0 ± 17.5). All laminopathy patients revealed

their symptoms before 14 years of age, and mean age at onset of the disease was 3.3 ± 2.9 years old, which was significantly younger than those with emerinopathy. In contrast to emerinopathy, the initial symptom was fairly homogeneous. All except one noted lower limb muscle weakness as the initial symptom presenting unsteady gait, easy to fall down, or slow runner. Only one patient noticed rigidity of hind neck before muscle symptoms. Cardiac symptoms appeared later than muscle/joint problems in all the patients. Joint contractures of Achilles Inhibitors,research,lifescience,medical tendons, elbows and/or hind neck were observed in 21 out of 27 patients (77.8%), however, only 6 patients showed humeroperoneal Inhibitors,research,lifescience,medical distribution of muscle involvement, as observed in typical EDMD patients. Twelve patients showed proximal

dominant limb muscle weakness with joint contractures, which suggested the existence of an intermediate form between AD-EDMD and LGMD1B. Five patients had proximal dominant limb muscle weakness with no joint contractures. They were diagnosed LGMD1B. It is worthwhile mentioning that calf hypertrophy was frequently seen in patients showing proximal dominant muscle involvement with no/minimal joint contractures. Therefore, mutation screening of LMNA should be considered for childhood muscular dystrophy with calf Inhibitors,research,lifescience,medical hypertrophy. Cardiac involvement was seen in 17 of the 27 patients (63.0%) with laminopathy, and only 5 patients were identified to have dilated cardiomyopathy. Six patients received pacemaker implantation at the age of 34.5 ± 10.7 years (average). In a mouse model of laminopathy carrying Inhibitors,research,lifescience,medical homozygous LMNA H222P mutation, the male mice showed more severe cardiomyopathy and shorter life span than the female (26). However, in our human series, no marked gender difference was seen. Clinical manifestations of the patients are heterogenous even though they carry the same mutation in LMNA. In our series, we found 6 patients with p.R453W substitution in LMNA. Inhibitors,research,lifescience,medical One patient showed proximal limb muscle weakness with no joint contractures, and was diagnosed

as having LGMD1B. On the other hand, the other five patients had joint contractures and 2 were clinically diagnosed to have rigid spine syndrome. One patient manifested as humeroperoneal muscle involvement with joint contractures of Achilles tendons, elbows and hind neck, and was diagnosed as AD-EDMD. find more Among 6 patients with p.R453W mutation in LMNA, cardiomyopathy with conduction defects was seen only in one oldest patient from the age of 34 years. Recently, Benedetti, et al. reported that premature termination mutations in LMNA cause rather late onset cardiac disorders or limb girdle muscular dystrophy (27). In our series, three laminopathy patients, in 2 families, had a BIBF 1120 order nonsense mutation of p.Q355X (c.1063C > T) or p.T510Tfs.37X (c.1527-1529 TAC > AA) in LMNA. The mutation of p.