Fukuyama Congenital Muscular Dystrophy Research Articles

Branchpoints as potential targets of exon-skipping therapies for genetic disorders

Fukutin (FKTN) c.647+2084G>T creates a pseudo-exon with apremature stop codon, which causes Fukuyama congenital muscular dystrophy (FCMD). We aimed to ameliorate aberrant splicing of FKTN caused by this variant. We screened compounds focusing on splicing regulation using the c.647+2084G>T splicing reporter and discovered that the branchpoint, which is essential for splicing reactions, could be a potential therapeutic target. To confirm the effectiveness of branchpoints as targets for exon skipping, we designed branchpoint-targeted antisense oligonucleotides (BP-AONs). This restored normal FKTN mRNA and protein production in FCMD patient myotubes. We identified a functional BP by detecting splicing intermediates and creating BP mutations in the FKTN reporter gene; this BP was non-redundant and sufficiently blocked by BP-AONs. Next, a BP-AON was designed for a different FCMD-causing variant, which induces pathogenic exon trapping by a common SINE-VNTR-Alu-type retrotransposon. Notably, this BP-AON also restored normal FKTN mRNA and protein production in FCMD patient myotubes. Our findings suggest that BPs could be potential targets in exon-skipping therapeutic strategies for genetic disorders.

VP.73 Characteristics of cardiac dysfunction in patients with Fukuyama congenital muscular dystrophy

VP.73 Characteristics of cardiac dysfunction in patients with Fukuyama congenital muscular dystrophy

Brain MR imaging findings in children with congenital muscular dystrophies

Congenital muscular dystrophies (CMDs) are a heterogeneous group of disorders presenting early in life during infancy or soon after birth with muscle weakness and hypotonia, sometime associated to severe brain involvement and histologically presenting with dystrophic lesions. They are classified on the basis of the clinical features, pathologic findings and pattern of inheritance. In fact most of these disorders are inherited and linked to specific genes. Several CDMs classifications have been proposed [1-3]. The main CMD subtypes, classified by pathogenic gene, are laminin alpha‐2 (merosin) deficiency (MDC1A), collagen VI-related CMD (COL6-RD), the dystroglycanopathies -such as Walker‐Warburg syndrome (WWS), Fukuyama CMD (FCMD), and muscle-eye-brain disease (MEB)-, SELENON (SEPN1)‐related CMD, and LMNA‐related CMD (L‐CMD) [4]. The incidence and prevalence of CMDs in various populations is not sufficiently known and may have been underestimated in early published CMD surveys owing to more limited diagnostic means available. Point prevalence in various studies ranges from 0.56 to 2.5 per 100,000 [5-10]. The relative frequency of CMD subtypes also varies in different populations. The most common CMD subtypes are laminin-α2 related CMD and dystroglycanopathies, followed by collagen VI-related CMD. The forms of congenital muscular dystrophy related to mutations in SEPN1 and LMNA are less frequent [9,11]. CMDs are often autosomal recessive, but some cases have been found to follow autosomal dominant patterns, by direct inheritance, spontaneous mutations, or mosaicism. Clinical genetic testing is available for virtually all genes known to be associated with CMDs. However, many affected individuals remain without a genetic diagnosis, an indicator that novel disease genes have yet to be identified [3]. Differential diagnosis of patients presenting with weakness in early infancy includes: Congenital myopathies like central core, nemaline road, and centronuclear myopathy and those secondary to metabolic disorders; Disorders of the myoneural junction including congenital myasthenia gravis and infant botulism and Neuropathies like spinal muscular atrophy (SMA) and hereditary motor sensory neuropathy (HMSN) [12]. Nowadays the diagnosis is based on clinical presentation, laboratory tests and genetic investigations. Muscular biopsy can be an important diagnostic tool if genetic tests are not available. Brain MRI and muscular MRI are performed if available. We discuss brain MR imaging findings in our patients with CMDs trying to outline common features and differences in order to aid in the diagnosis of these rare disorders before performing genetic tests.

Fukutin regulates tau phosphorylation and synaptic function: Novel properties of fukutin in neurons.

