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Rhabdomyolysis and fluctuating asymptomatic hyperCKemia associated with CACNA1S variant
C Anandan1, M A Cipriani2, R S Laughlin1
1Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Insights
A novel CACNA1S gene variant caused a muscle disorder with rhabdomyolysis and core-like structures, highlighting the link between CACNA1S and RYR1 related myopathies.
Area of Science:
- Muscle physiology and genetics
- Neuromuscular disorders
- Calcium channel function
Background:
- CACNA1S encodes Cav 1.1, crucial for muscle excitation-contraction coupling.
- Mutations in CACNA1S and RYR1 are linked to various myopathies, including malignant hyperthermia and congenital myopathy.
- RYR1 mutations also cause rhabdomyolysis.
Background And Purpose:
CACNA1S encodes Cav 1.1, a voltage sensor for muscle excitation-contraction coupling, which activates the ryanodine receptor 1 (RYR1) leading to calcium release from the sarcoplasmic reticulum. CACNA1S mutations cause hypokalemic periodic paralysis, malignant hyperthermia and congenital myopathy. RYR1 mutations result in congenital myopathy, malignant hyperthermia and rhabdomyolysis.
Methods:
The aim was to describe a novel phenotype associated with a CACNA1S variant at a site previously linked to hypokalemic periodic paralysis.
Results:
The patient presented with fluctuating asymptomatic creatine kinase elevation after an episode of rhabdomyolysis but has no history of periodic paralysis. His muscle biopsy showed core-like structures occurring mainly in type 2 fibers. He carries a novel Cav 1.1 variant (p.Arg528Leu) affecting a highly conserved amino acid. Different mutations at the same location cause hypokalemic periodic paralysis.
Conclusion:
This case underscores the similarity between the phenotypes caused by mutations in two functionally linked proteins, RYR1 and Cav 1.1.
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