Altered in vitro muscle differentiation in X-linked myopathy with excessive autophagy.

X-linked myopathy with excessive autophagy (XMEA) is a genetic disease associated with weakness of the proximal muscles. It is caused by mutations in the VMA21 gene, coding for a chaperone that functions in the vacuolar ATPase (v-ATPase) assembly. Mutations associated with lower content of assembled v-ATPases lead to an increase in lysosomal pH, culminating in partial blockage of macroautophagy, with accumulation of vacuoles of undigested content. Here, we studied a 5-year-old boy affected by XMEA, caused by a small indel in the VMA21 gene. Detection of sarcoplasmic Lc3 (also known as MAP1LC3B)-positive vacuoles in his muscle biopsy confirmed an autophagy defect. To understand how autophagy is regulated in XMEA myogenesis, we used patient-derived muscle cells to evaluate autophagy during in vitro muscle differentiation. An increase in lysosomal pH was observed in the patient's cells, compatible with predicted functional defect of his mutation. Additionally, there was an increase in autophagic flux in XMEA myotubes. Interestingly, we observed that differentiation of XMEA myoblasts was altered, with increased myotube formation observed through a higher fusion index, which was not dependent on lysosomal acidification. Moreover, no variation in the expression of myogenic factors nor the presence of regenerating fibers in the patient's muscle were observed. Myoblast fusion is a tightly regulated process; therefore, the uncontrolled fusion of XMEA myoblasts might generate cells that are not as functional as normal muscle cells. Our data provide new evidence on the reason for predominant muscle involvement in the context of the XMEA phenotype.This article has an associated First Person interview with the first author of the paper.

Complexity of the 5' Untranslated Region of EIF4A3, a Critical Factor for Craniofacial and Neural Development.

Repeats in coding and non-coding regions have increasingly been associated with many human genetic disorders, such as Richieri-Costa-Pereira syndrome (RCPS). RCPS, mostly characterized by midline cleft mandible, Robin sequence and limb defects, is an autosomal-recessive acrofacial dysostosis mainly reported in Brazilian patients. This disorder is caused by decreased levels of EIF4A3, mostly due to an increased number of repeats at the EIF4A3 5'UTR. EIF4A3 5'UTR alleles are CG-rich and vary in size and organization of three types of motifs. An exclusive allelic pattern was identified among affected individuals, in which the CGCA-motif is the most prevalent, herein referred as "disease-associated CGCA-20nt motif." The origin of the pathogenic alleles containing the disease-associated motif, as well as the functional effects of the 5'UTR motifs on EIF4A3 expression, to date, are entirely unknown. Here, we characterized 43 different EIF4A3 5'UTR alleles in a cohort of 380 unaffected individuals. We identified eight heterozygous unaffected individuals harboring the disease-associated CGCA-20nt motif and our haplotype analyses indicate that there are more than one haplotype associated with RCPS. The combined analysis of number, motif organization and haplotypic diversity, as well as the observation of two apparently distinct haplotypes associated with the disease-associated CGCA-20nt motif, suggest that the RCPS alleles might have arisen from independent unequal crossing-over events between ancient alleles at least twice. Moreover, we have shown that the number and sequence of motifs in the 5'UTR region is associated with EIF4A3 repression, which is not mediated by CpG methylation. In conclusion, this study has shown that the large number of repeats in EIF4A3 does not represent a dynamic mutation and RCPS can arise in any population harboring alleles with the CGCA-20nt motif. We also provided further evidence that EIF4A3 5'UTR is a regulatory region and the size and sequence type of the repeats at 5'UTR may contribute to clinical variability in RCPS.

Thomsen or Becker myotonia? A novel autosomal recessive nonsense mutation in the CLCN1 gene associated with a mild phenotype.

We describe a large Brazilian consanguineous kindred with 3 clinically affected patients with a Thomsen myotonia phenotype. They carry a novel homozygous nonsense mutation in the CLCN1 gene (K248X). None of the 6 heterozygote carriers show any sign of myotonia on clinical evaluation or electromyography. These findings confirm the autosomal recessive inheritance of the novel mutation in this family, as well as the occurrence of phenotypic variability in the autosomal recessive forms of myotonia.

Transcriptional regulation differs in affected facioscapulohumeral muscular dystrophy patients compared to asymptomatic related carriers.

