Dominant and Recessive RYR1 Mutations in Adults with Core Lesions and Mild Muscle Symptoms

INTRODUCTION: Ryanodine receptor gene (RYR1) mutations have been associated with central core disease (CCD), multiminicore/minicore/multicore disease (MmD), and susceptibility to malignant hyperthermia (MH). METHODS: Patients with muscle symptoms in adulthood, who had features compatible with CCD/MmD, underwent clinical, histological, and genetic (RYR1 and SEPN1 genes) evaluations. Published cases of CCD and MmD with adult onset were also reviewed. RESULTS: Eight patients fulfilled the criteria for further analysis. Five RYR1 mutations, 4 of them unreported, were detected in 3 patients. Compound heterozygosity was proven in 1 case. CONCLUSIONS: To our knowledge, this is the only report of adult onset associated with recessive RYR1 mutations and central core/multiminicores on muscle biopsy. Although adult patients with CCD, MmD, and minimally symptomatic MH with abnormal muscle biopsy findings usually have a mild clinical course, differential diagnosis and carrier screening is crucial for prevention of potentially life-threatening reactions to general anesthesia.

Clinical and genetic findings in a large cohort of patients with congenital myopathies due to mutations in the skeletal muscle ryanodine receptor (RYR1) gene

RYR1 mutations are the most common cause of structural congenital myopathies and may exhibit both dominant and recessive inheritance. Histopathological findings are variable and include central cores, multi-minicores, type 1 predominance/ uniformity, fibre type disproportion, increased internal nucleation and fatty and connective tissue. Until recently, diagnostic RYR1 sequencing was limited to mutational hotspots due to the large size of the gene. Since the introduction of full RYR1 sequencing in 2007 we have detected pathogenic mutations in 77 families: 39 had dominant inheritance and 38 recessive inheritance. In some cases with presumably recessive inheritance, only one heterozygous mutation inherited from an asymptomatic parent was identified. Of 28 dominant mutations, 6 were novel; 37 of the 59 recessive mutations were also novel. Dominant mutations were more frequently in recognized hotspot regions, while recessive mutations were distributed throughout the coding sequence. Dominant mutations were predominantly missense, whereas recessive mutations included many nonsense and splice mutations expected to result in reduced RyR1 protein. There was wide clinical variability in patients with both dominant and recessive inheritance. As a group, those with dominant mutations were generally more mildly affected than those with recessive inheritance, who had earlier onset and were weaker with more functional limitations. Extraocular muscle involvement was almost exclusively observed in the recessive group. Bulbar involvement was also more prominent in this group, resulting in a larger number requiring gastrostomy insertion. In conclusion, genomic sequencing of the entire RYR1 leads to the detection of many novel mutations, but may miss large genetic rearrangements in some cases. Assigning pathogenicity to novel mutations is often difficult and interpretation of genetic results in the context of clinical, histological and, increasingly, muscle MRI findings is essential.

Multigenerational Brazilian family with malignant hyperthermia and a novel mutation in the RYR1 gene

Malignant hyperthermia (MH) is a pharmacogenetic disease triggered in susceptible individuals by the administration of volatile halogenated anesthetics and/or succinylcholine, leading to the development of a hypermetabolic crisis, which is caused by abnormal release of Ca2+ from the sarcoplasmic reticulum, through the Ca2+ release channel ryanodine receptor 1 (RyR1). Mutations in the RYR1 gene are associated with MH in the majority of susceptible families. Genetic screening of a 5-generation Brazilian family with a history of MH-related deaths and a previous MH diagnosis by the caffeine halothane contracture test (CHCT) in some individuals was performed using restriction and sequencing analysis. A novel missense mutation, Gly4935Ser, was found in an important functional and conserved locus of this gene, the transmembrane region of RyR1. In this family, 2 MH-susceptible individuals previously diagnosed with CHCT carry this novel mutation and another 24 not previously diagnosed members also carry it. However, this same mutation was not found in another MH-susceptible individual whose CHCT was positive to the test with caffeine but not to the test with halothane. None of the 5 MH normal individuals of the family, previously diagnosed by CHCT, carry this mutation, nor do 100 controls from control Brazilian and USA populations. The Gly4932Ser variant is a candidate mutation for MH, based on its co-segregation with disease phenotype, absence among controls and its location within the protein.

