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. 2022;9(1):193-210.
doi: 10.3233/JND-210652.

A 20-year Clinical and Genetic Neuromuscular Cohort Analysis in Lebanon: An International Effort

Andre Megarbane  1   2 , Sami Bizzari  3 , Asha Deepthi  3 , Sandra Sabbagh  4 , Hicham Mansour  5 , Eliane Chouery  1 , Ghassan Hmaimess  5 , Rosette Jabbour  6 , Cybel Mehawej  1 , Saada Alame  7 , Abeer Hani  8 , Dana Hasbini  9 , Ismat Ghanem  10 , Salam Koussa  11 , Mahmoud Taleb Al-Ali  3 , Marc Obeid  12 , Diana Bou Talea  12 , Gerard Lefranc  13 , Nicolas Lévy  14   15 , France Leturcq  16 , Stephany El Hayek  3 , Valérie Delague  14 , J Andoni Urtizberea  17
Affiliations

A 20-year Clinical and Genetic Neuromuscular Cohort Analysis in Lebanon: An International Effort

Andre Megarbane et al. J Neuromuscul Dis. 2022.

Abstract

Background: Clinical and molecular data on the occurrence and frequency of inherited neuromuscular disorders (NMD) in the Lebanese population is scarce.

Objective: This study aims to provide a retrospective overview of hereditary NMDs based on our clinical consultations in Lebanon.

Methods: Clinical and molecular data of patients referred to a multi-disciplinary consultation for neuromuscular disorders over a 20-year period (1999-2019) was reviewed.

Results: A total of 506 patients were diagnosed with 62 different disorders encompassing 10 classes of NMDs. 103 variants in 49 genes were identified. In this cohort, 81.4% of patients were diagnosed with motor neuron diseases and muscular dystrophies, with almost half of these described with spinal muscular atrophy (SMA) (40.3% of patients). We estimate a high SMA incidence of 1 in 7,500 births in Lebanon. Duchenne and Becker muscular dystrophy were the second most frequently diagnosed NMDs (17% of patients). These disorders were associated with the highest number of variants (39) identified in this study. A highly heterogeneous presentation of Limb Girdle Muscular Dystrophy and Charcot-Marie-Tooth disease was notably identified. The least common disorders (5.5% of patients) involved congenital, metabolic, and mitochondrial myopathies, congenital myasthenic syndromes, and myotonic dystrophies. A review of the literature for selected NMDs in Lebanon is provided.

Conclusions: Our study indicates a high prevalence and underreporting of heterogeneous forms of NMDs in Lebanon- a major challenge with many novel NMD treatments in the pipeline. This report calls for a regional NMD patient registry.

Keywords: CMT; DMD; FSHD; Genetics; LGMD; Lebanon; SMA; neuromuscular.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Annex 1: Neuromuscular Diseases panel genes

