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Palmio J, Leonard-Louis S, Sacconi S, Savarese M, Penttilä S, Semmler AL, Kress W, Mozaffar T, Lai T, Stojkovic T, Berardo A, Reisin R, Attarian S, Urtizberea A, Cobo AM, Maggi L, Kurbatov S, Nikitin S, Milisenda JC, Fatehi F, Raimondi M, Silveira F, Hackman P, Claeys KG, Udd B. Expanding the importance of HMERF titinopathy: new mutations and clinical aspects. J Neurol 2019; 266:680-690. [PMID: 30666435 PMCID: PMC6394805 DOI: 10.1007/s00415-019-09187-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 02/08/2023]
Abstract
Objective Hereditary myopathy with early respiratory failure (HMERF) is caused by titin A-band mutations in exon 344 and considered quite rare. Respiratory insufficiency is an early symptom. A collection of families and patients with muscle disease suggestive of HMERF was clinically and genetically studied. Methods Altogether 12 new families with 19 affected patients and diverse nationalities were studied. Most of the patients were investigated using targeted next-generation sequencing; Sanger sequencing was applied in some of the patients and available family members. Histological data and muscle MRI findings were evaluated. Results Three families had several family members studied while the rest were single patients. Most patients had distal and proximal muscle weakness together with respiratory insufficiency. Five heterozygous TTN A-band mutations were identified of which two were novel. Also with the novel mutations the muscle pathology and imaging findings were compatible with the previous reports of HMERF. Conclusions Our collection of 12 new families expands mutational spectrum with two new mutations identified. HMERF is not that rare and can be found worldwide, but maybe underdiagnosed. Diagnostic process seems to be complex as this study shows with mostly single patients without clear dominant family history.
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Affiliation(s)
- Johanna Palmio
- Department of Neurology, Neuromuscular Research Center, Tampere University Hospital and University of Tampere, 33014, Tampere, Finland.
| | - Sarah Leonard-Louis
- Institute of Myology, National Reference Center for Neuromuscular Disorders, University Hospital of Salpêtrière, UPMC, Paris, France
| | - Sabrina Sacconi
- Nice University Hospital, Université Côte d'Azur, Nice, France
| | - Marco Savarese
- Folkhälsan Institute of Genetics and Medicum, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Sini Penttilä
- Department of Neurology, Neuromuscular Research Center, Tampere University Hospital and University of Tampere, 33014, Tampere, Finland
| | - Anna-Lena Semmler
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuropathology, RWTH Aachen University, Aachen, Germany
| | - Wolfram Kress
- Institute of Human Genetics, University of Würzburg, Würzburg, Germany
| | - Tahseen Mozaffar
- Neurology Department, University of California, Irvine, Orange, CA, USA
| | - Tim Lai
- Neurology Department, University of California, Irvine, Orange, CA, USA
| | - Tanya Stojkovic
- Center of Research in Myology, UPMC Univ Paris, INSERM UMRS, Institut de Myologie, Sorbonne Universités, Paris, France
| | - Andres Berardo
- Neuromuscular Unit, British Hospital, Buenos Aires, Argentina
| | - Ricardo Reisin
- Neuromuscular Unit, British Hospital, Buenos Aires, Argentina
| | - Shahram Attarian
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone 1338, Marseille, France
| | - Andoni Urtizberea
- Centre de Compétences Maladies Neuromusculaires Hendaye, Hendaye, France
| | - Ana Maria Cobo
- Centre de Compétences Maladies Neuromusculaires Hendaye, Hendaye, France
| | - Lorenzo Maggi
- Neuroimmunology and Neuromuscular Diseases Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Sergei Kurbatov
- Regional Medical Diagnostic Centre, Voronezh, Russia.,Regional Non-governmental Organization «Society of Neuro-Muscular Diseases Specialists», Moscow, Russia
| | - Sergei Nikitin
- Regional Non-governmental Organization «Society of Neuro-Muscular Diseases Specialists», Moscow, Russia
| | - José C Milisenda
- Muscle Research Unit, Internal Medicine Service, Hospital Clínic de Barcelona and CIBERER, Barcelona, Spain
| | - Farzad Fatehi
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Monika Raimondi
- Clinica Moncucco, Via Moncucco 10, 6900, Lugano, Switzerland
| | | | - Peter Hackman
- Folkhälsan Institute of Genetics and Medicum, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Kristl G Claeys
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Bjarne Udd
- Department of Neurology, Neuromuscular Research Center, Tampere University Hospital and University of Tampere, 33014, Tampere, Finland.,Folkhälsan Institute of Genetics and Medicum, Haartman Institute, University of Helsinki, Helsinki, Finland.,Department of Neurology, Vaasa Central Hospital, Vaasa, Finland
