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Distal myopathy with rimmed vacuoles is allelic to hereditary inclusion body myopathy

From the Department of Neuromuscular Research (Drs. Nishino, Noguchi, Driss, and Sugie and M. Murayama), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo; the Department of Neurology (Drs. Oya and Kawai), National Center Hospital for Mental, Nervous, and Muscular Disorders (Dr. Nonaka), NCNP; the Department of Neurology (Dr. Nishimiya), Kohnodai Hospital, NCNP, Kohnodai, Chiba; the Department of Neurology (Drs. Nagata and Chida), Iwate National Hospital, Iwate; the Department of Neurology (Dr. Takahashi), Nishitaga National Hospital, Sendai; the Department of Pediatrics (Dr. Takusa), Shimane Medical University, Shimane; Division of Neurology (Dr. Ohi), Department of Internal Medicine, Miyazaki Medical College, Miyazaki; Sunohara Medical Clinic (Dr. Sunohara), Kawasaki, Japan; Duke University Medical Center (Dr. Ciafaloni), Durham, NC; and Department of Neurology (Dr. Aoki), Tohoku University School of Medicine, Sendai, Japan

Address correspondence to Dr. Ichizo Nishino, Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, 187-8502 Japan; e-mail: nishino{at}ncnp.go.jp

Background: Distal myopathy with rimmed vacuoles (DMRV) is an autosomal-recessive disorder with preferential involvement of the tibialis anterior muscle that starts in young adulthood and spares quadriceps muscles. The disease locus has been mapped to chromosome 9p1-q1, the same region as the hereditary inclusion body myopathy (HIBM) locus. HIBM was originally described as rimmed vacuole myopathy sparing the quadriceps; therefore, the two diseases have been suspected to be allelic. Recently, HIBM was shown to be associated with the mutations in the gene encoding the bifunctional enzyme, UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase (GNE).

Objective: To determine whether DMRV and HIBM are allelic.

Methods: The GNE gene was sequenced in 34 patients with DMRV. The epimerase activity in lymphocytes from eight DMRV patients was also measured.

Results: The authors identified 27 unrelated DMRV patients with homozygous or compound-heterozygous mutations in the GNE gene. DMRV patients had markedly decreased epimerase activity.

Conclusions: DMRV is allelic to HIBM. Various mutations are associated with DMRV in Japan. The loss-of-function mutations in the GNE gene appear to cause DMRV/HIBM.

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