Facioscapulohumeral muscular dystrophy (FSHD) is a progressive muscle disorder that has been associated with a contraction of 3.3-kb repeats on chromosome 4q35. FSHD is characterized by a wide clinical inter- and intrafamilial variability, ranging from wheelchair-bound patients to asymptomatic carriers. Our study is unique in comparing the gene expression profiles from related affected, asymptomatic carrier, and control individuals. Our results suggest that the expression of genes on chromosome 4q is altered in affected and asymptomatic individuals. Remarkably, the changes seen in asymptomatic samples are largely in products of genes encoding several chemokines, whereas the changes seen in affected samples are largely in genes governing the synthesis of GPI-linked proteins and histone acetylation. Besides this, the affected patient and related asymptomatic carrier share the 4qA161 haplotype. Thus, these polymorphisms by themselves do not explain the pathogenicity of the contracted allele. Interestingly, our results also suggest that the miRNAs might mediate the regulatory network in FSHD. Together, our results support the previous evidence that FSHD may be caused by transcriptional dysregulation of multiple genes, in cis and in trans, and suggest some factors potentially important for FSHD pathogenesis. The study of the gene expression profiles from asymptomatic carriers and related affected patients is a unique approach to try to enhance our understanding of the missing link between the contraction in D4Z4 repeats and muscle disease, while minimizing the effects of differences resulting from genetic background.

Central core disease due to recessive mutations in RYR1 gene: is it more common than described?

Central core disease (CCD) is an autosomal-dominant congenital myopathy, with muscle weakness and malignant hyperthermia (MH) susceptibility. We identified two of nine Brazilian CCD families carrying two mutations in the RYR1 gene. The heterozygous parents were clinically asymptomatic, and patients were mildly affected, differing from the few autosomal-recessive cases described previously. Recessive inheritance in CCD may therefore be more common than previously appreciated, which has important implications for genetic counseling and MH prevention in affected families.

Equal proportions of affected cells in muscle and blood of a mosaic carrier of facioscapulohumeral muscular dystrophy.

Autosomal dominant facioscapulohumeral muscular dystrophy (FSHD) is associated with contractions of D4Z4 repeat on 4q35. It displays a remarkable inter- and intra-familial clinical variability ranging from severe phenotype to asymptomatic carriers. Mosaicism for the contracted FSHD-sized allele is a recurrent finding, but only DNA from lymphocytes had been studied. It is currently not known if mosaicism is unequally distributed between different tissues and if muscle is relatively spared for the presence of the disease allele in mosaic asymptomatic carriers of a disease allele. Here we compare DNA extracted from peripheral blood lymphocytes (PBL), fibroblasts and muscle from a mosaic asymptomatic female carrier and mother of a FSHD patient. PFGE analysis showed a complex allelic segregation: two independent mitotic rearrangement episodes occurred, resulting in mosaicism for a contracted D4Z4 repeat on 4q35 in the mother and mosaicism for an expanded D4Z4 repeat on 10q26 in the affected daughter. The results show that the proportion of mosaicism in PBL and muscle were comparable, while in fibroblasts there was some variation in the mosaicism, which might be caused by culturing artefacts. This finding supports the hypothesis that a mitotic contraction of D4Z4 is an early embryonic event and indicates that the degree of mosaicism in PBL is representative for that of muscle.

Protein and DNA analysis for the prenatal diagnosis of alpha2-laminin-deficient congenital muscular dystrophy.

Congenital muscular dystrophies (CMD) are characterized by neonatal hypotonia and/or artrogriposis associated with a dystrophic muscle biopsy. The CMD1A form is caused by a deficiency of the alpha2 chain of laminin 2 (LAMA2 gene at 6q2), a protein present in the basal lamina of muscle fibers, in Schwann cells, epidermis, and in fetal trophoblastic tissue. This allows its study for prenatal diagnosis in the chorionic villous (CV), which was performed in a family with one deceased affected CMD1A child. Immunohistochemical analysis of the CV using antibodies against the C- and N-terminal domains of the alpha2-laminin protein showed a normal positive labeling for both antibodies in the "at-risk" CV, which did not differ from the normal control CV. The integrity of the CV membrane was confirmed through the analysis with antibodies against alpha1, beta1, and gamma1 laminins. DNA study using markers flanking the 6q2 region showed that the affected patient and the "at-risk" fetus did not share the same haplotype. Therefore, the fetus was considered normal through both methodologies, which was confirmed after the birth of a clinically normal male baby. As the LAMA2 gene is very large and the spectrum of mutations causing disease is wide, the analysis of the protein in muscle biopsy has been largely used for the diagnosis. Besides, the possibility to detect it in the chorionic villous, mainly using positive markers, also offers a powerful tool for prenatal diagnosis.

