Biljana Ilkovski, Sandra T. Cooper, Kristen Nowak, Monique M

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Nemaline Myopathy Caused by Mutations in the Muscle α-Skeletal-Actin Gene Biljana Ilkovski, Sandra T. Cooper, Kristen Nowak, Monique M. Ryan, Nan Yang, Christina Schnell, Hayley J. Durling, Laurence G. Roddick, Ian Wilkinson, Andrew J. Kornberg, Kevin J. Collins, Geoff Wallace, Peter Gunning, Edna C. Hardeman, Nigel G. Laing, Kathryn N. North The American Journal of Human Genetics Volume 68, Issue 6, Pages 1333-1343 (June 2001) DOI: 10.1086/320605 Copyright © 2001 The American Society of Human Genetics Terms and Conditions

Figure 1 Position of mutated residues in α-skeletal actin. Five different missense mutations were identified in seven patients with NM. These mutations' respective locations within the actin molecule are represented by a schematic model of the three-dimensional structure of actin (Kabsch et al. 1990, p. 37 [reprinted by permission from Nature]). Patient 1 (I357L) (orange) shows lethal severe congenital; patient 2 (R183G) (pink), lethal severe congenital; patient 3 (G268C) (yellow), childhood onset; patient 4 (I136M) (blue), typical congenital. Also represented is the autosomal dominant family (N115S) (purple). The American Journal of Human Genetics 2001 68, 1333-1343DOI: (10.1086/320605) Copyright © 2001 The American Society of Human Genetics Terms and Conditions

Figure 2 Comparison of muscle α-skeletal-actin protein sequences in various species and in the five mutated residues in the patients. All mutated residues in α-skeletal actin are highly conserved across the species shown. An asterisk (*) denotes conserved amino acid, and a dash (–) denotes a deleted amino acid. The amino acid numbering nomenclature corresponds to that of the human muscle α-skeletal-actin protein sequence. The American Journal of Human Genetics 2001 68, 1333-1343DOI: (10.1086/320605) Copyright © 2001 The American Society of Human Genetics Terms and Conditions

Figure 3 Gomori trichrome staining of muscle-biopsy sections. Gomori trichrome treatment results in deep-purple staining of nemaline bodies (indicated by arrows), which were observed in muscle-biopsy sections from all patients. Stained sections are shown for patients 1 (severe congenital [a]), 2 (severe congenital [b]), and 6 (childhood onset [c]). The American Journal of Human Genetics 2001 68, 1333-1343DOI: (10.1086/320605) Copyright © 2001 The American Society of Human Genetics Terms and Conditions

Figure 4 EM of muscle samples from patients 1 (severe congenital NM [a and b]) and 6 (childhood onset NM [c and d]). Nemaline bodies are present in all patients and are associated with disruption of the sarcomeric register. Rods appear either as extensions of sarcomeric Z-lines, in random array without obvious attachment to Z-lines (often in areas devoid of sarcomeres) or in large clusters localized at the sarcolemma or intermyofibrillar spaces (d). Glycogen accumulation (long arrow in panel a) and an increase in intermyofibrillar spaces (arrow in panel d) are common. Additional features include intranuclear rods (short arrow in panel a) and dramatically atrophied fibers (arrow in panel b) in patient 1, as well as whorling of thin filaments in patient 6 (arrow in panel c). The American Journal of Human Genetics 2001 68, 1333-1343DOI: (10.1086/320605) Copyright © 2001 The American Society of Human Genetics Terms and Conditions

Figure 5 α-Actinin 2, sarcomeric-actin, and phalloidin staining of muscle-biopsy sections from patients 1 and 6. Immunolabeling with α-actinin 2 both demonstrated intense positive staining of Z-lines in all the patients and intensely stained the rods (arrowheads in panels e and i). Muscle sections labeled with a sarcomeric-actin antibody reveal a meshlike honeycomb staining pattern in the control (b) and in mildly affected patients (as shown for patient 6, in panel j). The two severely affected patients showed abnormal localization of actin, with large areas devoid of staining (as shown for patient 1, in panel f). Double labeling with α-actinin 2 and α-skeletal actin (g) demonstrated that areas devoid of sarcomeric actin in patients 1 and 2 contained α-actinin 2–reactive striations. Unlike the sarcomeric-actin antibody, phalloidin demonstrated a striated staining pattern and intensely stained the rods (arrowheads in panels h and l). The American Journal of Human Genetics 2001 68, 1333-1343DOI: (10.1086/320605) Copyright © 2001 The American Society of Human Genetics Terms and Conditions

Figure 6 RNA slot-blot analysis of α-skeletal-actin and α-cardiac-actin transcripts. RNA from patient 2 and from an age-matched control was blotted, in duplicate, onto membranes. Membranes were hybridized with oligonucleotide probes complementary to the 3′ UTR of the α-skeletal-actin or α-cardiac-actin transcripts, were washed, and then were exposed to film. The α-skeletal actin:α-cardiac actin ratio was ∼4–5:1 in both the patient and the control, on the basis of densitometric analysis. Specificity of oligonucleotide labeling was confirmed by an absence of hybridization to RNA isolated from blood, and equal loading between duplicate samples was verified by reprobing with an oligonucleotide complementary to β-spectrin. The American Journal of Human Genetics 2001 68, 1333-1343DOI: (10.1086/320605) Copyright © 2001 The American Society of Human Genetics Terms and Conditions