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Published on: August 15, 2019
Interfamilial phenotypic heterogeneity in SMARD1
S Joseph1, S A Robb, S Mohammed
1Department of Neurology, Evelina Children's Hospital, Lambeth Palace Road, London SE1 7EH, UK. sonia.joseph@luht.scot.nhs.uk
Insights
Spinal muscular atrophy with respiratory distress (SMARD1) shows varied symptoms even with the same genetic mutation. This suggests other factors influence the disease, impacting its presentation and progression.
Area of Science:
- Genetics
- Neurology
- Pediatrics
Background:
- Spinal muscular atrophy with respiratory distress (SMARD1) is a severe genetic disorder.
- It is caused by mutations in the IGHMBP2 gene.
- SMARD1 typically presents before 13 months with respiratory failure and limb weakness.
Observation:
- This case report details two siblings with identical SMARD1 mutations.
- One sibling experienced fatal respiratory failure at 6 months.
- The other sibling, aged 12, exhibits limb weakness and mild sleep hypoventilation.
Findings:
- The identical genetic mutation resulted in significantly different clinical outcomes.
- Phenotype variability in SMARD1 is more pronounced than previously understood.
- This suggests the influence of modifying genes or environmental factors.
Implications:
- SMARD1 should be considered in atypical spinal muscular atrophy cases, even without clear diaphragmatic weakness.
- Understanding phenotype variability can improve diagnostic approaches and patient management.
- Further research into compensatory mechanisms in SMARD1 is warranted.
Abstract:
Spinal muscular atrophy with respiratory distress (SMARD1: mu-binding protein 2 gene mutation) is characterised by low birth weight, progressive distal limb weakness, diaphragmatic paralysis and subsequent respiratory failure manifesting before 13 months of age. Our case report illustrates marked phenotype variability in two siblings with an identical genetic mutation of SMARD1, one of whom died of fulminant respiratory failure aged 6 months, whereas the other shows limb weakness but, only mild sleep hypoventilation aged 12 years. This suggests other compensatory mechanisms may play a role in modifying SMARD1; broadening our perception of phenotype. Therefore, SMARD1 phenotype should be considered in cases of atypical spinal muscular atrophy even in the absence of overt diaphragmatic weakness.
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