LGMD1D myopathy with cytoplasmic and nuclear inclusions in a Saudi family due to DNAJB6 mutation

Saeed A. Bohlega 1, Sarah Alfawaz 1, Hussam Abou-Al-Shaar 2, Hindi N. Al-Hindi 3, Hatem N. Murad 1, Mohamed S. Bohlega 1, Brian F. Meyer 4 5 and Dorota Monies 4 5

1 Division of Neurology, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 2 Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York, USA; 3 Department of Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 4 Department of Genetics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 5 Saudi Human Genome Program, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia

Autosomal dominant LGMD1D has been described in multiple families in Asia, Europe, and USA. However, to the best of our knowledge, no cases of LGMD1D have been reported among native Bedouin Saudi families. Fifty Saudi families with LGMD were analyzed and the causative underlying genes were studied utilizing genome wide linkage, homozygosity mapping, and neurological gene panel. We identified one family of a Bedouin origin with LGMD1D. Two patients had progressive proximal and distal weakness, dysphagia, and respiratory symptoms. Creatinine kinase was normal. Muscle biopsy showed marked variation in myofibers size with scattered angular atrophic fiber, necrotic fibers, and myophagocytosis, with red-rimmed vacuoles depicting a sarcoplasmic body. Heterozygous c.C287T (p.P96L) variant in exon 5 of DNAJB6 (NM_005494) gene was found. This change is localized within glycine and phenylalanine rich domain and alter an amino acid residue. Our findings will expand on the existing genotypic and phenotypic spectrum of this disorder and aid in elucidating hidden mechanisms implicated in LGMD1D. 

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