Fukutin, a product of the causative gene of Fukuyama congenital muscular dystrophy (FCMD), is known to be responsible for basement membrane formation. Patients with FCMD exhibit not only muscular dystrophy but also central nervous system abnormalities, including polymicrogyria and neurofibrillary tangles (NFTs) in the cerebral cortex. The formation of NFTs cannot be explained by basement membrane disorganization. To determine the involvement of fukutin in the NFT formation, we performed molecular pathological investigations using autopsied human brains and cultured neurons of a cell line (SH‐SY5Y). In human brains, NFTs, identified with an antibody against phosphorylated tau (p‐tau), were observed in FCMD patients but not age‐matched control subjects and were localized in cortical neurons lacking somatic immunoreactivity for glutamic acid decarboxylase (GAD), a marker of inhibitory neurons. In FCMD brains, NFTs were mainly distributed in lesions of polymicrogyria. Immunofluorescence staining revealed the colocalization of immunoreactivities for p‐tau and phosphorylated glycogen synthase kinase‐3β (GSK‐3β), a potential tau kinase, in the somatic cytoplasm of SH‐SY5Y cells; both the immunoreactivities were increased by fukutin knockdown and reduced by fukutin overexpression. Western blot analysis using SH‐SY5Y cells revealed consistent results. Enzyme‐linked immunosorbent assay (ELISA) confirmed the binding affinity of fukutin to tau and GSK‐3β in SH‐SY5Y cells. In the human brains, the density of GAD‐immunoreactive neurons in the frontal cortex was significantly higher in the FCMD group than in the control group. GAD immunoreactivity on Western blots of SH‐SY5Y cells was significantly increased by fukutin knockdown. On immunofluorescence staining, immunoreactivities for fukutin and GAD were colocalized in the somatic cytoplasm of the human brains and SH‐SY5Y cells, whereas those for fukutin and synaptophysin were colocalized in the neuropil of the human brains and the cytoplasm of SH‐SY5Y cells. ELISA confirmed the binding affinity of fukutin to GAD and synaptophysin in SH‐SY5Y cells. The present results provide in vivo and in vitro evidence for novel properties of fukutin as follows: (i) there is an inverse relationship between fukutin expression and GSK‐3β/tau phosphorylation in neurons; (ii) fukutin binds to GSK‐3β and tau; (iii) tau phosphorylation occurs in non‐GAD‐immunoreactive neurons in FCMD brains; (iv) neuronal GAD expression is upregulated in the absence of fukutin; and (v) fukutin binds to GAD and synaptophysin in presynaptic vesicles of neurons.

Experiences of advance care planning in patients with Fukuyama congenital muscular dystrophy

Experiences of advance care planning in patients with Fukuyama congenital muscular dystrophy

Efficacy of steroid therapy for Fukuyama congenital muscular dystrophy

Although there is only symptomatic treatment for Fukuyama congenital muscular dystrophy (FCMD), several reports have suggested that steroid therapy could be effective for FCMD; however, no independent intervention studies have been conducted. This study aimed to evaluate the efficacy of steroid therapy for restoring motor functions in FCMD patients. This study involved 3-to-10-year-old FCMD patients who exhibited a decline in motor functions, requested steroid therapy. Patients with consent started oral administration of 0.5-mg/kg prednisolone every alternate day, which was increased to 1.0 mg/kg if the response was inadequate. We used the Gross Motor Function Measure (GMFM) to evaluate and compare the motor functions of all patients. Wilcoxon signed-rank test (significance level, P ≤ 0.05) was used for statistical analysis. At the onset of steroid therapy, 8.10 years (SD, 2.14 years) was the mean age of FCMD patients. The mean GMFM difference between before and after the steroid therapy was + 1.23 (SD, 1.10), and a P value of 0.015 represented significant improvement in GMFM. Our results indicate that steroid therapy may contribute to the maintenance and improvement of the motor functions of advanced-stage FCMD patients.Clinical Trial Registration Registration Number: UMIN000020715, Registration Date: Feb 1st, 2016 (01/02/2016).

Fukutin Protein Participates in Cell Proliferation by Enhancing Cyclin D1 Expression through Binding to the Transcription Factor Activator Protein-1: An In Vitro Study.

The causative gene of Fukuyama congenital muscular dystrophy (fukutin) is involved in formation of the basement membrane through glycosylation of alpha-dystroglycan. However, there are other proposed functions that have not been fully understood. Using cultured astrocytes (1321N1), we found nuclear localization of fukutin and a positive relationship between fukutin expression and cell proliferation. Among potential proteins regulating cell proliferation, we focused on cyclin D1, by reverse-transcription polymerase chain reaction, Western blotting, immunocytochemistry, enzyme-linked immunosorbent assay (ELISA), and sandwich ELISA. Expression of cyclin D1 was significantly downregulated by fukutin knockdown and significantly upregulated by fukutin overexpression. Moreover, fukutin was proven to bind to the activator protein-1 (AP-1) binding site of cyclin D1 promoter, as well as the AP-1 component c-Jun. The c-Jun phosphorylation status was not significantly influenced by knockdown or overexpression of fukutin. The present results provide in vitro evidence for a novel function of fukutin, which participates in cell proliferation by enhancing cyclin D1 expression through forming a complex with AP-1. It is likely that fukutin is a potential cofactor of AP-1.

