G.P.197: Strongman syndrome: Clinical, pathological and genetic characterization of dominant herculean myalgic disorders

Abstract

Muscle mass and strength are variable traits in humans. Many French Canadians (FC) became international celebrities because of their exceptional strength. Though muscle hypertrophy has been associated in many mammals with myostatin mutations, to date only a single pediatric case has been reported in humans. Dominant pathological mutations in the CLCN1, SCN4A, CAV3, ATP2A1, LPIN1, LMNA and RYR1 gene have been known to lead to muscle hypertrophy in humans, in particular selective muscle hypertrophy in certain myopathies. These conditions are associated with either weakness or increased strength. We recruited a cohort of more than 115 cases belonging to more than 65 families of a heterogeneous dominant condition that we refer to as: "Strongman syndrome" (SM). In all families, the most affected case suffers from incapacitating myalgias with variable degree of muscle cramps, and they also have a personal and familial history of above average strength. On examination these patients have large well defined muscles, above average strength, non-electric prolonged muscle contractions and progressive weakness on repeated contractions. Exome sequencing of a large FC family identified a single segregating variant predicted to be damaging in the DCST2 gene shared also by two other FC families. The DCST2 gene is expressed in skeletal muscle and is predicted to code for a six transmembrane domains channel-like protein. To better characterize the herculean strength we assesses different biometric variables in a subset of cases with and without DCST2 mutations and investigated if myofiber hypertrophy is present. Results of quantifiable methods to evaluate the clinical and pathological phenotype of strongman cases will be presented, as well as functional data about DCST2. The uncovering of the function of DCST2 and other strongman genes will contribute to a better understanding of pathways important for muscle hypertrophy and strength in health and disease.