Clinical and genetic findings in a large cohort of patients with ryanodine receptor 1 gene-associated myopathies.

Ryanodine receptor 1 (RYR1) mutations are a common cause of congenital myopathies associated with both dominant and recessive inheritance. Histopathological findings frequently feature central cores or multi-minicores, more rarely, type 1 predominance/uniformity, fiber-type disproportion, increased internal nucleation, and fatty and connective tissue. We describe 71 families, 35 associated with dominant RYR1 mutations and 36 with recessive inheritance. Five of the dominant mutations and 35 of the 55 recessive mutations have not been previously reported. Dominant mutations, typically missense, were frequently located in recognized mutational hotspot regions, while recessive mutations were distributed throughout the entire coding sequence. Recessive mutations included nonsense and splice mutations expected to result in reduced RyR1 protein. There was wide clinical variability. As a group, dominant mutations were associated with milder phenotypes; patients with recessive inheritance had earlier onset, more weakness, and functional limitations. Extraocular and bulbar muscle involvement was almost exclusively observed in the recessive group. In conclusion, our study reports a large number of novel RYR1 mutations and indicates that recessive variants are at least as frequent as the dominant ones. Assigning pathogenicity to novel mutations is often difficult, and interpretation of genetic results in the context of clinical, histological, and muscle magnetic resonance imaging findings is essential.

Enhanced excitation-coupled Ca(2+) entry induces nuclear translocation of NFAT and contributes to IL-6 release from myotubes from patients with central core disease.

Prolonged depolarization of skeletal muscle cells induces entry of extracellular calcium into muscle cells, an event referred to as excitation-coupled calcium entry. Skeletal muscle excitation-coupled calcium entry relies on the interaction between the 1,4-dihydropyridine receptor on the sarcolemma and the ryanodine receptor on the sarcoplasmic reticulum membrane. In this study, we directly measured excitation-coupled calcium entry by total internal reflection fluorescence microscopy in human skeletal muscle myotubes harbouring mutations in the RYR1 gene linked to malignant hyperthermia (MH) and central core disease (CCD). We found that excitation-coupled calcium entry is strongly enhanced in cells from patients with CCD compared with individuals with MH and controls. Furthermore, excitation-coupled calcium entry induces generation of reactive nitrogen species and enhances nuclear localization of NFATc1, which in turn may be responsible for the increased IL-6 released by myotubes from patients with CCD.

β-Adrenergic modulation of skeletal muscle contraction: key role of excitation-contraction coupling.

Our aim is to describe the acute effects of catecholamines/β-adrenergic agonists on contraction of non-fatigued skeletal muscle in animals and humans, and explain the mechanisms involved. Adrenaline/β-agonists (0.1-30 μm) generally augment peak force across animal species (positive inotropic effect) and abbreviate relaxation of slow-twitch muscles (positive lusitropic effect). A peak force reduction also occurs in slow-twitch muscles in some conditions. β2 -Adrenoceptor stimulation activates distinct cyclic AMP-dependent protein kinases to phosphorylate multiple target proteins. β-Agonists modulate sarcolemmal processes (increased resting membrane potential and action potential amplitude) via enhanced Na(+) -K(+) pump and Na(+) -K(+) -2Cl(-) cotransporter function, but this does not increase force. Myofibrillar Ca(2+) sensitivity and maximum Ca(2+) -activated force are unchanged. All force potentiation involves amplified myoplasmic Ca(2+) transients consequent to increased Ca(2+) release from sarcoplasmic reticulum (SR). This unequivocally requires phosphorylation of SR Ca(2+) release channels/ryanodine receptors (RyR1) which sensitize the Ca(2+) -induced Ca(2+) release mechanism. Enhanced trans-sarcolemmal Ca(2+) influx through phosphorylated voltage-activated Ca(2+) channels contributes to force potentiation in diaphragm and amphibian muscle, but not mammalian limb muscle. Phosphorylation of phospholamban increases SR Ca(2+) pump activity in slow-twitch fibres but does not augment force; this process accelerates relaxation and may depress force. Greater Ca(2+) loading of SR may assist force potentiation in fast-twitch muscle. Some human studies show no significant force potentiation which appears to be related to the β-agonist concentration used. Indeed high-dose β-agonists (∼0.1 μm) enhance SR Ca(2+) -release rates, maximum voluntary contraction strength and peak Wingate power in trained humans. The combined findings can explain how adrenaline/β-agonists influence muscle performance during exercise/stress in humans.