CONGENITAL MUSCULAR DYSTROPHIES: EP.64 Brain image phenotypes and developmental milestones in Fukuyama congenital muscular dystrophy

Muscle and brain are affected in Fukuyama congenital muscular dystrophy (FCMD). Not much is known how the severity of brain abnormality affects the developmental milestones in patients with FCMD. In this study, we aimed to grade the severity of brain abnormality using magnetic resonance imaging (MRI), and assessed the correlation between brain image phenotypes and developmental milestones in FCMD. Medical records of patients with FCMD in our hospital were retrospectively assessed. The patients older than 10 years were selected.

CONGENITAL MUSCULAR DYSTROPHIES: EP.65 Evaluation of the levels of essential trace elements in patients with Fukuyama congenital muscular dystrophy

CONGENITAL MUSCULAR DYSTROPHIES: EP.65 Evaluation of the levels of essential trace elements in patients with Fukuyama congenital muscular dystrophy

Homozygous Fukutin Missense Mutation in Two Mexican Siblings with Dilated Cardiomyopathy.

Fukuyama congenital muscular dystrophy (FCMD) is the most common form of a group of autosomal recessive disorders characterized by altered α-dystroglycan glycosylation and caused by FKTN gene mutations. However, mutations of this gene may cause a broad range of phenotypes, including Walker-Warburg syndrome, muscle-brain-eye disease, FCMD, limbgirdle muscular dystrophy without mental retardation, and cardiomyopathy with no or minimal skeletal muscle weakness. Our purpose was to describe two siblings who died at a young age with dilated cardiomyopathy (DCM), no muscle weakness, or atrophy, and were homozygous for a FKTN missense mutation. Site-directed next-generation sequencing (NGS) was performed. Pathogenicity of variants of interest was established according to the American College of Medical Genetics (ACMG) criteria, and all available first-degree relatives were screened for mutations by Sanger sequencing. NGS revealed a homozygous FKTN variant in the index case (p.Gly424Ser, rs752358445), classified as likely pathogenic by ACMG criteria. Both parents and an unaffected brother were heterozygous carriers. Since the siblings had no apparent skeletal muscle weakness or central nervous system involvement, FKTN mutations were not initially suspected. This is the first report demonstrating that heterozygous individuals for the FKTN p.Gly424Ser mutation were healthy, while two homozygous brothers suffered severe DCM, strongly suggesting that this FKTN mutation is a rare cause of autosomal recessive DCM.

Restoration of Alpha Dystroglycan Glycosylation in Disease Models of Fukuyama Muscular Dystrophy

SUMMARY Fukuyama congenital muscular dystrophy (FCMD) is a severe, intractable genetic disease that affects the skeletal muscle, eyes, and brain and is attributed to a defect in alpha dystroglycan (αDG) O-mannosyl glycosylation. We previously established disease models of FCMD; however, they did not fully recapitulate the phenotypes observed in human patients. In this study, we generated induced pluripotent stem cells (iPSCs) from a human FCMD patient and differentiated these cells into three-dimensional brain organoids and skeletal muscle. The brain organoids successfully mimicked patient phenotypes not reliably reproduced by existing models, including decreased αDG glycosylation and abnormal radial glial cell (RG) fiber migration. The basic polycyclic compound Mannan-007 (Mn007) restored αDG glycosylation in all models tested and partially rescued the abnormal RG migration observed in cortical organoids. Therefore, our study underscores the importance of αDG O -mannosyl glycans for normal RG architecture and proper neuronal migration in corticogenesis.

Urinary titin as a biomarker in Fukuyama congenital muscular dystrophy

Fukuyama congenital muscular dystrophy (FCMD) is the second most prevalent childhood-onset muscular dystrophy in Japan. It is an autosomal recessive disorder caused by the fukutin mutation (FKTN), characterized by muscle wasting and brain abnormalities. So far, serum creatine kinase (CK) is recognized as the only biomarker for FCMD. Recently, an ELISA assay to quantify the N-terminal fragment of titin in urine was developed. Urinary titin concentration is elevated in patients with Duchenne muscular dystrophy (DMD) compared to normal controls. Levels vary according to age with excellent sensitivity and specificity for detecting DMD, and they can be used as a diagnostic and disease progression marker. In this study, we measured the urinary titin concentration of 18 patients with FCMD. It was remarkably higher than normal controls and correlated with CK. Especially in homozygotes, the score for gross motor function measure, which is a quantitative motor scale for FCMD, was correlated with urinary titin concentration. Elevated urinary titin concentrations were thought to be reflective of a common pathophysiology with DMD. Urinary titin concentrations can assist with making the diagnosis of FCMD and to estimate the patient's motor function at that point.

