title: Nonmuscle myosin heavy chain IIA mutations define a spectrum of autosomal dominant macrothrombocytopenias: May-Hegglin anomaly and Fechtner, Sebastian, Epstein, and Alport-like syndromes.
abstract: May-Hegglin anomaly (MHA) and Fechtner (FTNS) and Sebastian (SBS) syndromes are autosomal dominant platelet disorders that share macrothrombocytopenia and characteristic leukocyte inclusions. FTNS has the additional clinical features of nephritis, deafness, and cataracts. Previously, mutations in the nonmuscle myosin heavy chain 9 gene (MYH9), which encodes nonmuscle myosin heavy chain IIA (MYHIIA), were identified in all three disorders. The spectrum of mutations and the genotype-phenotype and structure-function relationships in a large cohort of affected individuals (n=27) has now been examined. Moreover, it is demonstrated that MYH9 mutations also result in two other FTNS-like macrothrombocytopenia syndromes: Epstein syndrome (EPS) and Alport syndrome with macrothrombocytopenia (APSM). In all five disorders, MYH9 mutations were identified in 20/27 (74%) affected individuals. Four mutations, R702C, D1424N, E1841K, and R1933X, were most frequent. R702C and R702H mutations were only associated with FTNS, EPS, or APSM, thus defining a region of MYHIIA critical in the combined pathogenesis of macrothrombocytopenia, nephritis, and deafness. The E1841K, D1424N, and R1933X coiled-coil domain mutations were common to both MHA and FTNS. Haplotype analysis using three novel microsatellite markers revealed that three E1841K carriers--one with MHA and two with FTNS--shared a common haplotype around the MYH9 gene, suggesting a common ancestor. The two new globular-head mutations, K371N and R702H, as well as the recently identified MYH9 mutation, R705H, which results in DFNA17, were modeled on the basis of X-ray crystallographic data. Altogether, our data suggest that MHA, SBS, FTNS, EPS, and APSM comprise a phenotypic spectrum of disorders, all caused by MYH9 mutations. On the basis of our genetic analyses, the name "MYHIIA syndrome" is proposed to encompass all of these disorders.
authors.affiliation: Department of Human Genetics, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Heath
authors.forename: A
authors.initials: A
authors.lastname: Campos-Barros
authors.forename: A
authors.initials: A
authors.lastname: Toren
authors.forename: G
authors.initials: G
authors.lastname: Rozenfeld-Granot
authors.forename: L E
authors.initials: LE
authors.lastname: Carlsson
authors.forename: J
authors.initials: J
authors.lastname: Savige
authors.forename: J C
authors.initials: JC
authors.lastname: Denison
authors.forename: M C
authors.initials: MC
authors.lastname: Gregory
authors.forename: J G
authors.initials: JG
authors.lastname: White
authors.forename: D F
authors.initials: DF
authors.lastname: Barker
authors.forename: A
authors.initials: A
authors.lastname: Greinacher
authors.forename: C J
authors.initials: CJ
authors.lastname: Epstein
authors.forename: M J
authors.initials: MJ
authors.lastname: Glucksman
authors.forename: J A
authors.initials: JA
authors.lastname: Martignetti
mesh_terms: D000595:Amino Acid Sequence; D002875:Chromosomes / Q000235:genetics; D004252:DNA Mutational Analysis; D019143:Evolution, Molecular; D005091:Exons / Q000235:genetics; D005799:Genes, Dominant / Q000235:genetics*; D006239:Haplotypes / Q000235:genetics; D006801:Humans; D018895:Microsatellite Repeats / Q000235:genetics; D008958:Models, Molecular; D020409:Molecular Motor Proteins; D008969:Molecular Sequence Data; D009154:Mutation / Q000235:genetics*; D018995:Myosin Heavy Chains / Q000737:chemistry / Q000235:genetics*; D009394:Nephritis, Hereditary / Q000235:genetics / Q000503:physiopathology; D024507:Nonmuscle Myosin Type IIA / Q000737:chemistry / Q000235:genetics*; D010641:Phenotype; D020161:Physical Chromosome Mapping; D011487:Protein Conformation; D016415:Sequence Alignment; D013329:Structure-Activity Relationship; D013577:Syndrome; D009626:Terminology as Topic; D013921:Thrombocytopenia / Q000235:genetics* / Q000503:physiopathology
chemical_list: C103814:MYH9 protein, human; D020409:Molecular Motor Proteins; D024507:Nonmuscle Myosin Type IIA; D018995:Myosin Heavy Chains