Identification des bases génétiques des myopathies à multi-minicores avec ou sans cardiomyopathie

Thèse réalisée en cotutelle avec l'Université Pierre et Marie Curie, Paris 6(UPMC, Paris, France).

Entwicklung eines ökonomisch ausgerichteten Zuchtprogramms für die bedrohte Schweinerasse „Bunte Bentheimer“

Das Ziel dieser Arbeit war, ein ökonomisch ausgerichtetes Zuchtprogramm für die bedrohte Schweinerasse „Bunte Bentheimer“ (BB) zu entwickeln. Ein wesentlicher Bestandteil von Zuchtprogrammen für bedrohte Rassen ist der Erhalt der genetischen Diversität durch Vermeidung von weiterer Inzucht und Reduzierung des Inzuchtzuwachses. In Kapitel 2 wurde die Population der BB unter Berücksichtigung der vorhandenen Abstammungsinformationen in Bezug auf genetische Diversität, Inzucht und Verwandtschaft analysiert. Durchschnittlicher Inzuchtkoeffizient und Inzuchtzunahme lagen mit 12% und 1,66% pro Generation auf einem relativ hohen Niveau. Effektive Maßnahmen zur Inzuchtkontrolle sollten daher im Zuchtprogramm integriert werden. Durch die Bestimmung optimaler Einsatzfrequenzen selektierter Tiere ist es möglich, Inzucht zu kontrollieren und gleichzeitig Zuchtfortschritt zu generieren. Das konnte am Beispiel von Zuchtwerten für Fruchtbarkeitsmerkmale gezeigt werden. Basierend auf den optimalen Einsatzfrequenzen der selektierten Elterntiere wurden zur weiteren Reduzierung der Inzucht in der Folgegeneration konkrete Anpaarungspläne erstellt. Die Anpaarungen wurden unter Berücksichtigung der Natursprungproblematik durch Festlegung von Zuchtgebieten konzipiert. Die Umsetzung dieser wurde allerdings erschwert durch die eingeschränkte Verfügbarkeit der Eber. Schließt man die künstliche Besamung als mögliche Alternative aus, müssten die Zuchtgebiete so optimiert werden, dass die vorgeschlagenen Anpaarungen auch in die Praxis umgesetzt werden können. Die Gestaltung eines Zuchtprogramms erfordert zudem die Verfügbarkeit populationsgenetischer Parameter. Für die Fruchtbarkeitsmerkmale „Anzahl lebend geborener Ferkel“ (NBA) und „abgesetzter Ferkel“ (NW) lagen die Heritabilitäten bei jeweils 12%. Auch die genetischen Varianzen lagen in einem guten Bereich, so dass für beide Merkmale Zuchtfortschritt durch Selektion möglich ist. In Kapitel 3 wurden genetische Parameter für Fleischleistungs- und Fleischqualitätsmerkmale geschätzt. Als Grundlage dafür dienten sowohl in vivo Ultraschallmessungen am lebenden Tier, als auch Messungen, die am Schlachtkörper bzw. an einer Fleischprobe erfolgten. Zucht-, Mast- und Schlachttiere wurden am RYR1 Genort typisiert, um Allel-Substitutionseffekte zu schätzen. Die quantitativen- und molekulargenetischen Ansätze wurden genutzt, um darauf aufbauend zur Verbesserung der Fleischqualität Zuchtstrategien zu entwickeln. Für das Fleischqualitätsmerkmal intramuskulärer Fettgehalt (IMF) wurde die höchste Heritabilität von 0,78 bei einer ebenfalls hohen additiv-genetischen Varianz geschätzt. Dennoch ist die Erfassung dieses Merkmals mit einem hohen Kostenaufwand verbunden. Ein mögliches Hilfsmerkmal