title: Extreme variability of phenotype in patients with an identical missense mutation in the lamin A/C gene: from congenital onset with severe phenotype to milder classic Emery-Dreifuss variant.
abstract: BACKGROUND
  Mutations of the LMNA gene, encoding the nuclear envelope proteins lamins A and C, have been associated with 7 distinct pathologic conditions.
  
  
  OBJECTIVE
  To report 5 cases with the same missense mutation in exon 6 of the LMNA gene, resulting in an E358K substitution in the central rod domain.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Three muscle centers in England.
  
  
  METHODS
  Five patients with missense mutations of the LMNA gene.
  
  
  RESULTS
  All 5 individuals had muscle involvement, but the onset, severity, distribution of muscle weakness, and presence of associated features were highly variable. Three patients had humeroperoneal distribution of weakness and typical features of Emery-Dreifuss muscular dystrophy. Two other patients showed additional novel features. One had congenital onset and predominant axial weakness, with poor neck control and inability to sit independently at the age of 21 months. Another patient presented in childhood with an unusual pattern of muscle weakness, short stature, and midface hypoplasia with striking fat accumulation around the face and neck, in contrast to wasting of adipose tissue and muscle in the limbs. She developed both respiratory failure and cardiac arrhythmias in her late 20s.
  
  
  CONCLUSIONS
  Our cases expand the clinical spectrum associated with mutations in the LMNA gene and further illustrate the overlapping phenotypes of the laminopathies.
authors.affiliation: Dubowitz Neuromuscular Centre, Hammersmith Hospital Imperial College, London, England. e.mercuri@ic.ac.uk
authors.forename: Eugenio
authors.initials: E
authors.lastname: Mercuri
authors.forename: Maja
authors.initials: M
authors.lastname: Poppe
authors.forename: Ros
authors.initials: R
authors.lastname: Quinlivan
authors.forename: Sonia
authors.initials: S
authors.lastname: Messina
authors.forename: Maria
authors.initials: M
authors.lastname: Kinali
authors.forename: Laurence
authors.initials: L
authors.lastname: Demay
authors.forename: John
authors.initials: J
authors.lastname: Bourke
authors.forename: Pascale
authors.initials: P
authors.lastname: Richard
authors.forename: Caroline
authors.initials: C
authors.lastname: Sewry
authors.forename: Mike
authors.initials: M
authors.lastname: Pike
authors.forename: Gisèle
authors.initials: G
authors.lastname: Bonne
authors.forename: Francesco
authors.initials: F
authors.lastname: Muntoni
authors.forename: Kate
authors.initials: K
authors.lastname: Bushby
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D034904:Lamin Type A / Q000235:genetics*; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D009136:Muscular Dystrophies / Q000235:genetics* / Q000503:physiopathology*; D020125:Mutation, Missense; D010641:Phenotype; D016133:Polymerase Chain Reaction
chemical_list: D034904:Lamin Type A; C440308:lamin C