A new early-onset neuromuscular disorder associated with kyphoscoliosis peptidase (KY) deficiency

Eur J Hum Genet. 2016 Dec;24(12):1771-1777. doi: 10.1038/ejhg.2016.98. Epub 2016 Aug 3.

Abstract

We describe a new early-onset neuromuscular disorder due to a homozygous loss-of-function variant in the kyphoscoliosis peptidase gene (KY). A 7.5-year-old girl with walking difficulties from 2 years of age presented with generalized muscle weakness; mild contractures in the shoulders, hips and feet; cavus feet; and lordosis but no scoliosis. She had previously been operated with Achilles tendon elongation. Whole-body MRI showed atrophy and fatty infiltration in the calf muscles. Biopsy of the vastus lateralis muscle showed variability in fiber size, with some internalized nuclei and numerous very small fibers with variable expression of developmental myosin heavy chain isoforms. Some small fibers showed abnormal sarcomeres with thickened Z-discs and small nemaline rods. Whole-exome sequencing revealed a homozygous one-base deletion (c.1071delG, p.(Thr358Leufs*3)) in KY, predicted to result in a truncated protein. Analysis of an RNA panel showed that KY is predominantly expressed in skeletal muscle in humans. A recessive variant in the murine ortholog Ky was previously described in a spontaneously generated mouse mutant with kyphoscoliosis, which developed postnatally and was caused by dystrophy of postural muscles. The abnormal distribution of Xin and Ky-binding partner filamin C in the muscle fibers of our patient was highly similar to their altered localization in ky/ky mouse muscle fibers. We describe the first human case of disease associated with KY inactivation. As in the mouse model, the affected child showed a neuromuscular disorder - but in contrast, no kyphoscoliosis.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age of Onset
  • Child
  • Codon, Nonsense
  • Female
  • Filamins / metabolism
  • Humans
  • Kyphosis / diagnostic imaging
  • Kyphosis / genetics*
  • Kyphosis / pathology
  • Muscle Proteins / deficiency
  • Muscle Proteins / genetics*
  • Peptide Hydrolases / deficiency
  • Peptide Hydrolases / genetics*
  • Quadriceps Muscle / metabolism
  • Quadriceps Muscle / pathology
  • Scoliosis / diagnostic imaging
  • Scoliosis / genetics*
  • Scoliosis / pathology

Substances

  • Codon, Nonsense
  • Filamins
  • Muscle Proteins
  • KY protein, human
  • Peptide Hydrolases