• 한국전문물리치료학회지
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• 제22권3호
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• pp.98-105
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• 2015

Muscular dystrophy is a hereditary musculoskeletal disorder caused by a mutation in the dystrophin gene. Duchenne muscular dystrophy (DMD) is one of the most common, and progresses relatively faster than other muscular dystrophies. It is characterized by progressive myofiber degeneration, muscle weakness and ultimately ambulatory loss. Since it is an X-linked recessive inheritance, DMD is mostly expressed in males and rarely expressed or less severe in females. The most effective measurement tool for DMD is magnetic resonance imaging (MRI), which allows non-invasive examination of longitudinal measurement. It can detect progressive decline of skeletal muscle size by measuring a maximal cross-sectional area of skeletal muscle. Additionally, other techniques in MRI, like $T_2$-weighted imaging, assess muscle damage, including inflammation, by detecting changes in $T_2$ relaxation time. Current MRI techniques even allow quantification of metabolic differences between affected and non-affected muscles in DMD. There is no current cure, but physical therapist can improve their quality of life by maintaining muscle strength and function, especially if treatment (and other forms of medical intervention) begins in the early stages of the disease.

• Clinical and Experimental Reproductive Medicine
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• 제23권1호
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• pp.109-114
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• 1996

General PCR technique alone has a limitation for preimplantation genetic diagnosis(PGD) using single blastomere. Recntly developed primer extension preamplification(PEP) technology amplifies the whole genome and thus, simultaneous multiple locus analysis became possible. In this study, we report the efficacy of PEP-PCR for PGD in three muscular dystrophy carriers undergoing IVF-ET. A total of 37 blastomeres were obtained from 40 embryos at six to eight cell stage in three IVF cycles in two DMD and one BMD carriers. Whole genome from single blastomeres were amplified using I5-base oligonucleotide random primers. PCR amplified products of exon 45 in the dystrophin gene and alphoid X/Y loci for gender determination were analysed by 2% metaphor gel electrophoresis. A total of 37 PEP-PCR replicates from 37 single blastomeres from 40 embryos and 37 blanks were performed. We obtained the reliable results for exon 45 and alphoid X/Y. Transfer of female embryos and unaffected male embryo was attempted in three couples. Unfortunately, pregnancy was not achieved in these cases. PEP-PCR is a reliable and efficient PGD method in multiple locus analysis using single blastomere.

• Clinical and Experimental Reproductive Medicine
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• 제32권1호
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• pp.17-26
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• 2005

Objective: Preimplantation genetic diagnosis (PGD) is reserved for couples with a risk of transmitting a serious and incurable disease, and hence avoids the undesirable therapeutic abortion. In this study, we evaluated the efficacy of PGD for Duchenne muscular dystrophy (DMD) cases by the fluorescent PCR with polymorphic linked markers and the conventional duplex-nested PCR methods. Methods: Biopsy of one or two blastomeres was done from the embryos fertilized by ICSI on the third day after fertilization. We performed two cases of PGD-DMD by the duplex-nested PCR for the causative mutation loci and the SRY gene on Y chromosome. The triplex fluorescent PCR for the mutation loci, the SRY gene and the polymorphic microsatellite marker on X chromosome was applied for two cases of PGD-DMD. Results: By the duplex-nested PCR, successful diagnosis rate was 95.5% (21/22), but we could not discriminate the female embryos whether normal or carrier in this X-linked recessive disease. However, the triplex fluorescent PCR method showed 100% (27/27) of successful diagnosis rate, and all female embryos (n=17) were distinguished normal (n=10) from carrier (n=7) embryos. Unaffected and normal embryos were transferred into mother's uterus after diagnosis. A healthy normal male was achieved after PGD with the duplex-nested PCR method and a twin, a male and a female, were delivered with triplex fluorescent PCR method. The normality of dystrophin gene was confirmed by amniocentesis and postnatal genetic analysis in all offsprings. Conclusion: The fluorescent PCR with polymorphic marker might be useful in improving the specificity and reliability of PGD for single gene disorders.