Examination of Motor Function and Changes Over Time in Patients with Fukuyama Congenital Muscular Dystrophy

Examination of Motor Function and Changes Over Time in Patients with Fukuyama Congenital Muscular Dystrophy

Unraveling the pathogenesis and development of therapeutic strategies for Fukuyama congenital muscular dystrophy using model animals

Unraveling the pathogenesis and development of therapeutic strategies for Fukuyama congenital muscular dystrophy using model animals

Infection-associated decrease of serum creatine kinase levels in Fukuyama congenital muscular dystrophy

BackgroundMarked decreases in serum creatine kinase levels have been noted in Duchenne and Becker muscular dystrophies as rare complications of autoimmune or autoinflammatory diseases. Subjects and methodsThe influence of systemic inflammation on serum creatine kinase levels was reviewed from the charts of three subjects with Fukuyama congenital muscular dystrophy. ResultsA total of 30 infectious events were identified. Elevated serum C-reactive protein levels coincided with decreased creatine kinase levels on 19 occasions. In one subject, administration of 2 mg/kg/d prednisolone for bronchial asthma resulted in a decrease in creatine kinase level on six other occasions. ConclusionApart from an increase in endogenous cortisol secretion, certain inflammation-related molecules could play a role in mitigating muscle cell damage in Fukuyama congenital muscular dystrophy during febrile infectious episodes. Corticosteroids may be a promising agent for the treatment of muscular symptoms in this disorder.

Noninvasive prenatal test of single-gene disorders by linked-read direct haplotyping: application in various diseases.

Direct haplotyping enables noninvasive prenatal testing (NIPT) without analyzing proband, which is a promising strategy for pregnancies at risk of an inherited single-gene disorder. Here, we aimed to expand the scope of single-gene disorders that NIPT using linked-read direct haplotyping would be applicable to. Three families at risk of myotonic dystrophy type 1, lipoid congenital adrenal hyperplasia, and Fukuyama congenital muscular dystrophy were recruited. All cases exhibited distinct characteristics that are often encountered as hurdles (i.e., repeat expansion, identical variants in both parents, and novel variants with retrotransposon insertion) in the universal clinical application of NIPT. Direct haplotyping of parental genomes was performed by linked-read sequencing, combined with allele-specific PCR, if necessary. Target DMPK, STAR, and FKTN genes in the maternal plasma DNA were sequenced. Posterior risk calculations and an Anderson-Darling test were performed to deduce the maternal and paternal inheritance, respectively. In all cases, we could predict the inheritance of maternal mutant allele with > 99.9% confidence, while paternal mutant alleles were not predicted to be inherited. Our study indicates that direct haplotyping and posterior risk calculation can be applied with subtle modifications to NIPT for the detection of an expanded range of diseases.

Characteristic Cochlear Hypoplasia in Patients with Walker-Warburg Syndrome: A Radiologic Study of the Inner Ear in α-Dystroglycan-Related Muscular Disorders.

Walker-Warburg syndrome, muscle-eye-brain disease, and Fukuyama congenital muscular dystrophy are α-dystroglycan-related muscular disorders associated with brain malformations and eye abnormalities in which no structural inner ear abnormality has been described radiologically. We collected patients from 6 tertiary pediatric hospitals and reported the radiologic features and frequency of inner ear dysplasias. Patients previously diagnosed clinicoradiologically with Walker-Warburg syndrome, muscle-eye-brain disease, or Fukuyama congenital muscular dystrophy were included. We recorded the pathogenic variant, when available. Brain MR imaging and/or CT findings were reviewed in consensus, and inner ear anomalies were classified according to previous description in the literature. We then correlated the clinicoradiologic phenotype with the inner ear phenotype. Thirteen patients fulfilled the criteria for the Walker-Warburg syndrome phenotype, 8 for muscle-eye-brain disease, and 3 for Fukuyama congenital muscular dystrophy. A dysplastic cochlea was demonstrated in 17/24. The most frequent finding was a pronounced cochlear hypoplasia type 4 with a very small anteriorly offset turn beyond the normal-appearing basal turn (12/13 patients with Walker-Warburg syndrome and 1/11 with muscle-eye-brain disease or Fukuyama congenital muscular dystophy). Two of 8 patients with muscle-eye-brain disease, 1/3 with Fukuyama congenital muscular dystrophy, and 1/13 with Walker-Warburg syndrome showed a less severe cochlear hypoplasia type 4. The remaining patients without Walker-Warburg syndrome were healthy. The vestibule and lateral semicircular canals of all patients were normal. Cranial nerve VIII was present in all patients with diagnostic MR imaging. Most patients with the severe α-dystroglycanopathy Walker-Warburg syndrome phenotype have a highly characteristic cochlear hypoplasia type 4. Patients with the milder variants, muscle-eye-brain disease and Fukuyama congenital muscular dystrophy, more frequently have a normal cochlea or milder forms of hypoplasia.