ist die Rückenspeckdicke (BFiv), die direkt am Selektionskandidaten erfasst werden kann. Die genetische Korrelation zwischen beiden Merkmale lag bei rg = 0,39. Die Assoziationsstudie am RYR1 Genort zeigte, dass die Anwesenheit des ungewünschten Allels einen negativen Effekt auf IMF hatte, d.h. der IMF Gehalt wurde reduziert. Darauf aufbauend wurde eine Zuchtstrategie entwickelt, die Phänotyp (BFiv) und Marker-Informationen am RYR1 Genort des Selektionskandidaten kombiniert. Durch die zusätzliche Berücksichtigung der Marker-Informationen konnten eine höhere Genauigkeit und ein höherer Zuchtfortschritt erzielt werden im Vergleich zu einer Strategie, die nur auf den phänotypischen Leistungen basiert. In Kapitel 4 wurde basierend auf einer Konsumentenbefragung mit integrierter Verkostung von Fleischproben indirekt die Zahlungsbereitschaft für unterschiedliche Fleischqualitäten erfasst. Alle Fleischproben wurden zusätzlich hinsichtlich der instrumental erfassbaren Fleischqualität untersucht und durch ein geschultes Panel im Sensorik Labor in Bezug auf die sensorische Qualität beurteilt. Außerdem wurde die direkte Zahlungsbereitschaft für unterschiedliche Qualitätsausprägungen der optischen Merkmale „Fleischfarbe“, „Fleischmarmorierung“ und „Fleischsaftverlust“ anhand von Fotografien erfasst. Die Ergebnisse dieser Befragung wurden genutzt, um ökonomischen Gewichte abzuleiten. Für IMF ergab sich ein hohes ökonomisches Gewicht von 57,52 € pro Merkmalseinheit bei dem aktuellen Populationsdurchschnitt von 1,57%. Mit steigendem Populationsmittel sinkt das ökonomische Gewicht und nähert sich ab einem Mittelwert von 2% einem Wert von 0,00 €. Aus züchterischer Sicht wäre daher ein durchschnittlicher IMF Gehalt von mindestens 2% anzustreben. Für Fleischqualitätsmerkmale, die beim Verzehr nicht direkt erfassbar sind, wie die Farbhelligkeit oder der Tropfsaftverlust, ist die direkte Methode zur Erfassung der Zahlungsbereitschaft (basierend auf den Fotografien) der indirekten (basierend auf der Verkostung) vorzuziehen, um ökonomische Gewichte abzuleiten. Genetische Parameter ökonomischen Gewichte wurden anschließend für Zuchtplanungsrechnungen verwendet. Im Zuchtziel wurde in erster Linie die Fruchtbarkeit (NBA) und Fleischqualität (IMF) berücksichtigt. Zur Vermeidung hoher Kosten und der besseren Anpassung an kleine Betriebsstrukturen wurde u.a. ein Zuchtprogramm modelliert, das auf in vivo Ultraschallmessungen für BFiv basiert, direkt erfasst am Selektionskandidaten. Der Züchtungsgewinn für diese Zuchtstrategie lag bei 35,92 € pro Tier. Der Zuchtfortschritt für IMF war allerdings erwartungsgemäß geringer als bei direkter Selektion auf das Merkmal. Basierend auf den Ergebnissen wurde in Kapitel 5 ein Entwurf für ein Zuchtprogramm erstellt, das die notwendigen Maßnahmen zur Inzuchtkontrolle beinhaltet und Zuchtfortschritt für rassespezifische Merkmale zulässt. Zudem ist dieser Entwurf angepasst an die kleinen Betriebsstrukturen und die unterschiedlichen Vermarktungsstrategien, die sich bereits etabliert haben.

