Abstract
Duchenne and Becker muscular dystrophy (DMD and BMD, respectively) are allelic disorders with different clinical presentations and severity determined by mutations in the gene DMD, which encodes the sarcolemmal protein dystrophin. Diagnosis is based on clinical aspects and muscle protein analysis, followed by molecular confirmation. We revised the main aspects of the natural history of dystrophinopathies to define genotype–phenotype correlations in large patient cohorts with extended follow-up. We also specifically explored subjects carrying nucleotide substitutions in the DMD gene, a comparatively less investigated DMD/BMD subgroup. We studied 320 dystrophinopathic patients (205 DMD and 115 BMD), defining muscular, cardiac, respiratory, and cognitive involvement. We also subdivided patients according to the kind of molecular defect (deletions, duplications, nucleotide substitutions or other microrearrangements) and the mutation sites (proximal/distal to exon 45), studying phenotype–genotype correlations for each group. In DMD, mutation type did not influence clinical evolution; mutations located in distal regions (irrespective of their nature) are more likely to be associated with lower IQ levels (p = 0.005). BMD carrying proximal deletions showed a higher degree of cardiac impairment than BMD with distal deletions (p = 0.0046). In the BMD population, there was a strong correlation between the entity of muscle dystrophin deficiency and clinical course (p = 0.002). An accurate knowledge of natural history may help in the clinical management of patients. Furthermore, several clinical trials are ongoing or are currently planned, some of which aim to target specific DMD mutations: a robust natural history is therefore essential to correctly design these experimental trials.
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Acknowledgments
We wish to thank the patients and their families for their support and collaboration. This research received funding support from Telethon—UILDM Grant GUP07009 (GPC). Telethon Genetic Biobanks Network GTB07001E was the source of the DNA used in this study. Eurobiobank project QLTR-2001-02769 is also gratefully acknowledged. Telethon North Star.
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Magri, F., Govoni, A., D’Angelo, M.G. et al. Genotype and phenotype characterization in a large dystrophinopathic cohort with extended follow-up. J Neurol 258, 1610–1623 (2011). https://doi.org/10.1007/s00415-011-5979-z
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DOI: https://doi.org/10.1007/s00415-011-5979-z