Hepatobiliary disease in XLMTM: a common comorbidity with potential impact on treatment strategies

Adele D’Amico,Adelina Carlesi,Luca Bosco,Maria Beatrice Chiarini Testa,Antonella Longo,Claudio Cherchi,Fabiana Fattori,Michele Tosi,Enrico Bertini,Maria Giovanna Paglietti,Irene Mizzoni

doi:10.1186/s13023-021-02055-1

Abstract

BackgroundX-linked myotubular myopathy (XLMTM) is a rare congenital myopathy resulting from pathogenic variants in the MTM1 gene. Affected male subjects typically present with severe hypotonia and respiratory distress at birth and they often require intensive supportive care. Long-term survivors are often non-ambulant, ventilator and feeding tube–dependent and they generally show additional organ manifestations, indicating that myotubularin does play a vital role in tissues other than muscle. For XLMTM several therapeutic strategies are under investigation. For XLMTM several therapeutic strategies are under investigation including a study of intravenous MTM1 gene transfer using a recombinant AAV8 vector of which has some concerns arises due to hepatotoxicity.ResultsWe report prospective and retrospective clinical data of 12 XLMTM patients collected over a period of up to 10 years. In particular, we carried out a thorough review of the data about incidence and the course of hepatobiliary disease in our case series.ConclusionsWe demonstrate that hepatobiliary disease represents a common comorbidity of XLMTM that seems irrespective to age and diseases severity. We recommend to carefully explore and monitor the hepatobiliary function in XLMTM patients. We believe that a better understanding of the pathogenic mechanisms that induce hepatobiliary damage is essential to understand the fatal events that may occur in the gene therapy program.

Highlights

X-linked myotubular myopathy (XLMTM, OMIM #310400) is a rare congenital myopathy resulting from pathogenic variants in the MTM1 gene
As part of our efforts to contribute to a deep knowledge of this comorbidity, we reviewed in detail the long-term follow-up of 12 XLMTM patients
We report on clinical findings and long-term follow up of 12 XLMTM patients with the aim to describe the systemic complication of this disease

Summary

Introduction

X-linked myotubular myopathy (XLMTM) is a rare congenital myopathy resulting from pathogenic variants in the MTM1 gene. Affected male subjects typically present with severe hypotonia and respiratory distress at birth and they often require intensive supportive care. X-linked myotubular myopathy (XLMTM, OMIM #310400) is a rare congenital myopathy resulting from pathogenic variants in the MTM1 gene. MTM1 encodes the protein myotubularin, a lipid phosphatase involved in the maintenance of skeletal muscle structure and membrane homeostasis, in particular in the organization of XLMTM has been classified in mild, intermediate, or severe forms based on the amount of the ventilator support required [7]. Affected babies typically present with marked hypotonia and respiratory distress at birth, and they require respiratory and feeding intensive support.

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