pediatric patients presenting with complex heart rhythm disorders.
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Affiliation(s)
- Tatiana Kovalchuk
- World-Class Research Centre for Personalized Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Elena Yakovleva
- World-Class Research Centre for Personalized Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Svetlana Fetisova
- World-Class Research Centre for Personalized Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Tatiana Vershinina
- World-Class Research Centre for Personalized Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Viktoriya Lebedeva
- Institute of Heart and Vessels, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Tamara Lyubimtseva
- Institute of Heart and Vessels, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Dmitriy Lebedev
- Institute of Heart and Vessels, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Lubov Mitrofanova
- Pathology Unit, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Anton Ryzhkov
- Radiology Unit, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Polina Sokolnikova
- Institute of Molecular biology and Genetics, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Yuliya Fomicheva
- Institute of Molecular biology and Genetics, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Alexandra Kozyreva
- Institute of Molecular biology and Genetics, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Sergey Zhuk
- Institute of Molecular biology and Genetics, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Natalia Smolina
- Institute of Molecular biology and Genetics, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Anna Zlotina
- Institute of Molecular biology and Genetics, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Tatiana Pervunina
- Institute of Perinatology and Pediatrics, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Anna Kostareva
- Institute of Molecular biology and Genetics, Almazov National Medical Research Centre, Saint Petersburg, Russia.,Department of Women's and Children's Health and Center for Molecular Medicine, Karolinska Institutet, Solna, Sweden
| | - Elena Vasichkina
- World-Class Research Centre for Personalized Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russia
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4
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Marchel M, Madej-Pilarczyk A, Tymińska A, Steckiewicz R, Ostrowska E, Wysińska J, Russo V, Grabowski M, Opolski G. Cardiac Arrhythmias in Muscular Dystrophies Associated with Emerinopathy and Laminopathy: A Cohort Study. J Clin Med 2021; 10:732. [PMID: 33673224 PMCID: PMC7917673 DOI: 10.3390/jcm10040732] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cardiac involvement in patients with muscular dystrophy associated with Lamin A/C mutations (LMNA) is characterized by atrioventricular conduction abnormalities and life-threatening cardiac arrhythmias. Little is known about cardiac involvement in patients with emerin mutation (EMD). The aim of our study was to describe and compare the prevalence and time distribution of cardiac arrhythmias at extended follow-up. PATIENTS AND METHODS 45 consecutive patients affected by muscular dystrophy associated to laminopathy or emerinopathy were examined. All patients underwent clinical evaluation, 12-lead surface electrocardiogram (ECG), 24 h electrocardiographic monitoring, and cardiac implanted device interrogation. RESULTS At the end of 11 (5.0-16.6) years of follow-up, 89% of the patients showed cardiac arrhythmias. The most prevalent was atrial standstill (AS) (31%), followed by atrial fibrillation/flutter (AF/Afl) (29%) and ventricular tachycardia (22%). EMD patients presented more frequently AF/AFl compared to LMNA (50% vs. 20%, p = 0.06). Half of the EMD patients presented with AS, whilst there was no occurrence of such in the LMNA (p = 0.001). Ventricular arrhythmias were found in 60% of patients with laminopathy compared to 3% in patients with emerinopathy (p < 0.001). The age of AVB occurrence was higher in the LMNA group (32.8 +/- 10.6 vs. 25.1 +/- 9.1, p = 0.03). CONCLUSIONS Atrial arrhythmias are common findings in patients with muscular dystrophy associated with EMD/LMNA mutations; however, they occurred earlier in EMD patients. Ventricular arrhythmias were very common (60%) in LMNA and occurred definitely earlier compared to the EMD group.
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Affiliation(s)
- Michał Marchel
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.T.); (R.S.); (E.O.); (J.W.); (M.G.); (G.O.)
| | | | - Agata Tymińska
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.T.); (R.S.); (E.O.); (J.W.); (M.G.); (G.O.)
| | - Roman Steckiewicz
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.T.); (R.S.); (E.O.); (J.W.); (M.G.); (G.O.)
| | - Ewa Ostrowska
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.T.); (R.S.); (E.O.); (J.W.); (M.G.); (G.O.)
| | - Julia Wysińska
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.T.); (R.S.); (E.O.); (J.W.); (M.G.); (G.O.)
| | - Vincenzo Russo
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80131 Naples, Italy;
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.T.); (R.S.); (E.O.); (J.W.); (M.G.); (G.O.)
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.T.); (R.S.); (E.O.); (J.W.); (M.G.); (G.O.)
