Abstract
Megacystis-microcolon-hypoperistalsis-syndrome (MMIHS) is a rare and early-onset congenital disease characterized by massive abdominal distension due to a large non-obstructive bladder, a microcolon and decreased or absent intestinal peristalsis. While in most cases inheritance is autosomal dominant and associated with heterozygous variant in ACTG2 gene, an autosomal recessive transmission has also been described including pathogenic bialellic loss-of-function variants in MYH11. We report here a novel family with visceral myopathy related to MYH11 gene, confirmed by whole genome sequencing (WGS). WGS was performed in two siblings with unusual presentation of MMIHS and their two healthy parents. The 38 years-old brother had severe bladder dysfunction and intestinal obstruction, whereas the 30 years-old sister suffered from end-stage kidney disease with neurogenic bladder and recurrent sigmoid volvulus. WGS was completed by retrospective digestive pathological analyses. Compound heterozygous variants of MYH11 gene were identified, associating a deletion of 1.2 Mb encompassing MYH11 inherited from the father and an in-frame variant c.2578_2580del, p.Glu860del inherited from the mother. Pathology analyses of the colon and the rectum revealed structural changes which significance of which is discussed. Cardiac and vascular assessment of the mother was normal. This is the second report of a visceral myopathy corresponding to late-onset form of MMIHS related to compound heterozygosity in MYH11; with complete gene deletion and a hypomorphic allele in trans. The hypomorphic allele harbored by the mother raised the question of the risk of aortic disease in adults. This case shows the interest of WGS in deciphering complex phenotypes, allowing adapted diagnosis and genetic counselling.
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Acknowledgements
The authors thank the patients and their parents, as well as all the medical and technical staff of genetics laboratory SeqoiA and Georges Pompidou European Hospital for their cooperation, which made this work possible.
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C Billon, M Hureaux, X Jeunemaitre, GB Piccoli contributed equally to design, analyze of data, redaction and final approval of the manuscript. JM de Saint-Agathe, N Derive contribued to genetics analysis, bioinformatics analysis, modeling of Myh11 protein structure, redaction and final approval of the manuscript. P Bruneval and D Berrebi contributed to pathological analysis, special coloring and immunostaining, redaction and final approval of the manuscript. L Heidet, R Stoeva, contributed to final approval of the manuscript.
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Billon, C., Piccoli, G.B., de Sainte Agathe, JM. et al. Genome-wide analysis identifies MYH11 compound heterozygous variants leading to visceral myopathy corresponding to late-onset form of megacystis-microcolon-intestinal hypoperistalsis syndrome. Mol Genet Genomics 299, 44 (2024). https://doi.org/10.1007/s00438-024-02136-3
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DOI: https://doi.org/10.1007/s00438-024-02136-3