Myotonie congénitale - CM

Genetic and clinical detail for veterinarians, geneticists and laboratories.

• Gene / locus: CLCN1 (chloride voltage-gated channel 1, skeletal muscle), ECA4.
• Variant: D592A (Asp592Ala), missense at a residue conserved across mammals, predicted probably damaging; candidate causal variant (Wijnberg et al., 2012). HGVS (EquCab3.0): NC_009147.3:g.96518592A>C; XM_001915636.4:c.1775A>C; XP_001915671.3:p.(Asp592Ala).
• Alternative designations: published against GenBank XM_001915636 / XP_001915671 (same numbering as the current RefSeq versions).
• Variant identifiers: rs5334475185 (EVA); OMIA variant 161.
• Variant classification: not currently evaluated (ISAG/AVCG, per OMIA).
• Mechanism: the CLCN1 chloride channel provides most of the resting membrane conductance of the muscle fibre; reduced channel function leaves the fibre firing after contraction, producing myotonia. Human homologue: myotonia congenita; the same gene underlies myotonia in goats, mice and dogs.
• Variant analysis: three CLCN1 differences were found; two did not segregate with disease and are unlikely to alter protein function. The full-length cDNA of the affected foal showed no other abnormality, which excludes a splicing effect (Wijnberg et al., 2012).
• Inheritance: autosomal recessive (OMIA code R).
• Penetrance / expressivity: heterozygous relatives were unaffected (Wijnberg et al., 2012).
• Breeds with documented carriers or cases: New Forest Pony only (OMIA variant record); absent in 56 horses of 13 other breeds (Wijnberg et al., 2012).
• Allele / carrier frequencies: no population survey published. In the discovery study (102 animals: affected foal, dam, sire, 22 relatives, 21 unrelated New Forest Ponies, 56 horses of 13 other breeds), the affected foal was the only homozygote and 9 carriers were found, all within one family: eight mares including the dam, and the sire. All traced to one suspected founder stallion, paternal grandsire and maternal great-grandsire of the affected foal; none of the 21 unrelated New Forest Ponies carried it. The authors suggest the variant may be recent and confined to one line (Wijnberg et al., 2012). Not detected in 296 horses with muscle disease tested at a neuromuscular laboratory (Aleman et al., 2022). Family-derived percentages are not breed carrier rates.
• Clinical / diagnostic notes for veterinarians: in the index case (Utrecht University equine clinic), electromyography showed myotonic discharges in every muscle tested; biopsies of four muscles showed marked variation in fibre diameter without necrosis; hyponatraemia, hypokalaemia, hypomagnesaemia and hypochloraemia with raised calcium and phosphate normalised after an episode; renal function was normal; HYPP genotype was negative. The myotonic EMG pattern is not specific to this disease. Electromyography and muscle biopsy are separate procedures and are not replaced by this test. The discovery authors state that direct genetic testing enables eradication of the disease from the New Forest pony breeding population.

Key references:

• Wijnberg ID, Owczarek-Lipska M, Sacchetto R, Mascarello F, Pascoli F, Grunberg W, van der Kolk JH, Drogemuller C (2012). A missense mutation in the skeletal muscle chloride channel 1 (CLCN1) as candidate causal mutation for congenital myotonia in a New Forest pony. Neuromuscul Disord 22:361-367. doi:10.1016/j.nmd.2011.10.001. PMID 22197188.
• Aleman M, Scalco R, Malvick J, Grahn RA, True A, Bellone RR (2022). Prevalence of genetic mutations in horses with muscle disease from a neuromuscular disease laboratory. J Equine Vet Sci 118:104129. doi:10.1016/j.jevs.2022.104129.