emerin and Cardiomyopathy--Dilated

Nuclear muscular dystrophies are referred to as inherited muscular dystrophies caused by mutations in genes--(STA) or lamina (LMNA)--encoding components of the nuclear envelope. Phenotypically, they present as Emery-Dreifuss muscular dystrophy (EDMD), limb-girdle muscle dystrophy 1B (LGMD1B), or dilated cardiomyopathy with conduction defects (DCM-CD). Genetically related are the Dunnigan-type of familial partial lipodystrophy (FPLD) and Charcot-Marie-Tooth neuropathy type 2 (CMT2B). Until now, approximately 70 unique STA mutations, leading to X-linked EDMD or DCM-CD, have resulted mostly in a complete lack of emerin. Further 50 mostly missense mutations in LMNA result in autosomal-dominant EDMD, autosomal-recessive EDMD, LGMD1B, DCM-CD, FPLD, or CMT2B. Independent of type or location of the mutations, emerinopathies and laminopathies show wide clinical intrafamilial and interfamilial variability. Although structural abnormalities of nuclei in animal and cell models have been observed, the molecular pathology of the nuclear muscular dystrophies needs still to be elucidated.

Topics: Cardiomyopathy, Dilated; Chromosomes, Human, X; Gene Expression; Genotype; Humans; Membrane Proteins; Muscular Dystrophies; Neural Conduction; Nuclear Lamina; Nuclear Proteins; Phenotype; Point Mutation; Thymopoietins

Topics: Cardiomyopathy, Dilated; DNA; Genetic Predisposition to Disease; Humans; Membrane Proteins; Mutation; Nuclear Proteins

Tissue inhibitors of matrix metalloproteinases (TIMPs) are known to be involved in cardiovascular diseases. Hitherto, they have not been examined in dilated cardiomyopathy in the course of Emery-Dreifuss muscular dystrophy (EDMD).. To define TIMPs in serum because they might help in defining cardiac dysfunction at the early cardiological stages of this disease and detect preclinical stages of cardiomyopathy.. Twenty-five EDMD patients connected with lamin A/C (AD-EDMD) or emerin (X-EDMD) deficiency and 20 healthy age-matched controls were examined. The serum levels of the tissue inhibitors TIMP-1, -2, -3 were quantified using the ELISA sandwich immunoassay procedure with appropriate antibodies.. Serum levels of TIMP-1 were normal in autosomal AD-EDMD and increased in the majority of X-linked EDMD. The level of TIMP-2 was decreased in 25%/21% of AD-EDMD/X-EDMD cases. TIMP-3 serum level was significantly reduced in all the examined patients. Receiver operating curves indicated that in terms of sensitivity and specificity characteristics the performance of TIMP-3 (less that of TIMP-2) makes them the best markers of cardiac involvement among the examined TIMPs.. Evidence shows that the levels of TIMP-3, and in some cases also TIMP-2, are decreased in EDMD. The decrease might be associated with an adverse effect on matrix metalloproteinases and remodelling of the myocardial matrix. The specific decrease of TIMP-3 indicates that this biomarker might help in early detection of cardiac involvement in EDMD. Up-regulation of TIMP-1 in the majority of patients with X-EDMD indicates increased myocardial extracellular matrix turnover, early onset of tissue remodelling, and may contribute to arrhythmia, frequently occurring in this form of the disease.

Topics: Adolescent; Adult; Biomarkers; Cardiomyopathy, Dilated; Female; Humans; Lamin Type A; Male; Matrix Metalloproteinase Inhibitors; Membrane Proteins; Muscular Dystrophy, Emery-Dreifuss; Myocardium; Nuclear Proteins; Tissue Inhibitor of Metalloproteinase-1; Tissue Inhibitor of Metalloproteinase-2; Tissue Inhibitor of Metalloproteinase-3; Young Adult

