Distal Arthrogryposis Type 7 (Trismus-Pseudocamptodactyly Syndrome) via the MYH8 Gene
- Summary and Pricing
- Clinical Features and Genetics
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For ordering sequencing of targeted known variants, please proceed to our Targeted Variants landing page.
The great majority of tests are completed within 18 days.
Clinical sensitivity cannot be estimated because only one missense pathogenic variant in MYH8 has been reported. Analytical sensitivity should be high because this missense variant is detectable by sequencing.
Distal arthrogryposis (DA) syndromes are a group of multiple congenital contracture disorders with distal joint involvement, variable clinical expression, and most often autosomal dominant inheritance (Bamshad et al. 2009).
Distal arthrogryposis type 7 (DA7), referred to as trismus-pseudocamptodactyly syndrome, is caused by pathogenic variants in MYH8. Trismus-pseudocamptodactyly syndrome (TPS) is a disorder of muscle development and function and is characterized by limited range of motion of the hands, legs, and mouth. TPS patients may not open the mouth fully (trismus) and show an unusual camptodactyly (flexion of the fingers) that is evident on dorsiflexion of the wrist (pseudocamptodactyly) (Ter Haar et al. 1974; Veugelers et al. 2004).
Distal arthrogryposis type 7 is inherited in an autosomal dominant pattern. MYH8 encodes 1937 amino acids and spans over 32 kb on Chromosome 17p13.1 (Weiss et al. 1999). Muscle myosins consist of two heavy chains (MyHCs), two essential light chains (MLCs), and two regulatory MLCs. The neonatal myosin heavy chains, coded by the myosin heavy chain 8 gene (MYH8), are expressed during fetal development, disappear shortly after birth from most muscle, and only persist throughout adult stages in specialized muscles, such as the extraocular and jaw-closing muscles, and in the muscle spindles (Schiaffino et al. 2015). TPS has been reported to be caused by a single missense variant, c.2021G>A (p.Arg674Gln) in MYH8. The amino acid residue p.Arg674 of the MYH8 protein is an evolutionary conserved residue, localized in the actin-binding domain of the perinatal myosin head. This residue is also close to the ATP binding site and may thus interfere with ATP binding to the mutant myosin heavy chain (Veugelers et al. 2004; Toydemir et al. 2006).
This test involves bidirectional Sanger DNA sequencing of all coding exons and splice sites of the MYH8 gene. The full coding sequence of each exon plus ~10 bp of flanking DNA on either side are sequenced. We will also sequence any single exon (Test #100) in family members of patients with a known mutation, or to confirm research results, or to cover the p.Arg674Gln variant.
Indications for Test
All patients with symptoms suggestive of distal arthrogryposis are candidates for this test.
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- Genetic Counselor Team - firstname.lastname@example.org
- Angela Gruber, PhD - email@example.com
- Bamshad M. et al. 2009. The Journal of Bone and Joint Surgery. American Volume. 91 Suppl 4: 40-6. PubMed ID: 19571066
- Human Gene Mutation Database (Bio-base).
- Schiaffino S. et al. 2015. Skeletal Muscle. 5: 22. PubMed ID: 26180627
- ter Haar B.G., van Hoof R.F. 1974. Journal of Medical Genetics. 11: 41-9. PubMed ID: 4837286
- Toydemir R.M. et al. 2006. American Journal of Medical Genetics. Part A. 140: 2387-93. PubMed ID: 17041932
- Veugelers M. et al. 2004. The New England Journal of Medicine. 351: 460-9. PubMed ID: 15282353
- Weiss A. et al. 1999. Journal of molecular biology. 290:61-75. PubMed ID: 10388558
Bi-Directional Sanger Sequencing
Nomenclature for sequence variants was from the Human Genome Variation Society (http://www.hgvs.org). As required, DNA is extracted from the patient specimen. PCR is used to amplify the indicated exons plus additional flanking non-coding sequence. After cleaning of the PCR products, cycle sequencing is carried out using the ABI Big Dye Terminator v.3.0 kit. Products are resolved by electrophoresis on an ABI 3730xl capillary sequencer. In most cases, sequencing is performed in both forward and reverse directions; in some cases, sequencing is performed twice in either the forward or reverse directions. In nearly all cases, the full coding region of each exon as well as 10 bases of non-coding DNA flanking the exon are sequenced.
As of February 2018, we compared 26.8 Mb of Sanger DNA sequence generated at PreventionGenetics to NextGen sequence generated in other labs. We detected only 4 errors in our Sanger sequences, and these were all due to allele dropout during PCR. For Proficiency Testing, both external and internal, in the 14 years of our lab operation we have Sanger sequenced roughly 14,300 PCR amplicons. Only one error has been identified, and this was an error in analysis of sequence data.