AAAS, AARS1, ABCC9, ABHD12, ABHD5, ACAD9, ACADL, ACADM, ACADS, ACADVL, ACTA1, ACTN2, ADCY6, ADGRG6, ADSS1, AGL, AGRN, AIFM1, ALDOA, ALG14, ALG2, ALG3, AMPD1, ANO5, ARHGEF10, ASAH1, ASCC1, ATL1, ATL3, ATP1A1, ATP1A2, ATP2A1, ATP7A, B3GALNT2, B4GAT1, BAG3, BICD2, BIN1, BSCL2, BVES, C12orf65, C1orf194, CACNA1E, CACNA1S, CAPN3, CASQ1, CAV3, CAVIN1, CCDC78, CCT5, CFL2, CHAT, CHCHD10, CHKB, CHRNA1, CHRNB1, CHRND, CHRNE, CHRNG, CHST14, CLCN1, CNTN1, CNTNAP1, COA7, COL12A1, COL13A1, COL6A1, COL6A2, COL6A3, COLQ, COX6A1, COX6A2, CPT2, CRYAB, CTDP1, DAG1, DCAF8, DCTN1, DCTN2, DES, DGAT2, DHTKD1, DMD, DNA2, DNAJB2, DNAJB5, DNAJB6, DNM2, DNMT1, DOK7, DPAGT1, DPM1, DPM2, DPM3, DRP2, DST, DYNC1H1, DYSF, ECEL1, EGR2, ELP1, EMD, EMILIN1, ENO3, ERBB3, ERGIC1, ETFA, ETFB, ETFDH, EXOSC3, EXOSC8, FBLN5, FBN2, FBXO38, FGD4, FHL1, FIG4, FKBP10, FKBP14, FKRP, FKTN, FLAD1, FLNB, FLNC, FXR1, G6PC, GAA, GAN, GARS1, GBE1, GDAP1, GFPT1, GJB1, GJB3, GLA, GLDN, GLE1, GMPPB, GNB4, GNE, GOLGA2, GSN, GYG1, GYS1, HACD1, HADH, HADHA, HADHB, HARS1, HEXA, HINT1, HK1, HNRNPDL, HOXD10, HSPB1, HSPB3, HSPB8, IGHMBP2, INF2, INPP5K, ISCU, ISPD, ITGA7, KARS1, KBTBD13, KCNE3, KCNJ2, KCNJ5, KIF1A, KIF1B, KIF5A, KLHL40, KLHL41, KLHL9, KY, LAMA2, LAMA5, LAMP2, LARGE1, LAS1L, LDB3, LDHA, LGI4, LIMS2, LITAF, LMNA, LMOD3, LPIN1, LRP12, LRP4, LRSAM1, MAP3K20, MARS1, MATR3, MB, MCM3AP, MED25, MEGF10, MET, MFN2, MICU1, MME, MORC2, MPV17, MPZ, MSTO1, MTM1, MTMR14, MTMR2, MUSK, MYBPC1, MYH14, MYH2, MYH3, MYH7, MYH8, MYL1, MYO9A, MYOD1, MYOF, MYOT, MYPN, NAGLU, NALCN, NDRG1, NEB, NEFH, NEFL, NEK9, NGF, NPL, NTRK1, NUP88, OPA1, ORAI1, PABPN1, PAX7, PDHA1, PDK3, PDXK, PFKM, PGAM2, PGK1, PGM1, PHKA1, PHKB, PHKG2, PIEZO2, PIP5K1C, PLEC, PLEKHG5, PLOD2, PMP2, PMP22, PNPLA2, POGLUT1, POLG, POLG2, POMGNT1, POMGNT2, POMK, POMT1, POMT2, POPDC3, PPP3CA, PRDM12, PREPL, PRKAG2, PRPS1, PRX, PUS1, PYGM, PYROXD1, RAB7A, RAPSN, RBCK1, RBM7, REEP1, RETREG1, RRM2B, RXYLT1, RYR1, RYR3, SBF1, SBF2, SCARF2, SCN10A, SCN11A, SCN4A, SCN9A, SCO2, SCYL2, SELENON, SEPTIN9, SETX, SGCA, SGCB, SGCD, SGCG, SGPL1, SH3TC2, SIGMAR1, SIL1, SLC12A6, SLC16A1, SLC18A3, SLC22A5, SLC25A1, SLC25A20, SLC25A21, SLC25A42, SLC25A46, SLC5A7, SLC9A3R1, SMCHD1, SMPD4, SNAP25, SOD1, SORD, SOX10, SPEG, SPG11, SPTAN1, SPTBN4, SPTLC1, SPTLC2, STAC3, STIM1, SUCLA2, SURF1, SYNE1, SYNE2, SYT2, TAZ, TCAP, TECPR2, TFG, TIA1, TIMM22, TK2, TMEM43, TMEM65, TNNI2, TNNT1, TNNT3, TNPO3, TOR1A, TOR1AIP1, TPM2, TPM3, TRAPPC11, TRIM2, TRIM32, TRIM54, TRIM63, TRIP4, TRPA1, TRPV4, TTN, TTR, TWNK, TYMP, UBA1, UBA5, UNC50, VAMP1, VAPB, VCP, VIPAS39, VMA21, VPS33B, VRK1, WARS1, WNK1, YARS1, YARS2, ZC4H2, ZFHX2.

Figures

Fig. 1
Fig. 1
Sunburst representing the spectrum of hereditary NMDs in the patient cohort. Arranged by number of patients clockwise, the inner ring represents NMD groups as classified by The 2021 version of the gene table of neuromuscular disorders [2]; the outer ring represents short names of NMD subtypes separated by number of patients. Full names and OMIM numbers for each disorder are included in Table 2. *Marked disorders indicate either an undetermined NMD subtype with all patients having been only clinically diagnosed, or disease-gene correlations not currently recognized as a subtype on OMIM.
Fig. 2
Fig. 2
Exonal dystrophin (DMD) deletion and truncating mutation patterns in patients with DMD and BMD in this study. Values over each bar represent the number of patients for each of the 36 variants. Remaining DMD mutations including duplication, translocation, and splice site variants are described in Table 2.
Fig. 3
Fig. 3
Distribution of Limb Girdle Muscular Dystrophies and Congenital Muscular Dystrophies in this cohort. MD disorders listed are based on the current revised classification of LGMD [81]; known aliases are included in a dotted box to the left of the official OMIM disease name. Disease subgroups are based on associated genes, derived from Liewluck and Milone [82].
See this image and copyright information in PMC

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