Mosaicism for dominant collagen 6 mutations as a cause for intrafamilial phenotypic variability

Hum Mutat. 2015 Jan;36(1):48-56. doi: 10.1002/humu.22691.


Collagen 6-related dystrophies and myopathies (COL6-RD) are a group of disorders that form a wide phenotypic spectrum, ranging from severe Ullrich congenital muscular dystrophy, intermediate phenotypes, to the milder Bethlem myopathy. Both inter- and intrafamilial variable expressivity are commonly observed. We present clinical, immunohistochemical, and genetic data on four COL6-RD families with marked intergenerational phenotypic heterogeneity. This variable expression seemingly masquerades as anticipation is due to parental mosaicism for a dominant mutation, with subsequent full inheritance and penetrance of the mutation in the heterozygous offspring. We also present an additional fifth simplex patient identified as a mosaic carrier. Parental mosaicism was confirmed in the four families through quantitative analysis of the ratio of mutant versus wild-type allele (COL6A1, COL6A2, and COL6A3) in genomic DNA from various tissues, including blood, dermal fibroblasts, and saliva. Consistent with somatic mosaicism, parental samples had lower ratios of mutant versus wild-type allele compared with the fully heterozygote offspring. However, there was notable variability of the mutant allele levels between tissues tested, ranging from 16% (saliva) to 43% (fibroblasts) in one mosaic father. This is the first report demonstrating mosaicism as a cause of intrafamilial/intergenerational variability of COL6-RD, and suggests that sporadic and parental mosaicism may be more common than previously suspected.

Keywords: Bethlem myopathy; COL6A1; COL6A2; COL6A3; Ullrich congenital muscular dystrophy; collagen VI; genetic counseling.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Collagen Type VI / genetics*
  • Collagen Type VI / metabolism
  • Contracture / genetics*
  • Contracture / metabolism
  • Contracture / pathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mosaicism
  • Muscles / pathology*
  • Muscular Dystrophies / congenital*
  • Muscular Dystrophies / genetics
  • Muscular Dystrophies / metabolism
  • Muscular Dystrophies / pathology
  • Mutation
  • Pedigree
  • Sclerosis / genetics*
  • Sclerosis / metabolism
  • Sclerosis / pathology
  • Young Adult


  • COL6A2 protein, human
  • COL6A3 protein, human
  • Col6a1 protein, human
  • Collagen Type VI

Supplementary concepts

  • Bethlem myopathy
  • Scleroatonic muscular dystrophy