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5
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Echocardiographic Features of Cardiomyopathy in Emery-Dreifuss Muscular Dystrophy. Cardiol Res Pract 2021; 2021:8812044. [PMID: 33614169 PMCID: PMC7878080 DOI: 10.1155/2021/8812044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Emery-Dreifuss muscular dystrophy (EDMD) is a very rare type of muscular dystrophy characterized by musculoskeletal abnormalities accompanied by cardiac defects. Two most common genetic subtypes are EDMD1 due to EMD and EDMD2 caused by LMNA gene mutations. The aim of the study was to characterize and compare the cardiac morphology and function in the two main genetic subgroups of EDMD with the use of echocardiography. Methods 41 patients with EDMD (29 EDMD1 and 12 EDMD2) as well as 25 healthy controls were enrolled in our study. Transthoracic echo with the use of a prescribed protocol was performed. Results Highly statistically significant differences with regard to left ventricle (LV) volumes between the EDMD and the control group were found. 51% of EDMD patients had an enlarged left atrium and as many as 71% had an enlarged right atrium. The LV ejection fraction (LVEF) was significantly lower in EDMD patients than in the control group which corresponded also with a lower systolic velocity of the mitral annulus. 43% of EDMD patients had LVEF below the normal limit. Diastolic dysfunction was detected in 17% of EDMD patients. There were no significant differences between the two types of EDMD in terms of diameters and volumes of any chamber, as well as the systolic function of both left and right ventricles. Conclusions A significant number of EDMD patients present LV dilatation and different degrees of systolic dysfunction. Dilatation of the atria dominates over ventricle dilatation. We did not present any significant differences between EDMD1 and EDMD2 in terms of the morphology and the function of the heart.
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6
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Heller SA, Shih R, Kalra R, Kang PB. Emery-Dreifuss muscular dystrophy. Muscle Nerve 2019; 61:436-448. [PMID: 31840275 PMCID: PMC7154529 DOI: 10.1002/mus.26782] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 12/19/2022]
Abstract
Emery-Dreifuss muscular dystrophy (EDMD) is a rare muscular dystrophy, but is particularly important to diagnose due to frequent life-threatening cardiac complications. EDMD classically presents with muscle weakness, early contractures, cardiac conduction abnormalities and cardiomyopathy, although the presence and severity of these manifestations vary by subtype and individual. Associated genes include EMD, LMNA, SYNE1, SYNE2, FHL1, TMEM43, SUN1, SUN2, and TTN, encoding emerin, lamin A/C, nesprin-1, nesprin-2, FHL1, LUMA, SUN1, SUN2, and titin, respectively. The Online Mendelian Inheritance in Man database recognizes subtypes 1 through 7, which captures most but not all of the associated genes. Genetic diagnosis is essential whenever available, but traditional diagnostic tools can help steer the evaluation toward EDMD and assist with interpretation of equivocal genetic test results. Management is primarily supportive, but it is important to monitor patients closely, especially for potential cardiac complications. There is a high potential for progress in the treatment of EDMD in the coming years.
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Affiliation(s)
- Scott A Heller
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida
| | - Renata Shih
- Congenital Heart Center, University of Florida College of Medicine, Gainesville, Florida
| | - Raghav Kalra
- Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Peter B Kang
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida.,Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.,Genetics Institute and Myology Institute, University of Florida, Gainesville, Florida
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7
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Bianchi A, Manti PG, Lucini F, Lanzuolo C. Mechanotransduction, nuclear architecture and epigenetics in Emery Dreifuss Muscular Dystrophy: tous pour un, un pour tous. Nucleus 2019; 9:276-290. [PMID: 29619865 PMCID: PMC5973142 DOI: 10.1080/19491034.2018.1460044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The alteration of the several roles that Lamin A/C plays in the mammalian cell leads to a broad spectrum of pathologies that – all together – are named laminopathies. Among those, the Emery Dreifuss Muscular Dystrophy (EDMD) is of particular interest as, despite the several known mutations of Lamin A/C, the genotype–phenotype correlation still remains poorly understood; this suggests that the epigenetic background of patients might play an important role during the time course of the disease. Historically, both a mechanical role of Lamin A/C and a regulative one have been suggested as the driving force of laminopathies; however, those two hypotheses are not mutually exclusive. Recent scientific evidence shows that Lamin A/C sustains the correct gene expression at the epigenetic level thanks to the Lamina Associated Domains (LADs) reorganization and the crosstalk with the Polycomb Group of Proteins (PcG). Furthermore, the PcG-dependent histone mark H3K27me3 increases under mechanical stress, finally pointing out the link between the mechano-properties of the nuclear lamina and epigenetics. Here, we summarize the emerging mechanisms that could explain the high variability seen in Emery Dreifuss muscular dystrophy.
