title: Genotype-phenotype correlations in a large series of patients with muscle type CPT II deficiency.
abstract: OBJECTIVE
  The adult or 'muscular' form of carnitine-palmitoyl-transferase II (CPT II) deficiency presents with recurrent rhabdomyolytic episodes and myoglobinuria, usually triggered by prolonged exercise. The aim of this study was to investigate a large series of patients in order to provide genotype-phenotype correlations.
  
  
  METHODS
  Our muscle tissue bank was surveyed for patients showing attacks of rhabdomyolysis with myoglobinuria. After exclusion of cases affected with toxic myoglobinuria, McArdle's disease and Becker muscular dystrophy, over 100 patients were selected for isotope-exchange radioenzymatic assay of CPT enzyme activity in muscle, and 25 cases resulted to be defective. Acylcarnitine profile was performed in five patients using tandem mass spectrometry. Mutations in the CPT2 gene were identified using DNA sequencing.
  
  
  RESULTS
  Although the clinical features were rather homogeneous, some patients presented life-threatening events (acute renal failure) and muscle weakness, and low levels of residual CPT activity. The typical acylcarnitine profile found in mutant patients confirmed its value as a screening method for further diagnostic investigations. We found a high frequency of the common p.Ser113Leu mutation, the recurrence of the rare p.Arg631Cys mutation in a genetic isolate in Southern Italy, and identified four novel mutations. In some affected patients only one mutant allele was found, suggesting either incomplete mutation detection or the possibility they are symptomatic carriers.
  
  
  CONCLUSIONS
  Null mutations and homozygous mutations were frequently associated with a more severe phenotype and biochemical defect. The identification of symptomatic obligate heterozygous carriers might suggest that additional epigenetic or environmental factors may contribute to determine the phenotype.
authors.affiliation: Department of Neurosciences, University of Padova, Venetian Institute of Molecular Medicine, Padova, Italy.
authors.forename: Angelica
authors.initials: A
authors.lastname: Anichini
authors.forename: Marina
authors.initials: M
authors.lastname: Fanin
authors.forename: Christine
authors.initials: C
authors.lastname: Vianey-Saban
authors.forename: Denise
authors.initials: D
authors.lastname: Cassandrini
authors.forename: Chiara
authors.initials: C
authors.lastname: Fiorillo
authors.forename: Claudio
authors.initials: C
authors.lastname: Bruno
authors.forename: Corrado
authors.initials: C
authors.lastname: Angelini
mesh_terms: D000293:Adolescent; D000328:Adult; D002331:Carnitine / Q000031:analogs & derivatives* / Q000097:blood; D002334:Carnitine O-Palmitoyltransferase / Q000097:blood / Q000172:deficiency / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D005260:Female; D056726:Genetic Association Studies; D006801:Humans; D008297:Male; D008661:Metabolism, Inborn Errors / Q000097:blood / Q000235:genetics / Q000473:pathology; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000201:enzymology / Q000473:pathology; D009154:Mutation
chemical_list: C116917:acylcarnitine; D002334:Carnitine O-Palmitoyltransferase; D002331:Carnitine