Biallelic MLIP variants cause mild muscular dystrophy with rhabdomyolysis and myalgia


Topic:

Translational Research

Poster Number: 35

Author(s):

Livija Medne MS, CGC, Osorio Lopes Abath Neto MD, Sandra Donkervoort MS, CGC, Maria Elena Rodriguez-Garcia PhD, Ying Hu MS, Eleonora Guadagnin PhD, A Reghan Foley MD, PhD, John Brandsema MD, Allan Glanzman DPT, Mariarita Santi-Vicini MD, Gihan Tennekoon MD, Berger Justin CRNP, Lynn Megeney PhD, Hirofumi Komaki MD, PhD, Michio Inoue MD, Francisco Javier Cotrina-Vinagre PhD, Aurelio Hernández-Lain MD, Elena Martin-Hernández PhD, Linford Williams MS, CGC, Sabine Borell MD, David Schorling MD, Kimberly Lin MD, Konstantinos Kolokotronis PhD, Uta Lichter-Konecki MD, PhD, Janbernd Kirschner MD, Ichizo Nishino MD, PhD, Brenda Banwell MD, Francisco Martínez-Azorín MD, PhD, Patrick Burgon PhD, Carsten Bönnemann MD

Institutions:

1. Children's Hospital of Philadelphia, 2. NINDS, NIH, 3. NINDS, NIH, 4. Instituto de Investigación Hospital 12 de Octubre, 5. NINDS, NIH, 6. NINDS, NIH, 7. NINDS, NIH, 8. Children's Hospital of Philadelphia, 9. Children's Hospital of Philadelphia, 10. Children's Hospital of Philadelphia, 11. Children's Hospital of Philadelphia, 12. Children's Hospital of Philadelphia, 13. Ottawa Hospital Research Institute, 14. National Center of Neurology and Psychiatry, Tokyo, Japan, 15. National Center of Neurology and Psychiatry, Tokyo, Japan, 16. Instituto de Investigación Hospital 12 de Octubre, 17. Servicio de Anatomía Patológica (Neuropatología), Hospital 12 de Octubre, 18. Hospital 12 de Octubre, 19. Children's Hospital Pittsburgh, 20. Dept of Neuropediatrics & Muscle Disorders, Medical Center, Univ of Freiburg, 21. Dept of Neuropediatrics & Muscle Disorders, Medical Center, Univ of Freiburg, Germany, 22. Children's Hospital of Philadelphia, 23. Institute of Hum Genet, Biocenter, Julius-Maximilians Univ, 24. Children's Hospital Pittsburgh, 24. Dept of Neuropediatrics & Muscle Disorders, Medical Center, Univ of Freiburg, 25. National Center of Neurology and Psychiatry, Tokyo, Japan, 26. Children's Hospital of Philadelphia, 27. Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain, 28. Qatar University, Dept of Chemistry & Earth Science, 29. NINDS/NIH, Bethesda, MD

Striated muscle needs to adapt its cellular homeostasis to frequent changes in physiological and metabolic demands. Failure to do so can result in loss of cellular integrity manifesting as rhabdomyolysis. The identification of novel genetic conditions associated with rhabdomyolysis helps to shed light on hitherto unrecognized homeostatic mechanisms. Here we report seven individuals in six families from different ethnic backgrounds with biallelic variants in the Muscular LMNA-interacting protein (MLIP). Muscular LMNA-interacting protein (MLIP) directly interacts with lamins A and C and has high expression in cardiac and skeletal muscle. While mice with knockout of cardiac Mlip show accelerated cardiomyopathy, to role of MLIP gene pathogenic variants in human disease is being elucidated. All patients presented with a consistent phenotype characterized by mild muscle weakness, exercise-induced muscle pain, variable susceptibility to episodes of rhabdomyolysis, and persistent basal hyperCKemia. Muscle imaging was normal or showed minimal changes. Muscle biopsy findings ranged from mild nonspecific changes in patients 1 and 3, presence of necrotic and regenerating fibers in patients 2, 6, and 7 and moderate dystrophic changes in patient 4. All seven patients were found to have biallelic pathogenic variants that lead to truncated alleles which were predicted to result in a loss of the nuclear localizing signal or in the disruption of MLIP's AT-hook DNA binding motif. Two siblings carried a homozygous missense variant within a highly conserved region of MLIP that generates a new splice site resulting in a frameshift deletion and premature truncation of MLIP with a predicted loss of a putative GSK3 phosphorylation site and NLS. Collectively, our data increase the understanding of the genetic etiologies of rhabdomyolysis, and solidifies MLIP's role in normal and diseased skeletal muscle homeostasis.