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Affiliation(s)
- Andrea Bianchi
- a CNR Institute of Cell Biology and Neurobiology, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia , Rome , Italy.,b Istituto Nazionale Genetica Molecolare Romeo ed Enrica Invernizzi , Milan , Italy
| | | | - Federica Lucini
- b Istituto Nazionale Genetica Molecolare Romeo ed Enrica Invernizzi , Milan , Italy
| | - Chiara Lanzuolo
- a CNR Institute of Cell Biology and Neurobiology, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia , Rome , Italy.,b Istituto Nazionale Genetica Molecolare Romeo ed Enrica Invernizzi , Milan , Italy.,c Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia , Rome , Italy
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8
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Strafella C, Campoli G, Galota RM, Caputo V, Pagliaroli G, Carboni S, Zampatti S, Peconi C, Mela J, Sancricca C, Primiano G, Minozzi G, Servidei S, Cascella R, Giardina E. Limb-Girdle Muscular Dystrophies (LGMDs): The Clinical Application of NGS Analysis, a Family Case Report. Front Neurol 2019; 10:619. [PMID: 31263448 PMCID: PMC6585112 DOI: 10.3389/fneur.2019.00619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022] Open
Abstract
The diagnosis of LGMD2A (calpainopathy) can be challenging due to genetic heterogeneity and to high similarity with other LGMDs or neuromuscular disorders. In this setting, NGS panels are highly recommended to perform differential diagnosis, identify new causative mutations and enable genotype-phenotype correlations. In this manuscript, the case of a patient affected by LGMD2A is reported, for which the application of a defined custom designed NGS panel allowed to confirm the diagnosis of calpainopathy linked with two heterozygous variants in CAPN3, namely c.550delA and c.1813G>C. The first variant has been extensively described in relation to calpainopathy. The second variant c.1813G>C, instead, is novel and has been predicted to be probably damaging. In addition, NGS analysis on the proband revealed a heterozygous variant (c.550C>T) in the LMNA gene, which is associated with dilated cardiomyopathy. The variant is novel and has been predicted to be deleterious by subsequent bioinformatic analysis. Successively, segregation analysis was performed on family members. Interestingly, none of them showed neuromuscular symptoms but the mother was diagnosed with bradycardia and syncopal episodes and showed a positive family history for cardiomyopathy. The segregation analysis reported that the proband inherited the c.1813G>C (CAPN3) from the father who was a healthy carrier. The mother was positive for c.550delA (CAPN3) and c.550C>T (LMNA), suggesting thereby a possible genetic explanation for her cardiovascular problems. Segregation analysis, therefore, confirmed the inheritance pattern of the variants carried by the proband and highlighted a familiarity for cardiomyopathy which should not be neglected. The NGS analysis was further performed on the partner of the proband, to estimate the reproductive risk of the couple. The partner was negative to NGS screening, suggesting thereby a low risk to have an affected child with calpainopathy and 50% probability to inherit the LMNA variant. This case report showed the clinical utility of the NGS panel in providing accurate LGMD2A diagnosis and identifying complex phenotypes originating from mutations in multiple genes. However, NGS results should always be accomplished by a dedicated genetic counseling, not only to evaluate the recurrence and reproductive risks but also to uncover unexpected findings which can be clinically significant.
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Affiliation(s)
- Claudia Strafella
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy.,Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Giulia Campoli
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy
| | - Rosaria Maria Galota
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy
| | - Valerio Caputo
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy.,Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Giulia Pagliaroli
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy
| | - Stefania Carboni
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy
| | - Stefania Zampatti
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy
| | - Cristina Peconi
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy
| | - Julia Mela
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy
| | - Cristina Sancricca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurofisiopatologia, Rome, Italy.,Unione Italiana Lotta Distrofia Muscolare (UILDM), Sezione Laziale, Rome, Italy
| | - Guido Primiano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurofisiopatologia, Rome, Italy
| | - Giulietta Minozzi
- Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - Serenella Servidei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurofisiopatologia, Rome, Italy
| | - Raffaella Cascella
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy.,Department of Biomedical Sciences, Catholic University Our Lady of Good Counsel, Tirana, Albania
| | - Emiliano Giardina
- Molecular Genetics Laboratory Unione Italiana Lotta Distrofia Muscolare (UILDM), Santa Lucia Foundation, Rome, Italy.,Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
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9
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Gal DB, Wojciak J, Perera J, Tanel RE, Patel AR. Atrial standstill in a pediatric patient with associated caveolin-3 mutation. HeartRhythm Case Rep 2017; 3:513-516. [PMID: 29387541 PMCID: PMC5778098 DOI: 10.1016/j.hrcr.2017.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dana B Gal
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Julianne Wojciak
- Department of Pediatric Cardiology, University of California, San Francisco, San Francisco, California
| | - Jennifer Perera
- Department of Pediatric Cardiology, University of California, San Francisco, San Francisco, California
| | - Ronn E Tanel
- Department of Pediatric Cardiology, University of California, San Francisco, San Francisco, California
| | - Akash R Patel
- Department of Pediatric Cardiology, University of California, San Francisco, San Francisco, California
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10
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Agrawal H, Aggarwal K, Alpert MA. Persistent atrial standstill following the Cox-maze III procedure: reversal with sustained atrial pacing. Ann Noninvasive Electrocardiol 2017; 22:e12399. [PMID: 27558131 PMCID: PMC6931504 DOI: 10.1111/anec.12399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Atrial standstill is a rare disorder of cardiac rhythm that is characterized by total absence of electrical activity in one or both atria. We report herein the case of a patient with atrial fibrillation and symptomatic 4.0 s pauses who received a ventricular demand pacemaker. The patient later underwent mitral valve replacement with a pericardial tissue valve and the Cox-maze III procedure for symptomatic mitral stenosis and atrial fibrillation. Following surgery, he developed atrial standstill and became pacemaker dependent. The pacemaker was later revised to an atrioventricular sequential pacemaker. Twelve hours after revision, atrioventricular sequential pacing was noted and mechanical function of the atria was confirmed by Doppler echocardiography.