Estratègies prèvies al sacrifici que poden afectar el benestar animal i la qualitat de la carn de porcs de diferent genotip RYRI

The main objective of this thesis was to study (i) the effect of the fasting and lairage on carcass and technological meat quality and (ii) the inclusion of magnesium (MgCO3 and MgSO4) and/or tryptophan during 5 days before slaughtering pigs as a strategy to decrease stress levels and improve meat quality, with two different porcine RYR1 genotypes (NN and nn). An adequate combination of fasting and lairage period is recommended. A supplement of MgCO3 or Trp did not improve meat quality under minimal stressful ante mortem conditions; and MgSO4 had a laxative effect on pigs supplemented with it. When including nn pigs to the herd, it is recommended to consider the supplements’ combination of tryptophan and a source of Mg (avoiding MgSO4) to alleviate the negative effect of the stress and to improve technological meat quality.

Animal models for genetic neuromuscular diseases

The neuromuscular disorders are a heterogeneous group of genetic diseases, caused by mutations in genes coding sarcolemmal, sarcomeric, and citosolic muscle proteins. Deficiencies or loss of function of these proteins leads to variable degree of progressive loss of motor ability. Several animal models, manifesting phenotypes observed in neuromuscular diseases, have been identified in nature or generated in laboratory. These models generally present physiological alterations observed in human patients and can be used as important tools for genetic, clinic, and histopathological studies. The mdx mouse is the most widely used animal model for Duchenne muscular dystrophy (DMD). Although it is a good genetic and biochemical model, presenting total deficiency of the protein dystrophin in the muscle, this mouse is not useful for clinical trials because of its very mild phenotype. The canine golden retriever MD model represents a more clinically similar model of DMD due to its larger size and significant muscle weakness. Autosomal recessive limb-girdle MD forms models include the SJL/J mice, which develop a spontaneous myopathy resulting from a mutation in the Dysferlin gene, being a model for LGMD2B. For the human sarcoglycanopahties (SG), the BIO14.6 hamster is the spontaneous animal model for delta-SG deficiency, whereas some canine models with deficiency of SG proteins have also been identified. More recently, using the homologous recombination technique in embryonic stem cell, several mouse models have been developed with null mutations in each one of the four SG genes. All sarcoglycan-null animals display a progressive muscular dystrophy of variable severity and share the property of a significant secondary reduction in the expression of the other members of the sarcoglycan subcomplex and other components of the Dystrophin-glycoprotein complex. Mouse models for congenital MD include the dy/dy (dystrophia-muscularis) mouse and the allelic mutant dy(2J)/dy(2J) mouse, both presenting significant reduction of alpha 2-laminin in the muscle and a severe phenotype. The myodystrophy mouse (Large(myd)) harbors a mutation in the glycosyltransferase Large, which leads to altered glycosylation of alpha-DG, and also a severe phenotype. Other informative models for muscle proteins include the knockout mouse for myostatin, which demonstrated that this protein is a negative regulator of muscle growth. Additionally, the stress syndrome in pigs, caused by mutations in the porcine RYR1 gene, helped to localize the gene causing malignant hypertermia and Central Core myopathy in humans. The study of animal models for genetic diseases, in spite of the existence of differences in some phenotypes, can provide important clues to the understanding of the pathogenesis of these disorders and are also very valuable for testing strategies for therapeutic approaches.

Prevalência de equinos quarto de milha portadores das mutações causadoras da miopatia por acúmulo de polissacarídeo tipo 1, paralisia periódica hipercalêmica e hipertermia maligna no Brasil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Mutation Spectrum in the Large GTPase Dynamin 2, and Genotype-Phenotype Correlation in Autosomal Dominant Centronuclear Myopathy

Centronuclear myopathy (CNM) is a genetically heterogeneous disorder associated with general skeletal muscle weakness, type I fiber predominance and atrophy, and abnormally centralized nuclei. Autosomal dominant CNM is due to mutations in the large GTPase dynamin 2 (DNM2), a mechanochemical enzyme regulating cytoskeleton and membrane trafficking in cells. To date, 40 families with CNM-related DNM2 mutations have been described, and here we report 60 additional families encompassing a broad genotypic and phenotypic spectrum. In total, 18 different mutations are reported in 100 families and our cohort harbors nine known and four new mutations, including the first splice-site mutation. Genotype-phenotype correlation hypotheses are drawn from the published and new data, and allow an efficient screening strategy for molecular diagnosis. In addition to CNM, dissimilar DNM2 mutations are associated with Charcot-Marie-Tooth (CMT) peripheral neuropathy (CMTD1B and CMT2M), suggesting a tissue-specific impact of the mutations. In this study, we discuss the possible clinical overlap of CNM and CMT, and the biological significance of the respective mutations based on the known functions of dynamin 2 and its protein structure. Defects in membrane trafficking due to DNM2 mutations potentially represent a common pathological mechanism in CNM and CMT. Hum Mutat 33: 949-959, 2012. (C) 2012 Wiley Periodicals, Inc.

