Phenotypic variability in a large Czech family with a dynamin 2-associated Charcot-Marie-Tooth neuropathy.

Mutations in the Dynamin 2 gene (DNM2) cause autosomal dominant centronuclear myopathy or autosomal dominant (AD) Charcot-Marie-Tooth (CMT) disease. Here the authors report one large Czech family with 15 members affected with an AD CMT phenotype of extraordinary variability. Genetic linkage analysis using SNP arrays revealed a locus of about 9.6 Mb on chromosome 19p13.1-13.2. In this critical interval, 373 genes were located. The only gene herein known to be associated with an intermediate type of CMT was Dynamin 2 (DNM2). Subsequent sequence analysis of the DNM2 gene in the index patient revealed a novel missense mutation p.Met580Thr. This missense mutation segregated with the neuropathy, indicating the causal character of this mutation. The phenotype of CMT in this family shows mild to moderate impairment with relatively preserved upper limbs and a very broad range of the onset of clinical symptoms from an early onset around the age of 12 to the late onset during the fifth decade. Electrophysiology showed an intermediate type of peripheral neuropathy. The motor median nerve conduction velocity varied from 36 m/s to normal values with signs of asymmetrical affection of peripheral nerves. No additional symptoms such as cranial nerve involvement, cataract, and signs of neutropenia or myopathy syndrome were observed in any member of the family yet. The progression was slow with no loss of ambulation. The authors suggest that the characterization of clinical variability in a single family may help to direct the genetic analysis directly to the rarely observed DNM2 mutations.

Hearing loss as the first feature of late-onset axonal CMT disease due to a novel P0 mutation.

A Czech family with three individuals carrying a novel mutation, 290 A-->T (Glu97Val), in the myelin protein zero gene (P0) is reported. The two eldest carriers developed progressive sensorineural hearing loss and abnormal pupillary reaction at age 18. These preceded the onset of the classic signs of Charcot-Marie-Tooth disease (CMT) by more than a decade. Sural nerve biopsy and nerve conduction studies were compatible with the axonal type of CMT. The authors show that progressive hearing loss can be the first symptom in P0 mutation carriers.

Transcriptional startpoints and methylation patterns in the PMP22 promoters of peripheral nerve, leukocytes and tumor cell lines.

PMP22 is a dosage sensitive gene responsible for Charcot-Marie-Tooth type 1A (CMT1A) neuropathy and hereditary neuropathy with liability to pressure palsies (HNPP). PMP22 is expressed in myelinating Schwann cells in the peripheral nerve, but also in a variety of other tissues. PMP22 expression is regulated by alternatively used promoters, the relative expression of the different PMP22 transcripts is tissue-specific. At first we analysed the transcriptional startpoints of the different PMP22 transcripts. Transcript 1A starts from a distinct nucleotide, whereas transcript 1B and the here described transcript 1C revealed multiple transcriptional startpoints in sciatic nerve as well as in the osteosarcoma and glioblastoma cell lines, RH30 and SF763. Using promoter specific primers we identified transcripts from each of the three promoters in sciatic nerve and RH30, whereas transcript 1B is absent in SF763. Leukocytes do not express PMP22 at all. Additionally, we determined the methylation pattern of CpG islands present in the PMP22 promoters 1B and 1C for leukocytes, sciatic nerve, SF763 and RH30, the latter carrying multiple copies of the PMP22 gene. We observed that there was no methylation in promoter 1B and 1C in sciatic nerve and leukocytes. However, hypermethylation of promoter 1B was discovered in SF763 and indicates a silencing effect. In RH30 most copies of promoters 1B and 1C were methylated but the few remaining hypomethylated copies were sufficient for strong expression of PMP22. These results indicate that the transcriptional control in tumor cell lines is probably different from leukocytes and sciatic nerve.