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Affiliation(s)
- Harsh Agrawal
- Division of Cardiovascular MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
| | - Kul Aggarwal
- Division of Cardiovascular MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
| | - Martin A. Alpert
- Division of Cardiovascular MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
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11
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Ramírez Botero AF, Posso Gómez LJ, Castillo A, Collado C, Fernández Pedrosa V, Rodríguez Cruz O, Lois S, Gil MT, Quiñones JA, Pachajoa H. Enfoque diagnóstico molecular utilizando secuenciación exómica en las distrofias musculares cintura-cadera. REVISTA DE LA FACULTAD DE MEDICINA 2016. [DOI: 10.15446/revfacmed.v64n1.53037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>Antecedentes. La distrofia muscular cintura-cadera tipo 1B es una enfermedad con herencia autosómica dominante y secundaria a una mutación en el gen LMNA. Esta enfermedad se caracteriza por su afectación a nivel neuromuscular y cardiaco. Objetivo. Realizar diagnóstico clínico y confirmatorio molecular en una paciente con debilidad muscular proximal y sintomatología cardíaca a través de secuenciación exómica. Materiales y métodos. Se presenta el caso de una paciente de 57 años de edad con cuadro de debilidad muscular proximal progresiva principalmente en extremidades y posterior afectación cardíaca; adicionalmente, la paciente tiene múltiples familiares con la misma sintomatología. Se realizó estudio de secuenciación exómica con confirmación, por método de Sanger, de la mutación hallada y posteriormente el análisis bioinformático de esta. Resultados. La detección de la mutación R377L en el gen LMNA por secuenciación exómica con confirmación por Sanger, junto con la sintomatología clínica de la paciente y el análisis bioinformático de la mutación hallada, permitió realizar diagnóstico confirmatorio de distrofia muscular cintura-cadera tipo 1B. Conclusión. Es difícil realizar un diagnóstico clínico debido a la heterogeneidad genética del fenotipo de distrofias musculares cintura-cadera. La aproximación diagnóstica es compleja y requiere clasificar las distrofias musculares según el patrón de afectación y el patrón de herencia de la enfermedad. Adicionalmente, debido a los múltiples genes que pueden generar clínica semejante a las diferentes distrofias musculares, se recomienda realizar secuenciación exómica solicitando especial énfasis en los genes candidatos de distrofias musculares cintura-cadera.</p>
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Meinke P, Mattioli E, Haque F, Antoku S, Columbaro M, Straatman KR, Worman HJ, Gundersen GG, Lattanzi G, Wehnert M, Shackleton S. Muscular dystrophy-associated SUN1 and SUN2 variants disrupt nuclear-cytoskeletal connections and myonuclear organization. PLoS Genet 2014; 10:e1004605. [PMID: 25210889 PMCID: PMC4161305 DOI: 10.1371/journal.pgen.1004605] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 07/16/2014] [Indexed: 11/19/2022] Open
Abstract
Proteins of the nuclear envelope (NE) are associated with a range of inherited disorders, most commonly involving muscular dystrophy and cardiomyopathy, as exemplified by Emery-Dreifuss muscular dystrophy (EDMD). EDMD is both genetically and phenotypically variable, and some evidence of modifier genes has been reported. Six genes have so far been linked to EDMD, four encoding proteins associated with the LINC complex that connects the nucleus to the cytoskeleton. However, 50% of patients have no identifiable mutations in these genes. Using a candidate approach, we have identified putative disease-causing variants in the SUN1 and SUN2 genes, also encoding LINC complex components, in patients with EDMD and related myopathies. Our data also suggest that SUN1 and SUN2 can act as disease modifier genes in individuals with co-segregating mutations in other EDMD genes. Five SUN1/SUN2 variants examined impaired rearward nuclear repositioning in fibroblasts, confirming defective LINC complex function in nuclear-cytoskeletal coupling. Furthermore, myotubes from a patient carrying compound heterozygous SUN1 mutations displayed gross defects in myonuclear organization. This was accompanied by loss of recruitment of centrosomal marker, pericentrin, to the NE and impaired microtubule nucleation at the NE, events that are