A mutation in the transmembrane/luminal domain of the ryanodine receptor is associated with abnormal Ca2+ release channel function and severe central core disease

Central core disease is a rare, nonprogressive myopathy that is characterized by hypotonia and proximal muscle weakness. In a large Mexican kindred with an unusually severe and highly penetrant form of the disorder, DNA sequencing identified an I4898T mutation in the C-terminal transmembrane/luminal region of the RyR1 protein that constitutes the skeletal muscle ryanodine receptor. All previously reported RYR1 mutations are located either in the cytoplasmic N terminus or in a central cytoplasmic region of the 5,038-aa protein. The I4898T mutation was introduced into a rabbit RYR1 cDNA and expressed in HEK-293 cells. The response of the mutant RyR1 Ca2+ channel to the agonists halothane and caffeine in a Ca2+ photometry assay was completely abolished. Coexpression of normal and mutant RYR1 cDNAs in a 1:1 ratio, however, produced RyR1 channels with normal halothane and caffeine sensitivities, but maximal levels of Ca2+ release were reduced by 67%. [3H]Ryanodine binding indicated that the heterozygous channel is activated by Ca2+ concentrations 4-fold lower than normal. Single-cell analysis of cotransfected cells showed a significantly increased resting cytoplasmic Ca2+ level and a significantly reduced luminal Ca2+ level. These data are indicative of a leaky channel, possibly caused by a reduction in the Ca2+ concentration required for channel activation. Comparison with two other coexpressed mutant/normal channels suggests that the I4898T mutation produces one of the most abnormal RyR1 channels yet investigated, and this level of abnormality is reflected in the severe and penetrant phenotype of affected central core disease individuals.

Ryanodine receptor point mutant E4032A reveals an allosteric interaction with ryanodine

The ryanodine receptor (RyR) family of proteins constitutes a unique type of calcium channel that mediates Ca2+ release from endoplasmic reticulum/sarcoplasmic reticulum stores. Ryanodine has been widely used to identify contributions made by the RyR to signaling in both muscle and nonmuscle cells. Ryanodine, through binding to high- and low-affinity sites, has been suggested to block the channel pore based on its ability to induce partial conductance states and irreversible inhibition. We examined the effect of ryanodine on an RyR type 1 (RyR1) point mutant (E4032A) that exhibits a severely compromised phenotype. When expressed in 1B5 (RyR null/dyspedic) myotubes, E4032A is relatively unresponsive to stimulation by cell membrane depolarization or RyR agonists, although the full-length protein is correctly targeted to junctions and interacts with dihydropyridine receptors (DHPRs) inducing their arrangement into tetrads. However, treatment of E4032A-expressing cells with 200–500 μM ryanodine, concentrations that rapidly activate and then inhibit wild-type (wt) RyR1, restores the responsiveness of E4032A-expressing myotubes to depolarization and RyR agonists. Moreover, the restored E4032A channels remain resistant to subsequent exposure to ryanodine. In single-channel studies, E4032A exhibits infrequent (channel-open probability, Po < 0.005) and brief (<250 μs) gating events and insensitivity to Ca2+. Addition of ryanodine restores Ca2+-dependent channel activity exhibiting full, 3/4, 1/2, and 1/4 substates. This evidence suggests that, whereas ryanodine does not occlude the RyR pore, it does bind to sites that allosterically induce substantial conformational changes in the RyR. In the case of E4032A, these changes overcome unfavorable energy barriers introduced by the E4032A mutation to restore channel function.