• Journal of Genetic Medicine
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• 제16권2호
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• pp.67-70
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• 2019

Limb-girdle muscular dystrophy (LGMD) is a group of muscular dystrophies that has extremely heterogeneous clinical features and genetic background. The caveolin-3 gene (CAV3) is one of the causative genes. LGMD appears as a clinical continuum, from isolated skeletal muscle involvement to long QT syndrome. Here we report two patients without apparent muscle weakness in a family with CAV3 mutation. A 7-month-old Korean boy visited our muscle clinic because of an incidental finding of elevated serum creatine kinase (CK) concentration (680 IU/L, reference range, 20-270 IU/L) without clinical symptoms. The patient was born after an uneventful pregnancy and showed normal developmental milestones. He developed pseudohypertrophy of his calf muscle during the follow-up. We obtained a muscle biopsy at age 14 months, which showed size variations and degenerating/regenerating myofibers with endomysial fibrosis and immunohistochemical evidence of normal dystrophin. Under the impression of LGMD, we performed target panel sequencing and identified a heterozygous in-frame mutation of CAV3, c.307_312delGTGGTG (p.Val103_Val104del). Immunohistochemical staining of muscle indicated complete loss of caveolin-3 compared with normal control muscle, which supported the variant's pathogenicity. We performed segregation analysis and found that the patient's mother had the same variant with elevated serum CK level (972 IU/L). We report on autosomal dominant familial caveolinopathy caused by a pathogenic variant in CAV3, which was asymptomatic until the fourth decade. This case highlights the utility of next generation sequencing in the diagnosis of muscular dystrophies and the additive role of muscle biopsy to confirm the variants.

• Journal of Genetic Medicine
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• 제5권1호
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• pp.15-20
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• 2008

목 적 : 듀시엔/베커형 근이영양증(Duchenne and Becker type muscular dystrophy; DMD/BMD)은 남아에게 나타나는 일반적인 X 염색체 연관 유전성 근육 질환으로 DMD(dystrophin) 유전자의 돌연변이로 인해 생긴다. 그 중 큰 exon 결실이 전체 DMD 환자의 약 50-60%에서 발견된다. 이 유전자의 돌연변이를 찾기 위해 여러 방법들이 사용되고 있지만 결실 돌연변이를 찾아내기 위한 가장 일반적인 방법으로 복합적 중합효소연쇄반응을 이용하고 있다. 하지만 이 방법의 단점은 하나의 시험관 안에 복합적인 시발체가 존재하여 정확한 반응 조건을 찾기 힘들 뿐 아니라 시발체 상호간의 간섭으로 중합효소 연쇄반응의 비특이적 생성물을 빈번하게 일으켜 잘못된 음성 또는 양성 결과를 가져올 수 있다. 이런 문제를 보완하고자 Dual Primer Oligonucleotide(DPO) 방법을 도입하였다. DPO는 polydeoxyinosine 연결에 의해 두 영역으로 분리된 올리고뉴클레오티드(oligonucleotide)로 표적 DNA 염기서열과의 교잡반응에 높은 특이적 반응을 보여 복합 중합효소 연쇄반응의 정확도를 높여준다. 본 연구에서는 3 그룹을 대상군으로 DMD 유전자의 결실돌연변이 검색을 위한 DPO-복합 중합효소 연쇄반응법의 특이성과 민감성을 알아보고자 하였다. 방 법 : 50명의 건강한 남자 대조군, 50명의 결실 돌연변이를 갖고 있는 양성반응 환자그룹 그리고 20명의 결실 돌연변이를 가지고 있지 않은 음성반응 환자 그룹으로 구성된 3 그룹을 대상으로 DPO-복합 중합효소 연쇄반응법을 이용하여 실험하였다. 이들 120명의 실험군 모두 PMter영역과 exon 3, 4, 6, 8, 12, 13, 17, 19, 43-48, 50-52, 60을 포함하는 18개의 exon에서의 결실의 여부와 결실 범위를 확인하였다. 결 과 : DPO-복합 중합효소 연쇄반응법은 결실 여부를 발견하는데 100%의 특이성과 민감성을 보였다. 하지만 결실 범위의 결정에는 97.1%의 민감성과 특이성을 보였다. 결 론 : DPO-복합 중합효소 연쇄반응법은 기존의 복합 중합효소 연쇄반응법 보다 높은 분석 확실성을 보일뿐 아니라 빠르고 저렴한 비용으로 쉽게 할 수 있기 때문에 듀시엔/베커형 근이영양증 환자의 DMD 유전자의 결실돌연변이 여부를 확인하는데 유용한 방법이다.