required for correct myonuclear arrangement. These defects were recapitulated in C2C12 myotubes expressing exogenous SUN1 variants, demonstrating a direct link between SUN1 mutation and impairment of nuclear-microtubule coupling and myonuclear positioning. Our findings strongly support an important role for SUN1 and SUN2 in muscle disease pathogenesis and support the hypothesis that defects in the LINC complex contribute to disease pathology through disruption of nuclear-microtubule association, resulting in defective myonuclear positioning. Emery-Dreifuss muscular dystrophy (EDMD) is an inherited disorder involving muscle wasting and weakness, accompanied by cardiac defects. The disease is variable in its severity and also in its genetic cause. So far, 6 genes have been linked to EDMD, most encoding proteins that form a structural network that supports the nucleus of the cell and connects it to structural elements of the cytoplasm. This network is particularly important in muscle cells, providing resistance to mechanical strain. Weakening of this network is thought to contribute to development of muscle disease in these patients. Despite rigorous screening, at least 50% of patients with EDMD have no detectable mutation in the 6 known genes. We therefore undertook screening and identified mutations in two additional genes that encode other components of the nuclear structural network, SUN1 and SUN2. Our findings add to the genetic complexity of this disease since some individuals carry mutations in more than one gene. We also show that the mutations disrupt connections between the nucleus and the structural elements of cytoplasm, leading to mis-positioning and clustering of nuclei in muscle cells. This nuclear mis-positioning is likely to be another factor contributing to pathogenesis of EDMD.
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Affiliation(s)
- Peter Meinke
- Institute of Human Genetics and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Elisabetta Mattioli
- National Research Council of Italy - CNR - Institute for Molecular Genetics, Unit of Bologna IOR, Bologna, Italy
- Rizzoli Orthopaedic Institute, Laboratory of Musculoskeletal Cell Biology, Bologna, Italy
| | - Farhana Haque
- Department of Biochemistry, University of Leicester, Leicester, United Kingdom
| | - Susumu Antoku
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Marta Columbaro
- Rizzoli Orthopaedic Institute, Laboratory of Musculoskeletal Cell Biology, Bologna, Italy
| | - Kees R. Straatman
- Centre for Core Biotechnology Services, University of Leicester, Leicester, United Kingdom
| | - Howard J. Worman
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Gregg G. Gundersen
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Giovanna Lattanzi
- National Research Council of Italy - CNR - Institute for Molecular Genetics, Unit of Bologna IOR, Bologna, Italy
- Rizzoli Orthopaedic Institute, Laboratory of Musculoskeletal Cell Biology, Bologna, Italy
| | - Manfred Wehnert
- Institute of Human Genetics and Interfaculty Institute of Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Sue Shackleton
- Department of Biochemistry, University of Leicester, Leicester, United Kingdom
- * E-mail:
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Yuan J, Ando M, Higuchi I, Sakiyama Y, Matsuura E, Michizono K, Watanabe O, Nagano S, Inamori Y, Hashiguchi A, Higuchi Y, Yoshimura A, Takashima H. Partial deficiency of emerin caused by a splice site mutation in EMD. Intern Med 2014; 53:1563-8. [PMID: 25030574 DOI: 10.2169/internalmedicine.53.8922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Emery-Dreifuss muscular dystrophy (EDMD) is caused by mutations in the EMD gene on the X chromosome, which codes for emerin, an inner nuclear membrane protein. Monoclonal antibodies against the N-terminus of emerin protein are used to screen for emerin deficiency in clinical practice. However, these tests may not accurately reflect the disease in some cases. We herein describe the identification of a splice site mutation in the EMD gene in a Japanese patient who suffered from complete atrioventricular conduction block, mild muscle weakness and joint contracture, and a persistently elevated serum creatine kinase level. We used multiple antibodies to confirm the presence of a novel truncating mutation in emerin without the transmembrane region and C-terminus in the skeletal muscle.
