Dominant Mutation of CCDC78 in a Unique Congenital Myopathy with Prominent Internal Nuclei and Atypical Cores  Karen Majczenko, Ann E. Davidson, Sandra.

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Dominant Mutation of CCDC78 in a Unique Congenital Myopathy with Prominent Internal Nuclei and Atypical Cores  Karen Majczenko, Ann E. Davidson, Sandra Camelo-Piragua, Pankaj B. Agrawal, Richard A. Manfready, Xingli Li, Sucheta Joshi, Jishu Xu, Weiping Peng, Alan H. Beggs, Jun Z. Li, Margit Burmeister, James J. Dowling  The American Journal of Human Genetics  Volume 91, Issue 2, Pages 365-371 (August 2012) DOI: 10.1016/j.ajhg.2012.06.012 Copyright © 2012 The American Society of Human Genetics Terms and Conditions

Figure 1 Histopathological Features of a Unique Centronuclear Myopathy with Cores (A) and (B) Hematoxylin and eosin staining highlights mild variation in fiber size (B is a higher magnification). A significant number of fibers have central nuclei (30%). (C) Trichrome shows fibers with irregular central staining (∗). (D) Toluidine blue highlights the marked (>90%) type 1 (dark blue) predominance. (E) and (F) Succinate dehydrogenase (SDH) (E) and combined SDH and cytochrome oxidase (F) reveal type 1 fibers with areas of central pallor. (G) and (H) Positive abnormal immunoreactivity for actin (G) and desmin (H). (I)–(L) Electron microscopy (EM) shows fibers with disorganized sarcomeric architecture (I–L), Z-band streaming (K), and a relative absence of mitochondria within the lesions, with increased accumulation of mitochondria at the periphery (L). Scale bars for EM = 2 μm. The American Journal of Human Genetics 2012 91, 365-371DOI: (10.1016/j.ajhg.2012.06.012) Copyright © 2012 The American Society of Human Genetics Terms and Conditions

Figure 2 CCDC78 Mutation in a Family with Autosomal-Dominant Centronuclear Myopathy (A) Pedigree of a family with autosomal-dominant centronuclear myopathy with cores. The index case is indicated with an arrow. Ten individuals (indicated by ∗), including five affected individuals, were clinically evaluated and were part of the linkage analysis. (B) SNP linkage plot showing LOD scores for chromosome 16. (C) Chromatograph from whole-exome sequencing of the index case indicating a heterozygous C>T change at c.68-1 of CCDC78. The sequence is in reverse orientation and is thus a G>A change in the canonical splice-acceptor sequence for intron 1. (D) RT-PCR from lymphoblastoid-cell-derived RNA with the use of CCDC78 exon 1–3-spanning primers. RNA from affected individuals (PT) reveals the presence of a higher molecular weight band (∗∗) that is barely detectable in RNA from unaffected relatives (CTL). (E) Sequencing of the upper (∗∗, top chromatogram) and lower (∗, bottom chromatogram) bands revealed that the upper band contains the entire sequence of intron 1. The reference sequence is listed (in black) below each chromatogram, and confirms that the upper band has intron 1 sequence contiguous with exon 2 sequence. The mutation is detected in the upper band of patient samples only (arrow). (F) Schematic of the exon-intron structure of the first three exons of CCDC78. Control individuals have normal processing of these exons, while affected individuals with the CCDC78 mutation have RNA products that do not remove intron 1. The American Journal of Human Genetics 2012 91, 365-371DOI: (10.1016/j.ajhg.2012.06.012) Copyright © 2012 The American Society of Human Genetics Terms and Conditions

Figure 3 Immunolocalization of CCDC78 in Normal and Patient Skeletal Muscle Immunofluorescent analysis of anti-CCDC78 (red) and anti-RyR1 (green) on control (upper panels) and patient (lower panels) skeletal-muscle cryosections. Upper panels (row A): CCDC78 is found localized to the sarcolemmal membrane (arrowheads) and the perinuclear region (∗∗), as well as in a latticework-type pattern within the sarcoplasm (arrow). Costaining with RyR1 reveals that the latticework pattern corresponds to the triad (arrow), which is the intersection of the terminal sarcoplasmic reticulum and the T-tubule. Lower panels (row B): Immunostaining on patient muscle reveals aggregates of both CCDC78 and RyR1 within the sarcoplasm (arrows). The American Journal of Human Genetics 2012 91, 365-371DOI: (10.1016/j.ajhg.2012.06.012) Copyright © 2012 The American Society of Human Genetics Terms and Conditions

Figure 4 Morpholino-Mediated Alteration of ccdc78 Intron 1 Splicing Results in Morphological, Behavioral, and Structural Abnormalities (A) RT-PCR on RNA from 3 dpf zebrafish injected with either control morpholino (CTL) or increasing concentrations of ccdc78 morpholino (in mM). RT-PCR with primers from exons 1–3 of ccdc78 demonstrate that the morpholino inhibits proper splicing of intron 1/exon 2. The most prominent change is the presence of a higher molecular band that was confirmed to contain exons 1–3 and all of intron 1 (arrow). RT-PCR with actin primers was done for verification of RNA integrity. (B) ccdc78 morphants are morphologically abnormal, having bent backs and foreshortened tails. (C) ccdc78 morphants had abnormal motor behavior. Depicted is a graph of the touch-evoked escape response (see also Movies S1 and S2). A total of 73.1% ± 3.9% of ccdc78 morphants (as opposed to 10.3% ± 3.5% of control morphants) had an abnormal touch-evoked escape response (n = 9 independently injected clutches, and a minimum of 20 embryos were assessed per clutch). MO, morpholino. (D) Immunostaining was performed on isolated myofibers from 3 dpf control (CTL) and ccdc78 morphants. Left panels show anti-CCDC78 staining. CTL morpholino (MO) myofibers had a staining pattern similar to that seen in human skeletal muscle, with localization to the membrane and the perinuclear region (nuclei in blue), as well as more faintly to the triad. ccdc78 MO myofibers had aberrantly aggregated clusters of CCDC78 (arrowheads). Right panels show anti-RyR1 staining. CTL MO myofibers had a normal pattern of staining, whereas ccdc78 MO myofibers had disorganized areas of RyR1 staining that included small aggregates (arrow). (E) Electron-microscopic analysis of 3 dpf morphant zebrafish. As compared to control muscle fibers (CTL MO, left panel), muscle from ccdc78 morphants had dilated terminal sarcoplasmic reticulum (boxes, middle panel). In addition, whirls of redundant membranes (arrow) and areas of dilated and swollen sarcoplasmic reticulum (∗∗) were frequently seen throughout the skeletal muscle of ccdc78 morphants and were never observed in controls (n = 3 embryos examined). Scale bar for left and center panels: 500 nm. Scale bar for right panel: 2 μm. The American Journal of Human Genetics 2012 91, 365-371DOI: (10.1016/j.ajhg.2012.06.012) Copyright © 2012 The American Society of Human Genetics Terms and Conditions