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Establishment of a screening service for Bethlem Myopathy and Ullrich Congenital Muscular Dystrophy. Tom Cullup Guy’s Hospital DNA Laboratory. Introduction. UCMD and BM Phenotypes The Collagen VI genes Testing Strategy Initial Results Discussion on cDNA sequencing. UCMD and BM. - PowerPoint PPT Presentation
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Establishment of a screening service for Bethlem Myopathy and Ullrich Congenital Muscular Dystrophy
Tom Cullup
Guy’s Hospital DNA Laboratory
Introduction
• UCMD and BM– Phenotypes – The Collagen VI genes
• Testing Strategy
• Initial Results
• Discussion on cDNA sequencing
UCMD and BM
UCMD Ullrich Congenital Muscular Dystrophy
BM Bethlem Myopathy
Inheritance: AR (AD) Inheritance: AD
Symptoms: Muscle weakness
Proximal joint contractures
Hyperelasticity of distal joints
Walking never achieved
Death from respiratory failure
Symptoms: Hypotonia
Delayed motor milestones
Weakness
Muscle atrophy
Contractures (temporary/permanent)
Differential diagnosis:
Other CMDs/Myopathies
SMA
Ehlers Danlos Syndrome
Marfan Syndrome
Differential diagnosis:
Sarcoglycanopathies
Calpainopathy
Dysferlinopathy
XL/AD Emery Dreyfus MD
Collagen VI
• Heterotrimeric• Extracellular matrix protein• Genes:
– COL6A1/COL6A2/COL6A3– Similar structure– COL6A1 and COL6A2: 21q22.3 (head to tail)– COL6A3: 2q37
Gene Exons Amino Acids
COL6A1 35 1028
COL6A2 28 1019
COL6A3 44 (43) 3177
Total 107 5224
vWF A
TH
Fibronectin type III motifKunitz Protease inhibitor motif
Cys
α1
α2
α3
Macromolecular Structure
• Assembly of Collagen VI multi-step process:1. Assembly of triple-helical monomer (1 x α1, α2, α3)
2. 2 x monomers assemble into antiparallel dimers
3. 2 x dimers align to form tetramers
• Cysteine residues in all 3 chains thought to be involved in dimer/tetramer formation/stability
Testing Strategy
• Options:– Pre-screen (TGCE) + genomic seq
– Genomic seq (+ dosage assay)
– cDNA seq
• cDNA seq:– Should pick up same mutations as genomic seq +
demonstrates splice + large del/dup
– Potential to reduce sequencing load• Genomic: 107 fragments
• cDNA: 26 fragments
Practical Overview
AAA
AAA
AAA Col6a1
Col6a2
Col6a3
Fibroblast sample
Extraction
mRNA
Reverse Transcription
cDNA
Overlapping 1°PCR primers
Tagged, nested 2°PCR primers
2°PCR Fragments Sequenced F+R Using
Tag primers
Initial Screen Results
• Initial cohort: 16 patients• 14 have definite pathogenic mutations• 87.5% pick-up (previous studies: 62%)
• Why so high?– Patient selection
• Phenotype screened by Hammersmith• Immunohistochemical analysis
– Screening strategy• 1 patient with het del – no confirmed DNA change• 1 patient with -10 change causing splicing defect - ? Classed as mutation if
only seen on DNA
Deletion of Ex10 (COL6A2) at the RNA level
No definitive change at DNA level - ?mosaic splicing mutation
Results Interpretation
• Large proportion of heterozygous mutations for UCMD cases
(8 het vs 5 hom)
– Previously thought of as AR
– UCMD/BM now thought of as continuous phenotypic spectrum
– Location of mutations as well as mutation type important
vWFA vWFATH FIII KPI
Het In-frame del/splice
Hom In-frame del/splice
Hom Out-of-frame del/splice
Het missense (TH Glycine residues)
Hom missense
N C
Theories on genotype-phenotype correlation
• “Classical” UCMD:– 2 x PTC mutations → No functional protein
• “Classical” BM:– 1 x Missense/in-frame del/splice → Weak dom-neg effect
• Glycine missense in TH domain:– Evidence that N-term Glycine changes cause ‘kinking’ of
tetramers → dominant neg effect– Only 1 example of hom glycine change
• Het del/splice:– Similar effect to Glycine missense– Preservation of Cys residue allows secretion of abnormal
tetramers → dom neg effects on microfibrillar assembly
Benefits and drawbacks of cDNA sequencing
• Benefits:– Smaller number of fragments to sequence– Demonstrates splicing mutations– Shows large rearrangements
• Drawbacks– RNA unstable– Alternative splicing– Does not fit into lab high-throughput processes– Checking overlapping fragments
Acknowledgments
• Guy’s DNA lab:– Michael Yau– Steve Abbs
• Hammersmith Neuromuscular unit:– Prof. Francesco Muntoni– Cecilia Jimenez-Mallebrera– Lucy Feng