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MESH Headings
- Biopsy
- Chromosomes, Human, X/genetics
- DNA/genetics
- DNA Mutational Analysis
- Diagnosis, Differential
- Humans
- Immunohistochemistry
- Male
- Membrane Proteins/deficiency
- Membrane Proteins/genetics
- Muscle, Skeletal/diagnostic imaging
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/pathology
- Muscular Dystrophy, Emery-Dreifuss/diagnosis
- Muscular Dystrophy, Emery-Dreifuss/genetics
- Muscular Dystrophy, Emery-Dreifuss/metabolism
- Mutation
- Nuclear Proteins/deficiency
- Nuclear Proteins/genetics
- Polymerase Chain Reaction
- Thymopoietins
- Tomography, X-Ray Computed
- Young Adult
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Affiliation(s)
- Junhui Yuan
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
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Saraiva F, Rodrigues D, Andrade H, Negrão L, Gonçalves L, Marinho A, Providência LA. [Emery-Dreifuss muscular dystrophy: case report]. Rev Port Cardiol 2013; 31:241-5. [PMID: 22284682 DOI: 10.1016/j.repc.2012.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 09/08/2011] [Indexed: 11/17/2022] Open
Abstract
Emery-Dreifuss muscular dystrophy type 1 (EDMD1) is a familial disease with X-Linked recessive transmission, caused by a mutation in a nuclear envelope protein, emerin. Clinical manifestations usually occur in adolescence and include contractures, muscle atrophy and weakness, and cardiac conduction disturbances. We describe the case of a young male, aged 16, with first-degree atrioventricular (AV) block and limited extension of both forearms. He had elevated CK, and cardiac monitoring showed severe conduction tissue disease, with significant sinus pauses, chronotropic incompetence and periods of AV dissociation during exercise. Immunohistochemical staining using an emerin antibody showed absence of the protein in a fragment of muscle tissue and genetic study identified a mutation associated with EDMD1. Study of his brother, aged 21, also established a diagnosis of EDMD1. Both individuals received a permanent pacemaker but musculoskeletal manifestations at that time did not warrant any other intervention: Screening for certain genetic diseases, including muscular dystrophies, is mandatory following identification of conduction abnormalities in young people.
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Affiliation(s)
- Fatima Saraiva
- Serviço de Cardiologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
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15
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Disertori M, Quintarelli S, Grasso M, Pilotto A, Narula N, Favalli V, Canclini C, Diegoli M, Mazzola S, Marini M, Del Greco M, Bonmassari R, Masè M, Ravelli F, Specchia C, Arbustini E. Autosomal recessive atrial dilated cardiomyopathy with standstill evolution associated with mutation of Natriuretic Peptide Precursor A. ACTA ACUST UNITED AC 2012; 6:27-36. [PMID: 23275345 DOI: 10.1161/circgenetics.112.963520] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial dilatation and atrial standstill are etiologically heterogeneous phenotypes with poorly defined nosology. In 1983, we described 8-years follow-up of atrial dilatation with standstill evolution in 8 patients from 3 families. We later identified 5 additional patients with identical phenotypes: 1 member of the largest original family and 4 unrelated to the 3 original families. All families are from the same geographic area in Northeast Italy. METHODS AND RESULTS We followed up the 13 patients for up to 37 years, extended the clinical investigation and monitoring to living relatives, and investigated the genetic basis of the disease. The disease was characterized by: (1) clinical onset in adulthood; (2) biatrial dilatation up to giant size; (3) early supraventricular arrhythmias with progressive loss of atrial electric activity to atrial standstill; (4) thromboembolic complications; and (5) stable, normal left ventricular function and New York Heart Association functional class during the long-term course of the disease. By linkage analysis, we mapped a locus at 1p36.22 containing the Natriuretic Peptide Precursor A gene. By sequencing Natriuretic Peptide Precursor A, we identified a homozygous missense mutation (p.Arg150Gln) in all living affected individuals of the 6 families. All patients showed low serum levels of atrial natriuretic peptide. Heterozygous mutation carriers were healthy and demonstrated normal levels of atrial natriuretic peptide. CONCLUSIONS Autosomal recessive atrial dilated cardiomyopathy is a rare disease associated with homozygous mutation of the Natriuretic Peptide Precursor A gene and characterized by extreme atrial dilatation with standstill evolution, thromboembolic risk, preserved left ventricular function, and severely decreased levels of atrial natriuretic peptide.
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Teekakirikul P, Kelly MA, Rehm HL, Lakdawala NK, Funke BH. Inherited cardiomyopathies: molecular genetics and clinical genetic testing in the postgenomic era. J Mol Diagn 2012; 15:158-70. [PMID: 23274168 DOI: 10.1016/j.jmoldx.2012.09.002] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 08/14/2012] [Accepted: 09/26/2012] [Indexed: 12/17/2022] Open
Abstract
Inherited cardiomyopathies include hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, left ventricular noncompaction, and restrictive cardiomyopathy. These diseases have a substantial genetic component and predispose to sudden cardiac death, which provides a high incentive to identify and sequence disease genes in affected individuals to identify pathogenic variants. Clinical genetic testing, which is now widely available, can be a powerful tool for identifying presymptomatic individuals. However, locus and allelic heterogeneity are the rule, as are clinical variability and reduced penetrance of disease in carriers of pathogenic variants. These factors, combined with genetic and phenotypic overlap between different cardiomyopathies, have made clinical genetic testing a lengthy and costly process. Next-generation sequencing technologies have removed many limitations such that comprehensive testing is now feasible, shortening diagnostic odysseys for clinically complex cases. Remaining challenges include the incomplete understanding of the spectrum of benign and pathogenic variants in the cardiomyopathy genes, which is a source of inconclusive results. This review provides an overview of inherited cardiomyopathies with a focus on their genetic etiology and diagnostic testing in the postgenomic era.