Our Sanger sequencing is capable of detecting virtually all nucleotide substitutions within the PCR amplicons. Similarly, we detect essentially all heterozygous or homozygous deletions within the amplicons. Homozygous deletions which overlap one or more PCR primer annealing sites are detectable as PCR failure. Heterozygous deletions which overlap one or more PCR primer annealing sites are usually not detected (see Analytical Limitations). All heterozygous insertions within the amplicons up to about 100 nucleotides in length appear to be detectable. Larger heterozygous insertions may not be detected. All homozygous insertions within the amplicons up to about 300 nucleotides in length appear to be detectable. Larger homozygous insertions may masquerade as homozygous deletions (PCR failure).
In exons where our sequencing did not reveal any variation between the two alleles, we cannot be certain that we were able to PCR amplify both of the patient’s alleles. Occasionally, a patient may carry an allele which does not amplify, due for example to a deletion or a large insertion. In these cases, the report contains no information about the second allele.
Similarly, our sequencing tests have almost no power to detect duplications, triplications, etc. of the gene sequences.
In most cases, only the indicated exons and roughly 10 bp of flanking non-coding sequence on each side are analyzed. Test reports contain little or no information about other portions of the gene, including many regulatory regions.
In nearly all cases, we are unable to determine the phase of sequence variants. In particular, when we find two likely causative mutations for recessive disorders, we cannot be certain that the mutations are on different alleles.
Our ability to detect minor sequence variants, due for example to somatic mosaicism is limited. Sequence variants that are present in less than 50% of the patient’s nucleated cells may not be detected.
Runs of mononucleotide repeats (eg (A)n or (T)n) with n >8 in the reference sequence are generally not analyzed because of strand slippage during PCR and cycle sequencing.
Unless otherwise indicated, the sequence data that we report are based on DNA isolated from a specific tissue (usually leukocytes). Test reports contain no information about gene sequences in other tissues.
myPrevent - Online Ordering
- The test can be added to your online orders in the Summary and Pricing section.
- Once the test has been added log in to myPrevent to fill out an online requisition form.
- A completed requisition form must accompany all specimens.
- Billing information along with specimen and shipping instructions are within the requisition form.
- All testing must be ordered by a qualified healthcare provider.
(Delivery accepted Monday - Saturday)
- Collect 3 ml -5 ml (5 ml preferred) of whole blood in EDTA (purple top tube) or ACD (yellow top tube). For Test #500-DNA Banking only, collect 10 ml -20 ml of whole blood.
- For small babies, we require a minimum of 1 ml of blood.
- Only one blood tube is required for multiple tests.
- Ship blood tubes at room temperature in an insulated container. Do not freeze blood.
- During hot weather, include a frozen ice pack in the shipping container. Place a paper towel or other thin material between the ice pack and the blood tube.
- In cold weather, include an unfrozen ice pack in the shipping container as insulation.
- At room temperature, blood specimen is stable for up to 48 hours.
- If refrigerated, blood specimen is stable for up to one week.
- Label the tube with the patient name, date of birth and/or ID number.
(Delivery accepted Monday - Saturday)
- Send in screw cap tube at least 5 µg -10 µg of purified DNA at a concentration of at least 20 µg/ml for NGS and Sanger tests and at least 5 µg of purified DNA at a concentration of at least 100 µg/ml for gene-centric aCGH, MLPA, and CMA tests, minimum 2 µg for limited specimens.
- For requests requiring more than one test, send an additional 5 µg DNA per test ordered when possible.
- DNA may be shipped at room temperature.
- Label the tube with the composition of the solute, DNA concentration as well as the patient’s name, date of birth, and/or ID number.
- We only accept genomic DNA for testing. We do NOT accept products of whole genome amplification reactions or other amplification reactions.
(Delivery preferred Monday - Thursday)
- PreventionGenetics should be notified in advance of arrival of a cell culture.
- Culture and send at least two T25 flasks of confluent cells.
- Some panels may require additional flasks (dependent on size of genes, amount of Sanger sequencing required, etc.). Multiple test requests may also require additional flasks. Please contact us for details.
- Send specimens in insulated, shatterproof container overnight.
- Cell cultures may be shipped at room temperature or refrigerated.
- Label the flasks with the patient name, date of birth, and/or ID number.
- We strongly recommend maintaining a local back-up culture. We do not culture cells.