REGISTRIES, CARE, QUALITY OF LIFE, MANAGEMENT OF NMD: P.343 Cardiac involvement in Fukuyama muscular dystrophy is less severe than in Duchenne muscular dystrophy

Fukuyama congenital muscular dystrophy (FCMD) is the second common, childhood muscular dystrophy with brain anomaly in Japan. It is caused by insertions of a SINE-VNTR-Alu retrotransposal element into the fukutin gene. One of the main complications in patients with muscular dystrophies is cardiac dysfunction. The literature on cardiac involvement in patients with Fukuyama congenital muscular dystrophy (FCMD) is limited. To compare cardiac involvement between patients with FCMD and Duchenne muscular dystrophy (DMD), we compared cardiac involvement between 30 patients with FCMD and 181 patients with DMD using echocardiography and serum biomarkers.

OMICs AND AI APPROACHES FOR MUSCLE DISEASES: O.08 Deep convolutional-neural-network can differentiate twelve major muscular diseases better than human

Muscle pathology plays an important role in the diagnosis of muscle disease even in the molecular era, as most muscle diseases have been classified or even partly defined by pathological features. Nevertheless, availability of experts is limited especially in underserved areas of the world. This study aims to establish the algorithm to assist muscle pathology diagnosis using deep convolutional neural networks (CNNs), which can differentiate major muscle diseases only by hematoxylin and eosin (H&E)-stained pathological images. Target diseases were dystrophinopathy (DYST), limb-girdle muscular dystrophy (LGMD) 2A (LG2A), LGMD2B (LG2B), Ullrich congenital muscular dystrophy (CMD) (UCMD), Fukuyama CMD (FCMD), congenital myopathy (CM), GNE myopathy (GNEM), dermatomyositis (DM), inclusion body myositis (IBM), immune-mediated necrotizing myopathy (IMNM), antisynthetase syndrome (ASS), and neuropathic disease (NP). All images to train CNNs were taken from slides with CCD cameras via light microscopes. A total of 4041 images were obtained from 1400 slides. The algorithm consists of two steps: 1) to differentiate between idiopathic inflammatory myopathy (IIM) and other conditions, and 2) to subclassify each category. For the first step, images of DM, IBM, IMNM, and ASS were combined to create the IIM group. Meanwhile, those of DYST, FCMD, LG2A, LG2B, UCMD, CM, GNEM, and NP were combined to create another group. At the second step, four subtypes of IIM were analyzed. The first step achieved 0.996 area under the curve (AUC). The accuracy of the CNN and the best pathologist of all were 96.9% and 93.8%, respectively, indicating the CNN outperformed muscle specialists. In the second step, the CNNs classified four subtypes (DM, IBM, IMNM, and ASS) with high AUCs: 0.953 (IMNM), 0.969 (IBM), 0.965 (DM), and 0.944 (ASS). The algorithm used only a few H&E images obtained by CCD, which does not need a huge financial investment. This system should be helpful in clinical settings especially in underserved regions, where experts are not easily available.

CONGENITAL MUSCULAR DYSTROPHIES: P.195 The efficacy of steroid therapy for patients with Fukuyama congenital muscular dystrophy

The hallmark of Fukuyama congenital muscular dystrophy (FCMD), the most common CMD in Japan, is cortical migration defects. Those who can sit on their own or slide on their buttocks are classified as having the typical form, and reportedly account for 75% of FCMD patients. Peak motor function was reportedly achieved at ages 2 to 8 years, and patients frequently become bed-ridden before age 15. Steroid therapy is now part of Duchenne muscular dystrophy care recommendations and is in widespread routine use.