Novel Missense CAPN3 Mutation Responsible for Adult-Onset Limb Girdle Muscular Dystrophy with Calves Hypertrophy

  • Sabrine RekikEmail author
  • Salma Sakka
  • Sawssan Ben Romdhan
  • Nouha Farhat
  • Yasmine Baba Amer
  • Leila Lehkim
  • François Jérôme Authier
  • Chokri Mhiri


CAPN3 gene encodes for calpain-3; this protein is a calcium-dependent intracellular protease. Deficiency of this enzyme leads to weakness of the proximal limb muscles and pelvic and shoulder girdles, the so-called limb-girdle muscular dystrophy type 2A (LGMD2A). Here, we reported the case of a Tunisian patient with LGMD2A associated with a novel missense mutation (c.T1681C/p.Y561H). A 61-year-old man, with consanguineous parents, was referred for gait difficulties and slowly progressive proximal weakness of the four limbs associated with moderate hypertrophy of the calves but his facial muscles were unaffected. Electromyography showed that the profile was myopathic pattern and creatine kinase (CK) level was high. Muscle biopsy processing included routine histological, immunohistochemical, and Western Blot reactions, using a panel of antibodies directed against dystrophin, dysferlin, calpain-3, sarcoglycan α, β, γ, and δ. For mutation analysis, we designed an NGS-based screening. Immunological analyses demonstrated a total deficiency in calpain-3 and δ-sarcoglycan, and a reduced expression of dysferlin. The genetic study yielded a homozygous missense mutation (c.T1681C) of the 13th exon of the CAPN3 gene. The mutation found in our patient (c.T1681C/p.Y561H) has not been previously reported. It is responsible for complete calpain-3 and δ-sarcoglycan deficiency and reduced dysferlin expression. The genetic study is mandatory in such cases with multiple-protein deficiency and ambiguous results of immune-histology and Western Blot studies.


Muscular dystrophies Immunohistochemistry Western Blot CAPN3 protein DNA sequencing LGMD2A 



We would like to thank the genomic platform members in IMRB (Institut Mondor de Recherche Biomédicale), all the staff of the Department of Neurology, as well as all the staff of the Laboratory of Pathology, Habib Bourguiba University Hospital in Sfax. We also thank Chokri Khalaf for proofreading the study.

Funding Information

This work was supported by the “Association Française contre les Myopathies” Translamuscle #19507.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Laboratory of Neurogenetics, Parkinson’s Disease and Cerebrovascular Disease (LR-12-SP-19)University Hospital Habib BourguibaSfaxTunisia
  2. 2.Clinical Investigation Center (CIC), CHU Habib BourguibaSfaxTunisia
  3. 3.U955-IMRB, Team 10, Biology of the Neuromuscular System, Inserm, UPECCréteilFrance
  4. 4.Anatomopathology Laboratory, CHU Habib BourguibaSfaxTunisia

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