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LGMD (limb-girdle muscular dystrophy) and CMD (congenital muscular dystrophy) are two common forms of neuromuscular disorders which are distinguishable by their age of onset but with probably a similar underlying pathway. In the present study, we report immunohistochemical, Western-blot and genetic analyses in a large consanguineous Tunisian family with two branches, including seven patients sharing similar LGMD2 phenotype in one branch and one CMD patient in the other branch. Linkage analyses were compatible with the LGMD2A locus in one branch and the MDC1A (muscular dystrophy congenital type 1A) locus in the other branch. This result was supported by deficiency in merosin and calpain3 in the CMD patient and LGMD patients respectively. Mutation analysis revealed two distinct mutations: a c.8005delT frameshift deletion in exon 56 of the LAMA2 (laminin-α2) gene (MDC1A) was found in the CMD patient and a new homozygous mutation c.1536+1G>T in the donor splice site of intron 12 of the CAPN3 (calpain3) gene (LGMD2A) was found in the LGMD patients. RT-PCR (reverse transcription-PCR) performed on total RNA from a LGMD2A patient's muscle biopsy showed complete retention of intron 12 in CAPN3 cDNA, generating a PTC (premature termination codon) that potentially elicits degradation of the nonsense mRNA by NMD (nonsensemediated mRNA decay). Our results indicate that mRNA analysis is necessary to clarify the primary effect of genomic mutations on splicing efficiency that alters mRNA processing and expression level. [ABSTRACT FROM AUTHOR]

Rett syndrome is a severe disorder characterized by loss of acquired skills after a period of normal development in infant girls. It is caused mainly by mutations in the MECP2 gene. In this study, we reported mutations in the MECP2 gene in 7 Tunisian patients with classic Rett syndrome. The results showed the presence of a double mutation in 1 patient: p.R306C and c.1461+ 98insA, which create a new hypothetical polyadenylation site in the 3'UTR of the MECP2 gene. We also detected in another patient a new variant c.1461+ 92C>G in the 30UTR located previous to 34 bp from the polyadenylation site with a score of 4.085. This variation is located in a hypothetical splicing enhancer with a score of 1.96277 according to the ESE finder program. In the remaining 5 patients, we found 2 common mutations: p.T158M in 4 individuals and p.R168X in only 1 girl. [ABSTRACT FROM AUTHOR]

Congenital muscular dystrophies (CMDs) are a clinically and genetically heterogeneous group of neuromuscular disorders, with autosomal recessive inheritance. We report a patient with severe congenital muscular dystrophy and total deficiency in the laminin alpha2 chain. Genetic analyses showed a linkage to the MDC1A locus for the patient's family, and DNA sequencing revealed in the propositus of a new homozygous mutation in the donor splice site of intron 58 of the LAMA2 gene. RT-PCR experiments performed on total RNA from a patient's muscle biopsy showed a complete skipping of exon 58 in LAMA2 cDNA and a significant decrease in the LAMA2 mRNA level. This exon skipping altered the open reading frame of the mutant transcript and generated a premature termination codon (PTC) within exon 59, which potentially elicits the nonsense mRNA to degradation by NMD (nonsense-mediated mRNA decay). However, the residual exon 58-lacking mRNA could potentially be translated, and the resulting truncated alpha2 chain would lack its LG4 and LG5 domains that are involved in binding with alpha-dystroglycan. These results demonstrate the utility of mRNA analysis to understand the mutation primary impact and the disease phenotype in the patients.

Objective: To minimize the uncertainty in clinical diagnosis and improve the classification of 14 Tunisian patients belonging to 12 families and affected with congenital muscular dystrophy (CMD)., Methods: Fourteen patients belonging to 12 unrelated families originating from the south of Tunisia and affected with CMD were clinically examined between 1990 and 2001 in the neurology service of Chu Habib Bourguiba, Sfax, Tunisia. Immunohistochemical and western blot analyses were used to explore protein expression in muscular biopsies and homozygosity mapping using microsatellite markers for the genetic study. These analyses were performed in the human molecular genetics laboratory., Results: Among the patients tested with anti-merosin antibodies, 3 showed total laminin-a2 deficiency and the remaining patients showed partial laminin-a2 deficiency. All patients expressed normally a-sarcoglycan, b-dystroglycan and dystrophin except 2 showing reduction of expression in a-sarcoglycan and b-dystroglycan. Linkage analysis, performed for 8 families, was compatible with linkage to the LAMA2 gene for only 2., Conclusion: Our results showed that clinical and immunohistochemical analyses have allowed classification of only 3 patients, immunohistochemical and genotyping studies have contributed to the classification of 7 patients. In the remaining cases, there is no evident classification due to the lack of the genetic exploration. Our results also confirmed the broad spectrum of phenotypes associated with a defect in laminin-a2.