OVERVIEW

The muscular disorders presented here encompass a wide range of disorders and symptoms, all related to abnormal functionality of the muscle. Some diseases present themselves in newborns such as spinal muscular atrophy, while others are related to the progressive degeneration of muscle tissue, such as Duchenne muscular dystrophy. Muscular Dystrophies is the group of disorders that describes diseases which cause progressive weakness in the muscles the most common dystrophy is the X-linked disorder Duchenne muscular dystrophy which occurs 1:3,500 in males. Muscular Atrophes is the group of disorders that describes diseases which cause a progressive degeneration of the spinal nerves leading to wasting away of the muscles they control. Hereditary Myopathies primarily affect the skeletal muscle tissue and can cause feeding and breathing difficulties and delayed motor development. Early identification of individuals at risk can help establish the right clinical management plan.

We offer comprehensive and syndrome-specific panels testing for muscular disorders. The test can offer a molecular genetic diagnosis of a muscular disorder that is observed or predicted in you or a family member.

IMPORTANCE OF GETTING TESTED

If you or a family member show a symptom of a muscular disorder, identifying the cause can help to take actions to improve the outcome of the disorder. Additionally, family members can be informed and encouraged to also get tested. Our genetic counsellors can provide medical advice.

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You/your child has
a muscle weakness and atrophy

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You/your child shows
progressive muscle weakness

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You/your child has
a weak heart muscle

POSSIBLE OUTCOMES OF THE TEST

A molecular genetic diagnostic report outlining the results of the sequencing analysis is provided. Changes in DNA sequences (variants) can be detrimental and lead to the development of a cardiac or aortic disorder, including asymptomatic disorders that develop later in life. We will report pathogenic and likely pathogenic variants as well as variants of unknown significance.
Pathogenic and likely pathogenic variants mean the genetic cause of the observed symptoms has been identified and may help determine the right treatment and management plan.
Variants of unknown significance means there was not enough evidence to classify the variant as either pathogenic or neutral. Annual variant reclassification and testing family members is recommended.
It is important to note that a negative result does not guarantee the absence of a disorder or that the disorder does not have a genetic cause. Genetic testing is an evolving field and may not detect all variants or there may not currently be enough evidence to classify all variants that lead to an inherited disease.

MEDICAL GENETIC COUNSELLING

We provide expert medical genetic counselling as part of a genetic testing journey. Genetic counselling is a process of communication that supports patients and their relatives before and after genetic testing. It is educational, impartial and nondirective. Prior to any genetic test, genetic counsellors will obtain a detailed family history, explain the method of testing that will be used, its risks and benefits, the limitations of the diagnosis and the implications of making a genetic diagnosis (Elliott and Friedman, 2018, Nat Rev Genet 19:735).

Upon receiving the genetic test results, genetic counselling can help the specialist physician and the patient to interpret them. They can be advised of the consequences of the results including the probability of developing the genetic disorder or passing it on to children, as well as ways to prevent, avoid or reduce these risks (Yang and Kim, 2018, Ann Lab Med 38:291). Our goal of counselling is to provide the patient with greater knowledge and thus, a better understanding of the results and the ability to make a more informed decision.

ACCEPTED MATERIAL

1 ml EDTA Blood

TURNAROUND TIME

15-25 working days

TECHNOLOGY

DNA is isolated and next generation sequencing is performed on all coding exons and conserved intronic regions. Single base pair changes, small deletions and duplications and copy number variants (CNV) are identified. Sequencing runs result in a Quality Score of >30 (accuracy >99.9%) in at least 75% of all bases with a coverage of >20-fold. CNV detection sensitivity is 76.99% and precision is 62.59% (with GC limitation between 0.4 and 0.6 per target sensitivity is 77.04% and precision is 84.10%). Variant classification is performed following ACMG guidelines (Richards et al. 2015, Genet Med 17:405; Kearney et al. 2011, Genet Med 13:680).

TEST METHODOLOGY
Sequencing

Next generation
sequencing (Illumina)

Enrichment

Twist Human Core
Exome plus Ref Seq
Spikeln

SNV and CNV data anlaysis

Illumina DRAGEN
Bio-IT Platform

Data Evaluation

VarSeq by
GoldenHelix

Reference Genome

hg38, NCBI GR38

Quality Criteria

>30 (precision >99,9%)
in min. 75% of bases

SNV detection sensitivity

99.92-99.93%; confirmation of reported SNV with Sanger
sequencing, data analysis with
SeqPilot

Classification of variants

Richards et al. 2015, Genet Med
17:405; Ellard et al. “ACGS Best
Practice Guidelines for Variant
Classification 2020″

in silico algorithms

MaxEntScan,
SpliceSiteFinder-like,
REVEL

Databases

HGMD Professional
release, ClinVar,
gnomAD

OUR TESTS

Core myopathies (extended)

Genes: ACTA1, BIN1, DNM2, MTM1, RYR1, SELENON, TPM2, TPM3, TTN

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Core myopathies (standard)

Genes: RYR1

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DUCHENNE/BECKER MUSCULAR DYSTROPHY

Genes: DMD

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Emery-Dreifuss muscular dystrophy

Genes: EMD, FHL1, LMNA, SYNE2

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Hypokalemic periodic paralysis

Genes: CACNA1S, KCNJ2, SCN4A

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Metabolic myopathies (Defects in mitochondrial ß-oxidation and mitochondrial DNA depletion syndromes (MTDPS) and myopathy) (standard)

Genes: ACADVL, AGK, DGUOK, ETFA, ETFB, ETFDH, HADHA, HADHB, INIP, POLG, RRM2B, SUCLA2, SUCLG1, TK2, TWNK, TYMP

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Metabolic myopathies (extended)