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Semmler AL, Sacconi S, Bach JE, Liebe C, Bürmann J, Kley RA, Ferbert A, Anderheiden R, Van den Bergh P, Martin JJ, De Jonghe P, Neuen-Jacob E, Müller O, Deschauer M, Bergmann M, Schröder JM, Vorgerd M, Schulz JB, Weis J, Kress W, Claeys KG. Unusual multisystemic involvement and a novel BAG3 mutation revealed by NGS screening in a large cohort of myofibrillar myopathies. Orphanet J Rare Dis 2014; 9:121. [PMID: 25208129 PMCID: PMC4347565 DOI: 10.1186/s13023-014-0121-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/21/2014] [Indexed: 12/14/2022] Open
Abstract
Background Myofibrillar myopathies (MFM) are a group of phenotypically and genetically heterogeneous neuromuscular disorders, which are characterized by protein aggregations in muscle fibres and can be associated with multisystemic involvement. Methods We screened a large cohort of 38 index patients with MFM for mutations in the nine thus far known causative genes using Sanger and next generation sequencing (NGS). We studied the clinical and histopathological characteristics in 38 index patients and five additional relatives (n = 43) and particularly focused on the associated multisystemic symptoms. Results We identified 14 heterozygous mutations (diagnostic yield of 37%), among them the novel p.Pro209Gln mutation in the BAG3 gene, which was associated with onset in adulthood, a mild phenotype and an axonal sensorimotor polyneuropathy, in the absence of giant axons at the nerve biopsy. We revealed several novel clinical phenotypes and unusual multisystemic presentations with previously described mutations: hearing impairment with a FLNC mutation, dysphonia with a mutation in DES and the first patient with a FLNC mutation presenting respiratory insufficiency as the initial symptom. Moreover, we described for the first time respiratory insufficiency occurring in a patient with the p.Gly154Ser mutation in CRYAB. Interestingly, we detected a polyneuropathy in 28% of the MFM patients, including a BAG3 and a MYOT case, and hearing impairment in 13%, including one patient with a FLNC mutation and two with mutations in the DES gene. In four index patients with a mutation in one of the MFM genes, typical histological findings were only identified at the ultrastructural level (29%). Conclusions We conclude that extraskeletal symptoms frequently occur in MFM, particularly cardiac and respiratory involvement, polyneuropathy and/or deafness. BAG3 mutations should be considered even in cases with a mild phenotype or an adult onset. We identified a genetic defect in one of the known genes in less than half of the MFM patients, indicating that more causative genes are still to be found. Next generation sequencing techniques should be helpful in achieving this aim.
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Affiliation(s)
- Anna-Lena Semmler
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,Institute of Neuropathology, RWTH Aachen University, Aachen, Germany.
| | - Sabrina Sacconi
- Centre de Référence des Maladies Neuromusculaires, Nice Hospital and UMR CNRS6543, Nice University, Nice, France.
| | - J Elisa Bach
- Department of Human Genetics, University of Würzburg, Würzburg, Germany.
| | - Claus Liebe
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,Institute of Neuropathology, RWTH Aachen University, Aachen, Germany.
| | - Jan Bürmann
- Department of Neurology, Saarland University, Homburg/Saar, Germany.
| | - Rudolf A Kley
- Department of Neurology, Neuromuscular Center Ruhrgebiet, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
| | | | | | - Peter Van den Bergh
- Department of Neurology, Neuromuscular Reference Center, University Hospital Saint-Luc, Brussel, Belgium.
| | | | - Peter De Jonghe
- Institute Born-Bunge, University of Antwerpen, Antwerpen, Belgium. .,Neurogenetics Group, VIB-Department of Molecular Genetics, University of Antwerpen, Antwerpen, Belgium. .,Department of Neurology, University Hospital of Antwerpen, Antwerpen, Belgium.
| | - Eva Neuen-Jacob
- Institute of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Oliver Müller
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Heidelberg, Germany.
| | - Marcus Deschauer
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
| | - Markus Bergmann
- Institute of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany.
| | | | - Matthias Vorgerd
- Department of Neurology, Neuromuscular Center Ruhrgebiet, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,JARA - Translational Brain Medicine, Jülich and Aachen, Germany.
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University, Aachen, Germany. .,JARA - Translational Brain Medicine, Jülich and Aachen, Germany.
| | - Wolfram Kress
- Department of Human Genetics, University of Würzburg, Würzburg, Germany.
| | - Kristl G Claeys
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,Institute of Neuropathology, RWTH Aachen University, Aachen, Germany. .,JARA - Translational Brain Medicine, Jülich and Aachen, Germany.
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