Variants in the emerin gene (EMD) were implicated in X-linked recessive Emery-Dreifuss muscular dystrophy (EDMD), characterized by early-onset contractures of tendons, progressive muscular weakness and cardiomyopathy. To date, 223 mutations have been reported in EMD gene and the majority of them caused a predominant skeletal muscular phenotype. In this study, we identified a novel deletion mutation in EMD exon 1, which results in almost a complete loss of emerin protein in a large Chinese family. However, the patients suffered severe dilated cardiomyopathy (DCM) but very mild skeletal muscle disorder.. Whole exome sequencing (WES) and linkage analysis were performed to identify the underlying mutation in a Chinese DCM family spanning five generations. A missense variation in the GPR50 gene was found co-segregated with the disease phenotype, whereas no functional alteration was detected in the variant GPR50 protein. When analyzing the failure sequences in the exome sequencing data, a novel deletion mutation (c.26_39delATACCGAGCTGACC) in EMD exon 1, was identified in this family. Different from the typical clinical features caused by most reported EMD mutations, patients in our study presented very mild skeletal muscle degeneration that had not been diagnosed until the mutation was found.. We described a family with rare clinical presentations caused by a novel EMD deletion mutation. Our findings broaden the heterogeneous spectrum of phenotypes attributed to EMD mutations and provide new insight to explain the genotype-phenotype correlations between EMD mutations and EDMD symptoms.

Topics: Cardiomyopathy, Dilated; China; Exome; Exons; Female; Genetic Association Studies; Genetic Heterogeneity; Genetic Linkage; Genetic Variation; Genotype; Humans; Male; Membrane Proteins; Muscular Dystrophy, Emery-Dreifuss; Nerve Tissue Proteins; Nuclear Proteins; Pedigree; Phenotype; Receptors, G-Protein-Coupled; Sequence Analysis, DNA; Sequence Deletion

Mutations in the lamin A/C gene (LMNA) are known to be involved in several diseases such as Emery-Dreifuss muscular dystrophy, limb-girdle muscular dystrophy type 1B and dilated cardiomyopathies with conduction disease, with considerable phenotype heterogeneity. Here we report on a novel autosomal dominant mutation in LMNA in two direct relatives presenting with different clinical phenotypes, characterized by severe life-threatening limb-girdle muscle involvement and cardiac dysfunction treated with heart transplantation in the proband, and by ventricular tachyarrhythmias with preserved cardiac and skeletal muscle function in her young son. To our knowledge, this is the first report of a duplication in the LMNA gene. The two phenotypes described could reflect different clinical stages of the same disease. We hypothesize that early recognition and initiation of therapeutic manoeuvres in the younger patient may retard the rate of progression of the cardiomyopathy.

Topics: Adult; Amino Acid Sequence; Cardiomyopathy, Dilated; Electrocardiography; Female; Gene Duplication; Heart; Heart Diseases; Heart Transplantation; Humans; Immunohistochemistry; Lamin Type A; Membrane Proteins; Middle Aged; Molecular Sequence Data; Muscle Weakness; Muscle, Skeletal; Muscular Dystrophies, Limb-Girdle; Nuclear Proteins; Pedigree; Phenotype; Stroke Volume; Tomography, X-Ray Computed

Individuals with the same genetic disorder often show remarkable differences in clinical severity, a finding generally attributed to the genetic background. We identified two patients with genetically proven Emery-Dreifuss muscular dystrophy (EDMD) who followed an unusual course and had uncommon clinicopathological findings. We hypothesized digenic inheritance and looked for additional molecular explanations. Mutations in additional separate genes were identified in both patients. The first patient was a member of a family with molecularly proven X-linked EDMD. However, the clinical features were unusually severe for this condition in the propositus: he presented at 2.5 years with severe proximal weakness and markedly elevated serum creatine kinase. Muscle weakness rapidly progressed, leading to loss of independent ambulation by the age of 12. In addition, the patient developed cardiac conduction system disease requiring pacing at the age of 11 and severe dilated cardiomyopathy in the early teens. Despite pacing, he had several syncopal episodes attributed to ventricular dysrhythmias. As these resemble the cardiac features of patients with the autosomal dominant variant of EDMD, we examined the lamin A/C gene, identifying a de-novo mutation in the propositus. The second patient had a cardioskeletal myopathy, similar to his mother who had died more than 20 years previously. Because of the dominant family history, a laminopathy was suspected and a mutation in exon 11 of the LMNA gene was identified. This mutation, however, was not present in his mother, but instead, surprisingly, was identified in his virtually asymptomatic father. Unusual accumulations of desmin found in the cardiac muscle of the propositus prompted us to examine the desmin gene in this patient, and in so doing, we identified a desmin mutation, in addition to the LMNA mutation in the propositus. These cases suggest that separate mutations in related proteins that are believed to interact, or that represent different parts of a presumed functional pathway, may synergistically contribute to disease severity in autosomal dominant EDMD. Furthermore, digenic inheritance may well contribute to the clinical severity of many other neuromuscular disorders.