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Affiliation(s)
- Srijita Sen-Chowdhry
- Inherited Cardiovascular Disease Group, University College London, The Heart Hospital, 16-18 Westmoreland Street, London, UK
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18
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Emery-Dreifuss muscular dystrophy: Case report. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ishikawa K, Mimuro M, Tanaka T. Ventricular arrhythmia in X-linked Emery-Dreifuss muscular dystrophy: a lesson from an autopsy case. Intern Med 2011; 50:459-62. [PMID: 21372459 DOI: 10.2169/internalmedicine.50.4598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Emery-Dreifuss muscular dystrophy (EDMD) is a distinctive form of muscular dystrophy which is often associated with cardiac abnormalities. Conduction disturbances are frequently observed, and may necessitate pacemaker implantation to prevent sudden death. In this case report, we present an autopsy of a 31-year-old man with X-linked EDMD who developed only minimal skeletal muscle symptoms, and who died from ventricular arrhythmia despite undergoing a previous pacemaker implantation. Ventricular arrhythmias in X-linked EDMD patients are also discussed.
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MESH Headings
- Adult
- Arrhythmias, Cardiac/etiology
- Atrioventricular Block/etiology
- Autopsy
- Cardiomyopathy, Dilated/etiology
- Cardiomyopathy, Dilated/pathology
- Death, Sudden, Cardiac/etiology
- Humans
- Male
- Muscular Dystrophy, Emery-Dreifuss/complications
- Muscular Dystrophy, Emery-Dreifuss/diagnosis
- Muscular Dystrophy, Emery-Dreifuss/genetics
- Pacemaker, Artificial
- Tachycardia, Ventricular/etiology
- Ventricular Fibrillation/etiology
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Gotic I, Schmidt WM, Biadasiewicz K, Leschnik M, Spilka R, Braun J, Stewart CL, Foisner R. Loss of LAP2 alpha delays satellite cell differentiation and affects postnatal fiber-type determination. Stem Cells 2010; 28:480-8. [PMID: 20039368 DOI: 10.1002/stem.292] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Lamina-associated polypeptide 2 alpha (LAP2 alpha) is a nucleoplasmic protein implicated in cell cycle regulation through its interaction with A-type lamins and the retinoblastoma protein. Mutations in lamin A/C and LAP2 alpha cause late onset striated muscle diseases, but the molecular mechanisms are poorly understood. To study the role of LAP2 alpha in skeletal muscle function and postnatal tissue homeostasis, we generated complete and muscle-specific LAP2 alpha knockout mice. Whereas overall muscle morphology, function, and regeneration were not detectably affected, the myofiber-associated muscle stem cell pool was increased in complete LAP2 alpha knockout animals. At molecular level, the absence of LAP2 alpha preserved the stem cell-like phenotype of Lap2 alpha(-/-) primary myoblasts and delayed their in vitro differentiation. In addition, loss of LAP2 alpha shifted the myofiber-type ratios of adult slow muscles toward fast fiber types. Conditional Cre-mediated late muscle-specific ablation of LAP2 alpha affected early stages of in vitro myoblast differentiation, and also fiber-type determination, but did not change myofiber-associated stem cell numbers in vivo. Our data demonstrate multiple and distinct functions of LAP2 alpha in muscle stem cell maintenance, early phases of myogenic differentiation, and muscle remodeling.
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Affiliation(s)
- Ivana Gotic
- Department of Medical Biochemistry, Max F. Perutz Laboratories, Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
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Méjat A, Decostre V, Li J, Renou L, Kesari A, Hantaï D, Stewart CL, Xiao X, Hoffman E, Bonne G, Misteli T. Lamin A/C-mediated neuromuscular junction defects in Emery-Dreifuss muscular dystrophy. ACTA ACUST UNITED AC 2009; 184:31-44. [PMID: 19124654 PMCID: PMC2615092 DOI: 10.1083/jcb.200811035] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The LMNA gene encodes lamins A and C, two intermediate filament-type proteins that are important determinants of interphase nuclear architecture. Mutations in LMNA lead to a wide spectrum of human diseases including autosomal dominant Emery-Dreifuss muscular dystrophy (AD-EDMD), which affects skeletal and cardiac muscle. The cellular mechanisms by which mutations in LMNA cause disease have been elusive. Here, we demonstrate that defects in neuromuscular junctions (NMJs) are part of the disease mechanism in AD-EDMD. Two AD-EDMD mouse models show innervation defects including misexpression of electrical activity–dependent genes and altered epigenetic chromatin modifications. Synaptic nuclei are not properly recruited to the NMJ because of mislocalization of nuclear envelope components. AD-EDMD patients with LMNA mutations show the same cellular defects as the AD-EDMD mouse models. These results suggest that lamin A/C–mediated NMJ defects contribute to the AD-EDMD disease phenotype and provide insights into the cellular and molecular mechanisms for the muscle-specific phenotype of AD-EDMD.
