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Published on: July 14, 2016
Genotype modulators of clinical severity in McArdle disease
Juan C Rubio1, Félix Gómez-Gallego, Catalina Santiago
1Centro de Investigación, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain.
Abstract:
The phenotypic manifestation of McArdle disease varies considerably from one individual to the next. The purpose of this study was to assess the possible association between the clinical severity of the disease, and each of the genotypes PYGM (R50X), ACE (I/D), AMPD1 (Q12X), PPARGC1A (G482S) and ACTN3 (R577X). We also assessed links between clinical disease severity and other potential phenotype modulators such as age or gender. McArdle disease was diagnosed in 99 patients of Spanish origin (60 male, 39 female; age range 8-81 years) by identifying the two mutant alleles of the PYGM gene. Disease severity was assessed using the grading scheme previously reported by Martinuzzi et al. [A. Martinuzzi, E. Sartori, M. Fanin, et al., Phenotype modulators in myophosphorylase deficiency, Ann. Neurol. 53 (2003) 497-502]. Significant correlation was observed (exact two-sided P<0.0001) between the number of D alleles of the ACE gene and the disease severity score. Rank-order correlation coefficients were 0.296 (95% CI: 0.169, 0.423) (Kendall's tau) and 0.345 (95% CI: 0.204, 0.486) (Somer's D). No significant relationships were detected between clinical severity and the remaining genotypes examined. Finally, disease severity was significantly worse in women with the disease. Our findings indicate that both ACE genotype and gender contribute to how McArdle disease manifests in an individual patient. The role of other candidate genes remains to be elucidated.
Insights
McArdle disease severity varies. The ACE gene (I/D genotype) and female gender significantly correlate with worse clinical outcomes in patients with this rare genetic disorder.
Area of Science:
- Genetics
- Neurology
- Metabolic Disorders
Background:
- McArdle disease, a glycogen storage disease type V, presents with heterogeneous clinical phenotypes.
- Understanding factors influencing disease severity is crucial for patient management.
Purpose of the Study:
- To investigate the association between specific genotypes (PYGM, ACE, AMPD1, PPARGC1A, ACTN3) and clinical severity in McArdle disease.
- To explore the influence of age and gender on McArdle disease phenotype.
Main Methods:
- Genotyping of 99 Spanish patients diagnosed with McArdle disease.
- Assessment of disease severity using the Martinuzzi et al. grading scale.
- Statistical analysis including rank-order correlation for genotype-phenotype relationships.
Main Results:
- A significant positive correlation was found between the number of D alleles of the ACE gene and McArdle disease severity (P<0.0001).
- Disease severity was significantly worse in female patients compared to male patients.
- No significant associations were detected between clinical severity and PYGM, AMPD1, PPARGC1A, or ACTN3 genotypes.
Conclusions:
- The ACE (I/D) genotype and female gender are identified as significant modulators of clinical severity in McArdle disease.
- Further research is needed to elucidate the role of other candidate genes in disease manifestation.
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