Experience with molecular and cytogenetic diagnosis of fragile X syndrome in Brazilian families

Realizamos análises citogenéticas e moleculares em 55 famílias com a mutaçäo da síndrome do cromossomo X frágil, loco FMR-1 (318 indivíduos e 15 amostras de vilosidade coriônica). Foram estudados 129 indivíduos do sexo masculino, 75 com retardo mental e 54 normais. Entre os 54 normais, 11 eram portadores da pré-mutaçäo e nenhum apresentou o sítio frágil. Foram detectados 73 portadores da mutaçäo completa e 18 por cento eram mosaicos, ou seja, apresentavam também a pré-mutaçäo. Todos expressaram o sítio frágil em pelo menos um dos sistemas de induçäo utilizados. O tamanho da expansäo de trinucleotídeos CGG (delta) e a freqüência de manifestaçäo do sítio frágil apresentaram correlaçäo positiva. Entre as 153 mulheres normais, 85 eram portadoras da pré-mutaçäo e 15 da mutaçäo completa. A freqüência de expressäo do fra(X) foi zero ou extremamente baixa entre as pré-mutadas e essa freqüência näo diferiu da expressäo das näo portadoras da mutaçäo. Portanto a análise citogenética é ineficaz na determinaçäo de indivíduos pré-mutados, homens ou mulheres. Entre as 51 mulheres com a mutaçäo completa, 70 por cento manifestaram algum grau de comprometimento mental. Encontramos também correlaçäo entre o delta e a freqüência de expressäo do fra(X) nessas mulheres. Contudo, a detecçäo citogenética das mulheres com mutaçäo completa foi menos eficiente do que no caso dos homens, pois 14 por cento de falsos negativos foram observados. A análise de segregaçäo confirmou que o risco de prole afetada aumenta com o delta, e o risco médio de prole afetada para todas as heterozigotas foi de 30 por cento. Näo houve indicaçäo de desvio de segregaçäo nas famílias estudadas, pois o número de indivíduos que herdaram a mutaçäo näo diferiu do número daqueles que herdaram os alelos normais. Näo foi detectada nenhuma mutaçäo nova nas 55 genealogias investigadas.

Estudo imuno-histoquímico da distrofina em musculo de afetados por distrofias musculares progressivas

A deficiência da proteína Distrofina (locvalizada na membrana das fibras musculares) foi descrita recentemente como provável causa da distrofia muscular tipo Duchenne (DMD). No presente trabalho, foi feita uma reaçäo imuno-histoquímica para a detecçäo da distrofina em cortes histológicos de congelaçäo, obtidos a partir de biópsias musculares. Foram estudadas 56 indivíduos: Em quatro biópsias de musculo normal, ocorreu uma marcaçäo nítida e homogênea em todo o sarcolema das fibras musculares. No musculo de 20 pacientes com DMD, näo se observou marcaçäo na membrana da maioria das fibras, embora em muitos casos tenha ocorrido uma marcaçäo parcial de algumas delas (entre 4% e 30%). Em 10 afetados pela distrofia tipo Becker (DMB), 8 apresentaram marcaçäo normal em todo o sarcolema das fibras e 2 mostraram uma reaçäo aparentemente mais fraca. Nos quatro afetados por distrofia tipo Cinturas (DMC), apesar das alteraçöes histopatológicos típicas de afecçäo muscular primária, a membrana de todas as fibras mostrou-se com forte padräo imuno-reativo. Foram estudadas também 11 heterozigotas certas quanto ao gene da DMD (8 com atividade de enzimas séricas elevadas e 3 com enzimas normais), 4 filhas de heterozigotas certas com enzimas muito elevadas e 3 heterozigotas para o gene da DMB (todas com enzimas normais). Em todas elas observou-se marcaçäo total e homogênea em todas as fibras musculares. estes resultados säo muito importantes para a padronizaçäo de uma metodologia que possibilite um diagnóstico diferencial entre alguns tipos de distrofia, bem como tentar aprimorar a taxa de detecçäo de portadores, para fins de Aconselhamento Genético

Serum creatine-kinase and pyruvate-kinase levels in females of different racial background at risk for Duchenne muscular dystrophy

As atividades séricas das enzimas creatino-cinase (CK) e piruvato-cinase (PK) foram determinadas em 146 mulheres beterozigotas certas quanto ao gene da distrofia muscular de Duchenne (DMD) e 187 mäes de casos isolados, pertencentes a dois grupos raciais: caucasóide e negroide. A atividade da CK foi medida em 206 mulheres caucasoides e 127 mulheres negroides e a da PK em 148 caucasoides e 92 negroides. Os resultados desta pesquisa mostraram um aumento da média de atividade enzimática no grupo de mulheres heterozigotes e mäes de casos isolados negroides em comparaçäo ao grupo de mulheres caucasoides. Entretanto, as diferenças foram estatísticamente significantes apenas para a CK sérica. Sugere-se portanto, que os resultados da atividade sérica da CK de mulheres em risco de serem portadoras do gene da DMD sejam comparados com os de mulheres normais de mesmo grupo racial