title: Congenital myasthenic syndrome caused by low-expressor fast-channel AChR delta subunit mutation.
abstract: OBJECTIVE
  To determine the molecular basis of a disabling congenital myasthenic syndrome (CMS) observed in two related and one unrelated Arab kinship.
  
  
  BACKGROUND
  CMS can arise from defects in presynaptic, synaptic basal lamina-associated, or postsynaptic proteins. Most CMS are postsynaptic, and most reside in the AChR epsilon subunit; only two mutations have been reported in the AChR delta subunit to date.
  
  
  METHODS
  Cytochemistry, electron microscopy, alpha-bungarotoxin binding studies, microelectrode and patch-clamp recordings, mutation analysis, mutagenesis, and expression studies in human embryonic kidney cells were employed.
  
  
  RESULTS
  Endplate studies showed AChR deficiency, fast decaying, low-amplitude endplate currents, and abnormally brief channel opening events. Mutation analysis revealed a novel homozygous missense mutation (deltaP250Q) of the penultimate proline in the first transmembrane domain (TMD1) of the AChR delta subunit. Expression studies indicate that deltaP250Q (1) hinders delta/alpha subunit association during early AChR assembly; (2) hinders opening of the doubly occupied closed receptor (A(2)R); and (3) speeds the dissociation of acetylcholine from A(2)R. Mutagenesis studies indicate that deltaP250L also has fast-channel effects, whereas epsilon P245L and epsilon P245Q, identical mutations of the corresponding proline in the epsilon subunit, have mild slow-channel effects.
  
  
  CONCLUSIONS
  deltaP250Q represents the third mutation observed in the AChR delta subunit. The severe phenotype caused by deltaP250Q is attributed to endplate AChR deficiency, fast decay of the synaptic response, and lack of compensatory factors. That the penultimate prolines in TMD1 of the delta and epsilon subunits exert a reciprocal regulatory effect on the length of the channel opening bursts reveals an unexpected functional asymmetry between the two subunits.
authors.affiliation: Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: X-M
authors.initials: XM
authors.lastname: Shen
authors.forename: K
authors.initials: K
authors.lastname: Ohno
authors.forename: T
authors.initials: T
authors.lastname: Fukudome
authors.forename: A
authors.initials: A
authors.lastname: Tsujino
authors.forename: J M
authors.initials: JM
authors.lastname: Brengman
authors.forename: D C
authors.initials: DC
authors.lastname: De Vivo
authors.forename: R J
authors.initials: RJ
authors.lastname: Packer
authors.forename: A G
authors.initials: AG
authors.lastname: Engel
mesh_terms: D000109:Acetylcholine / Q000378:metabolism; D000110:Acetylcholinesterase / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000595:Amino Acid Sequence; D019943:Amino Acid Substitution / Q000235:genetics; D002038:Bungarotoxins / Q000378:metabolism; D002460:Cell Line; D002648:Child; D004252:DNA Mutational Analysis; D004594:Electrophysiology; D005260:Female; D006801:Humans; D007700:Kinetics; D008297:Male; D008564:Membrane Potentials / Q000502:physiology; D008969:Molecular Sequence Data; D009045:Motor Endplate / Q000473:pathology / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D020125:Mutation, Missense / Q000235:genetics; D020294:Myasthenic Syndromes, Congenital / Q000235:genetics* / Q000378:metabolism; D018408:Patch-Clamp Techniques; D011392:Proline / Q000378:metabolism; D011950:Receptors, Cholinergic / Q000235:genetics* / Q000378:metabolism
chemical_list: D002038:Bungarotoxins; D011950:Receptors, Cholinergic; D011392:Proline; D000110:Acetylcholinesterase; D000109:Acetylcholine