Clinical and molecular characterization of limb-girdle muscular dystrophy 2G/R7 in a large cohort of Brazilian patients.

Limb-girdle muscular dystrophy type 2G/R7 (LGMD2G/R7) is an ultra-rare condition initially identified within the Brazilian population. We aimed to expand clinical and genetic information about this disease, including its worldwide distribution. A multicenter historical cohort study was performed at 13 centers in Brazil in which data from index cases and their affected relatives from consecutive families with LGMD2G/R7 were reviewed from July 2017 to August 2023. Additionally, a systematic literature review was conducted to identify case reports and series of the disease worldwide. Forty-one LGMD2G/R7 cases were described in the Brazilian cohort, being all subjects homozygous for the c.157C>T/(p.Gln53*) variant in TCAP. Survival curves showed that the median disease duration before individuals required walking aids was 21 years. Notably, women exhibited a slower disease progression, requiring walking aids 13 years later than men. LGMD2G/R7 was frequently reported not only in Brazil but also in China and Bulgaria, with 119 cases identified globally, with possible founder effects in the Brazilian, Eastern European, and Asian populations. These findings are pivotal in raising awareness of LGMD2G/R7, understanding its progression, and identifying potential modifiers. This can significantly contribute to the development of future natural history studies and clinical trials for this disease.

Clinicogenetic lessons from 370 patients with autosomal recessive limb-girdle muscular dystrophy.

Limb-girdle muscular dystrophies (LGMD) are a group of genetically heterogeneous disorders characterized by predominantly proximal muscle weakness. We aimed to characterize epidemiological, clinical and molecular data of patients with autosomal recessive LGMD2/LGMD-R in Brazil. A multicenter historical cohort study was performed at 13 centers, in which index cases and their affected relatives' data from consecutive families with genetic or pathological diagnosis of LGMD2/LGMD-R were reviewed from July 2017 to August 2018. Survival curves to major handicap for LGMD2A/LGMD-R1-calpain3-related, LGMD2B/LGMD-R2-dysferlin-related and sarcoglycanopathies were built and progressions according to sex and genotype were estimated. In 370 patients (305 families) with LGMD2/LGMD-R, most frequent subtypes were LGMD2A/LGMD-R1-calpain3-related and LGMD2B/LGMD-R2-dysferlin-related, each representing around 30% of families. Sarcoglycanopathies were the most frequent childhood-onset subtype, representing 21% of families. Five percent of families had LGMD2G/LGMD-R7-telethonin-related, an ultra-rare subtype worldwide. Females with LGMD2B/LGMD-R2-dysferlin-related had less severe progression to handicap than males and LGMD2A/LGMD-R1-calpain3-related patients with truncating variants had earlier disease onset and more severe progression to handicap than patients without truncating variants. We have provided paramount epidemiological data of LGMD2/LGMD-R in Brazil that might help on differential diagnosis, better patient care and guiding future collaborative clinical trials and natural history studies in the field.

Phenotypic Variability of Dystrophinopathy Symptomatic Female Carriers.

BACKGROUND: Dystrophinopathies are X-linked muscular dystrophies characterized by pathogenic mutations in the dystrophin gene. Symptomatic dystrophinopathy female carriers may present with limb-girdle weakness. The diagnosis may be challenging in the absence of affected male relatives. We aimed to describe the phenotypic variability in a series of molecular-confirmed female dystrophinopathy patients. METHODS: This is a retrospective analysis of medical records from 1997 to 2015. RESULTS: Ten female dystrophinopathy patients were selected, two with unusual phenotypes: one with early joint contractures muscular dystrophy and the other with very late onset myopathy. Muscle imaging studies demonstrated predominant asymmetric fat replacement. Muscle biopsy immunohistochemistry demonstrated clear mosaic pattern in two cases and only subtle reduction of dystrophin intensity in three. CONCLUSIONS: Adequate diagnosis is fundamental for genetic counseling and cardiologic follow-up. Female patients with dystrophinopathy may present unusual phenotypes such as early contractures and very late onset myopathy.

Hematological adaptation in Holstein calves during the neonatal period / Adaptação hematológica de bezerras Holandesas durante o período neonatal

The aim of this study was to evaluate the hematological profile of Holstein calves during the first month of life. Blood samples were harvested (n = 208) from 26 calves, from birth until 30 days of life. Hematologic values were determined by an automatic system associated with differential leukocyte count by manual methods. Variations in the erythrogram components were detected from birth up to the 30th day of life, except for hemoglobin (Hb) concentration and Mean Corpuscular Hemoglobin Concentration (MCHC). At birth, higher values were observed for hematocrit, Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH) that decreased in subsequent moments. During the first days of life, leukocytosis was found due to neutrophilia and eosinopenia. A gradual increase of lymphocytes with the increase of age was also observed. Finally, the present research showed that the first month of life is a hematological adaptation period. Based on the results, it detected that blood component variations, characterized by hemoconcentration and leukocyte prolife compatible with glucocorticoids response up to the 4th day of life, were responsible for neutrophil lymphocyte ratio > 1.0 at birth.

Foi avaliado o perfil hematológico de bezerros da raça Holandesa durante o primeiro mês de vida. Foram colhidas 208 amostras de sangue total de 26 bezerras(os) do nascimento aos trinta dias de vida. Os valores hematológicos foram determinados por sistema automatizado associado à contagem diferencial dos leucócitos por metodologia manual. Foram detectadas variações nos componentes do hemograma do nascimento aos 30 dias de vida, exceto para os teores de hemoglobina (Hb) e concentração hemoglobínica corpuscular média (CHCM). Os maiores valores do hematócrito, volume corpuscular médio (VCM) e hemoglobina corpuscular média (HCM) foram observados ao nascimento, com decréscimo nos momentos subsequentes. Nos primeiros dias de vida foi observada leucocitose por neutrofilia e eosinopenia e com o avançar da idade houve aumento gradativo dos linfócitos. Com base nos resultados obtidos pode-se concluir que a adaptação dos bezerros no período pós-neonatal foi caracterizada por variações nos componentes do hemograma, observando-se hemoconcentração e padrão leucocitário compatível com resposta aos glicocorticoides até o 4º dia de vida, responsável pela relação neutrófilo-linfócito > 1,0 ao nascimento.

Classic manifestations of Duchenne dystrophy in a young female patient: a case report.

Duchenne and Becker muscular dystrophies (DMD/DMB) are neuromuscular diseases linked to chromosome X and affect mainly male individuals. Duchenne muscular dystrophy is the most severe form of the disease, leading to a decreased patient survival compared with individuals with Becker type and female carriers of the mutated gene. In this paper we present the case of a female adolescent whose clinical picture and disease course closely resembled male individuals.