Deficiency of the 50 kDa dystrophin associated glycoprotein (adhalin) in severe autosomal recessive muscular dystrophies in children native from European countries.

A large oligomeric complex of sarcolemmal glycoproteins is associated with dystrophin, the protein absent in Duchenne muscular dystrophy (DMD). The dystrophin-glycoprotein complex spans the sarcolemma, providing a link between the subsarcolemmal cytoskeleton and the extracellular matrix. It was recently shown that one component of this complex, the 50 kDa dystrophin-associated glycoprotein (50 DAG or adhalin), is deficient in severe childhood autosomal recessive muscular dystrophy with DMD-like phenotype (SCARMD). This disease, initially described in Tunisia, was also reported in patients from other North-African and Middle-Eastern countries. It has not been known whether this disease exists in other populations or regions of the world. The present study provides immunocytochemical evidence of 50 DAG specific deficiency in muscle biopsies of European sporadic patients (three French, one Italian and one Greek) who clinically presented with a Duchenne or Becker-like muscular dystrophy. This study demonstrates that SCARMD exists in distinct European populations. Without knowing the status of the 50 kDa, such patients could be either undiagnosed or misdiagnosed as Duchenne, Becker or limb girdle muscular dystrophy. Their accurate diagnosis, which is essential for genetic counseling and eventual future therapies, is now possible by immunocytochemical analysis of the 50 DAG in the biopsied skeletal muscle.