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Affiliation(s)
- Alexandre Méjat
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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22
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Wolf CM, Wang L, Alcalai R, Pizard A, Burgon PG, Ahmad F, Sherwood M, Branco DM, Wakimoto H, Fishman GI, See V, Stewart CL, Conner DA, Berul CI, Seidman CE, Seidman JG. Lamin A/C haploinsufficiency causes dilated cardiomyopathy and apoptosis-triggered cardiac conduction system disease. J Mol Cell Cardiol 2007; 44:293-303. [PMID: 18182166 DOI: 10.1016/j.yjmcc.2007.11.008] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 11/11/2007] [Accepted: 11/14/2007] [Indexed: 11/26/2022]
Abstract
Mutations in the lamin A/C (LMNA) gene, which encodes nuclear membrane proteins, cause a variety of human conditions including dilated cardiomyopathy (DCM) with associated cardiac conduction system disease. To investigate mechanisms responsible for electrophysiologic and myocardial phenotypes caused by dominant human LMNA mutations, we performed longitudinal evaluations in heterozygous Lmna(+/-) mice. Despite one normal allele, Lmna(+/-) mice had 50% of normal cardiac lamin A/C levels and developed cardiac abnormalities. Conduction system function was normal in neonatal Lmna(+/-) mice but, by 4 weeks of age, atrioventricular (AV) nodal myocytes had abnormally shaped nuclei and active apoptosis. Telemetric and in vivo electrophysiologic studies in 10-week-old Lmna(+/-) mice showed AV conduction defects and both atrial and ventricular arrhythmias, analogous to those observed in humans with heterozygous LMNA mutations. Isolated myocytes from 12-month-old Lmna(+/-) mice exhibited impaired contractility. In vivo cardiac studies of aged Lmna(+/-) mice revealed DCM; in some mice this occurred without overt conduction system disease. However, neither histopathology nor serum CK levels indicated skeletal muscle pathology. These data demonstrate cardiac pathology due to heterozygous Lmna mutations reflecting a 50% reduction in lamin protein levels. Lamin haploinsufficiency caused early-onset programmed cell death of AV nodal myocytes and progressive electrophysiologic disease. While lamin haploinsufficiency was better tolerated by non-conducting myocytes, ultimately, these too succumbed to diminished lamin levels leading to dilated cardiomyopathy, which presumably arose independently from conduction system disease.
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Affiliation(s)
- Cordula M Wolf
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
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Antoniades L, Eftychiou C, Kyriakides T, Christodoulou K, Katritsis DG. Malignant mutation in the lamin A/C gene causing progressive conduction system disease and early sudden death in a family with mild form of limb-girdle muscular dystrophy. J Interv Card Electrophysiol 2007; 19:1-7. [PMID: 17605093 DOI: 10.1007/s10840-007-9133-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 05/01/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lamin proteins A and C are major functional and structural components of the nuclear lamina. Mutations of the LMNA gene have been associated with dilated cardiomyopathy, conduction system defects and skeletal muscle dystrophy simultaneously, in variable involvement. We report on a family with a mutation of the lamin A/C gene (c.908-909delCT). METHODS Thirty five members of the family of a proband were studied and underwent clinical and genetic evaluation. Family members were considered to be affected if they demonstrated conduction system defects, limb-girdle muscular dystrophy, dilated cardiomyopathy, carried the lamin A/C mutation or suffered sudden death. RESULTS Fifteen members of the family were considered to be affected. Conduction system defects were the major feature of the affected members (67%), with variable involvement of dilated cardiomyopathy (33%), and limb-girdle muscular dystrophy (53%). Sudden death occurred in four members (27%) and was the presenting feature in three (20%) of the affected members at an early age. Mutation c.908-909delCT was confirmed in 12 of the affected members. The pattern of inheritance was autosomal dominant. CONCLUSION Lamin c.908-909delCT mutation is malignant compared to other dilated cardiomyopathy-associated mutations of the Lamin A/C gene. Patients with this mutation have rapid progression of atrioventricular conduction abnormalities, and sudden death may be the presenting feature. Early identification of affected families and consideration of an implantable defibrillator is important in this setting.
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