Topics: Adolescent; Adult; Cardiomyopathy, Dilated; Child, Preschool; Desmin; Female; Humans; Laminin; Magnetic Resonance Imaging; Male; Membrane Proteins; Middle Aged; Muscle, Skeletal; Muscular Dystrophy, Emery-Dreifuss; Mutation; Myocardium; Nuclear Proteins; Pedigree; Thymopoietins

Dilated cardiomyopathy is a form of heart muscle disease characterized by impaired systolic function and ventricular dilation. The mutations in lamin A/C gene have been linked to dilated cardiomyopathy. We screened genetic mutations in a large Chinese family of 50 members including members with dilated cardiomyopathy and found a Glu82Lys substitution mutation in the rod domain of the lamin A/C protein in eight family members, three of them have been diagnosed as dilated cardiomyopathy, one presented with heart dilation. The pathogenic mechanism of lamin A/C gene defect is poorly understood. Glu82Lys mutated lamin A/C and wild type protein was transfected into HEK293 cells. The mutated protein was not properly localized at the inner nuclear membrane and the emerin protein, which interacts with lamin A/C, was also aberrantly distributed. The nuclear membrane structure was disrupted and heterochromatin was aggregated aberrantly in the nucleus of the HEK293 cells stably transfected with mutated lamin A/C gene as determined by transmission electron microscopy.

Topics: Adult; Amino Acid Sequence; Amino Acid Substitution; Asian People; Cardiomyopathy, Dilated; Cell Nucleus; Cells, Cultured; Child; Female; Glutamic Acid; Heart Block; Heart Conduction System; Humans; Lamin Type A; Lysine; Male; Membrane Proteins; Molecular Sequence Data; Nuclear Envelope; Nuclear Proteins; Pedigree; Point Mutation; Thymopoietins

Heritable dilated cardiomyopathy is a genetically highly heterogeneous disease. To date 17 different chromosomal loci have been described for autosomal dominant forms of dilated cardiomyopathy with or without additional clinical manifestations. Among the 10 mutated genes associated with dilated cardiomyopathy, the lamin A/C (LMNA) gene has been reported in forms associated with conduction-system disease with or without skeletal muscle myopathy. For the first time, we report here a French family affected with a new phenotype composed of an autosomal dominant severe dilated cardiomyopathy with conduction defects or atrial/ventricular arrhythmias, and a specific quadriceps muscle myopathy. In all previously reported cases with both cardiac and neuromuscular involvement, neuromuscular disorders preceded cardiac abnormalities. The screening of the coding sequence of the LMNA gene on all family members was performed and we identified a missense mutation (R377H) in the lamin A/C gene that cosegregated with the disease in the family. Cell transfection experiments showed that the R377H mutation leads to mislocalization of both lamin and emerin. These results were obtained in both muscular (C2C12) and non-muscular cells (COS-7). This new phenotype points out the wide spectrum of neuromuscular and cardiac manifestations associated with lamin A/C mutations, with the functional consequence of this mutation seemingly associated with a disorganization of the lamina.

Topics: Adult; Animals; Cardiomyopathy, Dilated; Cell Line; COS Cells; Desmin; DNA; DNA Mutational Analysis; Dystrophin; Family Health; Female; Humans; Immunohistochemistry; Lamin Type A; Male; Membrane Proteins; Middle Aged; Muscle, Skeletal; Mutation; Mutation, Missense; Myocardium; Nuclear Proteins; Pedigree; Plasmids; Thymopoietins; Transfection

Topics: Adolescent; Adult; Arrhythmias, Cardiac; Cardiomyopathy, Dilated; Child; DNA Mutational Analysis; Heart Diseases; Humans; Lamin Type A; Lamins; Membrane Proteins; Middle Aged; Muscular Dystrophies; Muscular Dystrophy, Emery-Dreifuss; Mutation; Nuclear Proteins; Phenotype; Thymopoietins