Genes: ACADVL, AGK, ALDOA, CPT2, DGUOK, ETFA, ETFB, ETFDH, FBXL4, GAA, HADHA, HADHB, INIP, ISCU, LAMA2, LDHA, LPIN1, MGME1, MPV17, PFKM, PGAM2, PHKA1, PHKB, POLG, PYGM, RRM2B, SLC25A20, SLC25A4, SUCLA2, SUCLG1, TK2, TWNK, TYMP

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Metabolic myopathies (glycogenosis with muscular involvement and carnitine cycle disorders) (standard)

Genes: ALDOA, CPT2, GAA, LDHA, PFKM, PGAM2, PHKA1, PHKB, PYGM, SLC25A20

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Muscular dystrophies

Genes: B3GALNT2, B4GAT1, CHKB, COL6A1, COL6A2, COL6A3, CRPPA, DAG1, FHL1, FKRP, FKTN, GMPPB, ITGA7, LAMA2, LARGE1, POMGNT1, POMGNT2, POMK, POMT1, POMT2, RXYLT1, SELENON

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MUSCULAR DYSTROPHIES, CONGENITAL

Genes: CHKB, COL6A1, COL6A2, COL6A3, CRPPA, DNM2, FHL1, FKRP, FKTN, ITGA7, LAMA2, LARGE1, LMNA, POMGNT1, POMGNT2, POMT1, POMT2, SELENON, TCAP

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Muscular dystrophies, progressive

Genes: ANO5, BVES, CAPN3, CAV3, CRPPA, DAG1, DES, DMD, DNAJB6, DYSF, EMD, FHL1, FKRP, FKTN, GAA, GMPPB, HNRNPDL, LAMA2, LIMS2, LMNA, MYOT, PLEC, POMGNT1, POMK, POMT1, POMT2, SGCA, SGCB, SGCD, SGCG, SYNE1, SYNE2, TCAP, TMEM43, TNPO3, TRAPPC11, TRIM32, TTN

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MUSCULAR DYSTROPHIES, PROGRESSIVE

Genes: ANO5, CAPN3, CAV3, DYSF, FKRP, FKTN, LMNA, MYOT, SGCA, SGCB, SGCD, SGCG, TCAP, TRIM32

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Muscular dystrophy-dystroglycanopathy, type A

Genes: B3GALNT2, B4GAT1, CRPPA, DAG1, FKRP, FKTN, GMPPB, LARGE1, POMGNT1, POMGNT2, POMK, POMT1, POMT2, RXYLT1

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Muscular dystrophy-dystroglycanopathy, type A & B

Genes: B3GALNT2, B4GAT1, CRPPA, DAG1, FKRP, FKTN, GMPPB, LARGE1, POMGNT1, POMGNT2, POMK, POMT1, POMT2, RXYLT1

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Muscular dystrophy-dystroglycanopathy, type B & C

Genes: CRPPA, DAG1, FKRP, FKTN, GMPPB, LARGE1, POMGNT1, POMK, POMT1, POMT2

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Muscular dystrophy, collagen-associated and others

Genes: CHKB, COL6A1, COL6A2, COL6A3, FHL1, ITGA7, SELENON

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MYOPATHY, CONGENITAL (extended)

Genes: ACTA1, BIN1, CCDC78, CFL2, CNTN1, DNM2, GNE, KBTBD13, KLHL40, KLHL41, LMOD3, MEGF10, MTM1, MTMR14, MYF6, MYH2, MYH7, MYL1, MYO18B, MYPN, NEB, RYR1, SELENON, SPEG, SPTBN4, STAC3, TNNT1, TPM2, TPM3, TTN, VCP

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MYOPATHY, CONGENITAL (standard)

Genes: ACTA1, MYH7, RYR1, TPM3

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MYOPATHY, MYOFIBRILLAR

Genes: BAG3, CRYAB, DES, DNAJB6, FHL1, FLNC, KY, LDB3, MYOT, PLEC, PYROXD1, TTN

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MYOTONIAS, NON-DYSTROPHIC

Genes: CLCN1, HSPG2, SCN4A

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NEMALINE MYOPATHY, CORE-MYOPATHY

Genes: ACTA1, CFL2, KBTBD13, KLHL40, KLHL41, LMOD3, MYPN, NEB, TNNT1, TPM2, TPM3

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SPINAL AND BULBAR MUSCULAR ATROPHY/X-LINKED BULBOSPINAL MUSCULAR ATROPHY (KENNEDY DISEASE)

Genes: AR

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Spinal muscular atrophy (extended)

Genes: ASAH1, ATP7A, BICD2, BSCL2, CHCHD10, DNAJB2, DYNC1H1, EXOSC3, EXOSC8, FBXO38, GARS, HSPB8, IGHMBP2, PLEKHG5, REEP1, SLC5A7, TFG, TRIP4, TRPV4, UBA1, VAPB, VRK1

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Spinal muscular atrophy (late-onset)

Genes: ATP7A, BICD2, BSCL2, CHCHD10, DNAJB2, FBXO38, GARS, HSPB8, REEP1, SLC5A7, TFG, TRPV4, VAPB

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Spinal muscular atrophy (neonatal / early-onset) and pontocerebellar hypoplasia

Genes: ASAH1, ATP7A, EXOSC3, EXOSC8, IGHMBP2, PLEKHG5, TRPV4, UBA1, VRK1

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SPINAL MUSCULAR ATROPHY TYPES I, II, III, IV

Genes: SMN1

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OUR NETWORK