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      Identification of a GNE homozygous mutation in a Han‐Chinese family with GNE myopathy

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          Abstract

          GNE myopathy is a rare, recessively inherited, early adult‐onset myopathy, characterized by distal and proximal muscle degeneration which often spares the quadriceps. It is caused by mutations in the UDP‐N‐acetylglucosamine 2‐epimerase/N‐acetylmannosamine kinase gene ( GNE ). This study aimed to identify the disease‐causing mutation in a three‐generation Han‐Chinese family with members who have been diagnosed with myopathy. A homozygous missense mutation, c.1627G>A (p.V543M) in the GNE gene co‐segregates with the myopathy present in this family. A GNE myopathy diagnosis is evidenced by characteristic clinical manifestations, rimmed vacuoles in muscle biopsies and the presence of biallelic GNE mutations. This finding broadens the GNE gene mutation spectrum and extends the GNE myopathy phenotype spectrum.

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          Most cited references31

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          The UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase gene is mutated in recessive hereditary inclusion body myopathy.

          Hereditary inclusion body myopathy (HIBM; OMIM 600737) is a unique group of neuromuscular disorders characterized by adult onset, slowly progressive distal and proximal weakness and a typical muscle pathology including rimmed vacuoles and filamentous inclusions. The autosomal recessive form described in Jews of Persian descent is the HIBM prototype. This myopathy affects mainly leg muscles, but with an unusual distribution that spares the quadriceps. This particular pattern of weakness distribution, termed quadriceps-sparing myopathy (QSM), was later found in Jews originating from other Middle Eastern countries as well as in non-Jews. We previously localized the gene causing HIBM in Middle Eastern Jews on chromosome 9p12-13 (ref. 5) within a genomic interval of about 700 kb (ref. 6). Haplotype analysis around the HIBM gene region of 104 affected people from 47 Middle Eastern families indicates one unique ancestral founder chromosome in this community. By contrast, single non-Jewish families from India, Georgia (USA) and the Bahamas, with QSM and linkage to the same 9p12-13 region, show three distinct haplotypes. After excluding other potential candidate genes, we eventually identified mutations in the UDP-N-acetylglucosamine-2-epimerase/N-acetylmannosamine kinase (GNE) gene in the HIBM families: all patients from Middle Eastern descent shared a single homozygous missense mutation, whereas distinct compound heterozygotes were identified in affected individuals of families of other ethnic origins. Our findings indicate that GNE is the gene responsible for recessive HIBM.
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            Sialylation is essential for early development in mice.

            Sialic acids are widely expressed as terminal carbohydrates on glycoconjugates of eukaryotic cells. Sialylation is crucial for a variety of cellular functions, such as cell adhesion or signal recognition, and regulates the biological stability of glycoproteins. The key enzyme of sialic acid biosynthesis is the bifunctional UDP-N-acetylglucosamine-2-epimerase/N-acetylmannosamine kinase (UDP-GlcNAc 2-epimerase), which catalyzes the first two steps of sialic acid biosynthesis in the cytosol. We report that inactivation of the UDP-GlcNAc 2-epimerase by gene targeting causes early embryonic lethality in mice, thereby emphasizing the fundamental role of this bifunctional enzyme and sialylation during development. The need of UDP-GlcNAc 2-epimerase for a defined sialylation process is exemplified with the polysialylation of the neural cell adhesion molecule in embryonic stem cells.
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              Prophylactic treatment with sialic acid metabolites precludes the development of the myopathic phenotype in the DMRV-hIBM mouse model.

              Distal myopathy with rimmed vacuoles (DMRV)-hereditary inclusion body myopathy (hIBM) is an adult-onset, moderately progressive autosomal recessive myopathy; eventually, affected individuals become wheelchair bound1. It is characterized clinically by skeletal muscle atrophy and weakness, and pathologically by rimmed vacuoles, which are actually accumulations of autophagic vacuoles2, 3, 4, scattered angular fibers and intracellular accumulation of amyloid and other proteins5. To date, no therapy is available for this debilitating myopathy, primarily because the disease pathomechanism has been enigmatic. It is known that the disease gene underlying DMRV-hIBM is GNE, encoding glucosamine (UDP-N-acetyl)-2-epimerase and N-acetylmannosamine kinase6, 7, 8--two essential enzymes in sialic acid biosynthesis9. It is still unclear, however, whether decreased sialic acid production causes muscle degeneration, as GNE has been proposed to have roles other than for sialic acid biosynthesis10, 11, 12. By showing that muscle atrophy and weakness are completely prevented in a mouse model of DMRV-hIBM after treatment with sialic acid metabolites orally, we provide evidence that hyposialylation is indeed one of the key factors in the pathomechanism of DMRV-hIBM. These results support the notion that DMRV-hIBM can potentially be treated simply by giving sialic acids, a strategy that could be applied in clinical trials in the near future.
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                Author and article information

                Contributors
                hdeng008@yahoo.com
                Journal
                J Cell Mol Med
                J. Cell. Mol. Med
                10.1111/(ISSN)1582-4934
                JCMM
                Journal of Cellular and Molecular Medicine
                John Wiley and Sons Inc. (Hoboken )
                1582-1838
                1582-4934
                29 August 2018
                November 2018
                : 22
                : 11 ( doiID: 10.1111/jcmm.2018.22.issue-11 )
                : 5533-5538
                Affiliations
                [ 1 ] Center for Experimental Medicine The Third Xiangya Hospital Central South University Changsha China
                [ 2 ] Department of Clinical Laboratory The Third Xiangya Hospital Central South University Changsha China
                [ 3 ] Department of Medical Information Information Security and Big Data Research Institute Central South University Changsha China
                [ 4 ] Department of Orthopedics The Third Xiangya Hospital Central South University Changsha China
                [ 5 ] Department of Neurology The Third Xiangya Hospital Central South University Changsha China
                [ 6 ] Department of Radiology The Third Xiangya Hospital Central South University Changsha China
                Author notes
                [*] [* ] Correspondence: Hao Deng, Center for Experimental Medicine, The Third Xiangya Hospital, Central South University, Changsha, China ( hdeng008@ 123456yahoo.com ).

                Wu and Yuan equally contributed to this study.

                Author information
                http://orcid.org/0000-0003-3240-4352
                Article
                JCMM13827
                10.1111/jcmm.13827
                6201217
                30160005
                36b97d38-17a4-4264-9489-10a8d6a59686
                © 2018 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 December 2017
                : 09 July 2018
                Page count
                Figures: 3, Tables: 2, Pages: 6, Words: 3562
                Funding
                Funded by: Natural Science Foundation of Hunan Province
                Award ID: 2015JJ4088, 2016JJ2166 and 2017JJ3469
                Funded by: National Natural Science Foundation of China
                Award ID: 8167021
                Funded by: The New Xiangya Talent Project of the Third Xiangya Hospital of Central South University
                Award ID: 20150301
                Funded by: Grant for the Foster Key Subject of the Third Xiangya Hospital of Central South University
                Funded by: National Key Research and Development Program of China
                Award ID: 2016YFC1306604
                Funded by: National‐level College Students’ Free Exploration Program
                Award ID: 201810533389
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                jcmm13827
                November 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.1 mode:remove_FC converted:25.10.2018

                Molecular medicine
                gne myopathy,homozygous,missense mutation,the gne gene
                Molecular medicine
                gne myopathy, homozygous, missense mutation, the gne gene

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