Most pathogenic missense mutations in the lamin A/C gene identified so far cause autosomal-dominant dilated cardiomyopathy and/or Emery-Dreifuss muscular dystrophy. A few specific mutations, however, cause a disease with remarkably different clinical features: FPLD, or familial partial lipodystrophy (Dunnigan-type), which mainly affects adipose tissue. We have prepared lamin A with a known FPLD mutation (R482Q) by in vitro mutagenesis. Nuclear targeting of lamin A in transfected COS cells, human skeletal muscle cells or mouse adipocyte cell cultures (pre- and post-differentiation) was not detectably affected by the mutation. Quantitative in vitro measurements of lamin A interaction with emerin using a biosensor also showed no effect of the mutation. The results show that the loss of function of R482 in lamin A/C in FPLD does not involve loss of ability to form a nuclear lamina or to interact with the nuclear membrane protein, emerin.

Topics: Adipocytes; Animals; Base Sequence; Cardiomyopathy, Dilated; Cell Nucleus; COS Cells; DNA Primers; Lamin Type A; Lamins; Lipodystrophy; Membrane Proteins; Muscular Dystrophies; Mutation; Nuclear Proteins; Thymopoietins

Emerin (34 kDa) is a 254 amino acid protein located on the cytoplasmic surface of the inner nuclear membrane in cardiac muscle. It interacts with nuclear lamins and nuclear actin. Emerin is usually completely absent in Emery-Dreifuss muscular dystrophy, a condition that also manifests in the heart. Nuclear lamins are specialized nuclear proteins that line the inner nuclear membrane. Two isoforms, lamin A and C, differ in their C-terminal amino acids. Both are important in apoptosis and are degraded by caspase enzymes. Mutations in the rod domain of the lamin A/C gene are known to cause dilated cardiomyopathy (DCM) (Fatkin et al. New Engl. J. Med. 1999, 351, 1715-1724). We have used Western blots to detect emerin and lamin A/C in left ventricles from both nondiseased and failing DCM samples. The lamins form dimers, however it is not known if they are homodimers and / or heterodimers. In this report we compare and quantify expression levels of emerin from samples of left ventricles from ten failing DCM patients and five nondiseased (donor) hearts. We observed three lamin bands that suggest the expression of the three isoforms of the A-type lamin gene, lamin A, lamin C and lamin C2 (Ye et al. Subcellular Biochem. 1998, 31, 587-610). Preliminary data show that both lamin isoforms and emerin are present.

Topics: Blotting, Western; Cardiomyopathy, Dilated; Electrophoresis, Polyacrylamide Gel; Humans; Membrane Proteins; Nuclear Envelope; Nuclear Proteins; Thymopoietins

Nuclear lamin A and C alleles that are linked to three distinct human diseases have been expressed both in HeLa cells and in fibroblasts derived from Lmna null mice. Point mutations that cause dilated cardiomyopathy (L85R and N195K) and autosomal dominant Emery-Dreifuss muscular dystrophy (L530P) modify the assembly properties of lamins A and C and cause partial mislocalization of emerin, an inner nuclear membrane protein, in HeLa cells. At the same time, these mutant lamins interfere with the targeting and assembly of endogenous lamins and in this way may cause significant changes in the molecular organization of the nuclear periphery. By contrast, lamin A and C molecules harboring a point mutation (R482W), which gives rise to a dominant form of familial partial lipodystrophy, behave in a manner that is indistinguishable from wild-type lamins A and C, at least with respect to targeting and assembly within the nuclear lamina. Taken together, these results suggest that nuclear structural defects could contribute to the etiology of both dilated cardiomyopathy and autosomal dominant Emery-Dreifuss muscular dystrophy.

Topics: Animals; Cardiomyopathy, Dilated; Fibroblasts; Fluorescent Antibody Technique; Gene Expression; Genetic Linkage; HeLa Cells; Humans; Lamin Type A; Lamins; Membrane Proteins; Mice; Mice, Knockout; Muscular Dystrophy, Emery-Dreifuss; Mutagenesis, Site-Directed; Nuclear Envelope; Nuclear Proteins; Point Mutation; Thymopoietins; Transfection; X Chromosome