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  • Updated 03.25.2023
  • Released 12.19.1994
  • Expires For CME 03.25.2026

Emery-Dreifuss muscular dystrophy



Emery-Dreifuss muscular dystrophy is a syndrome classically characterized by (1) slowly progressive muscle weakness and wasting in a scapulo-humeroperoneal distribution, (2) early contractures of the elbows, ankles, and posterior neck, and (3) dilated cardiomyopathy with conduction defects. Originally described as an X-linked disorder, Emery-Dreifuss muscular dystrophy–like phenotypes can arise from mutations in both autosomal and X chromosome genes, including those encoding emerin and A-type lamins, as well as in less frequent cases those encoding nesprin1, nesprin2, SUN1, SUN2, four-and-a-half-LIM protein 1, LUMA, and lamina-associated polypeptide 1. Although the skeletal muscle involvement can vary as a result of mutations in these genes, dilated cardiomyopathy is the most prevalent and potentially life-threatening feature.

Key points

• Emery-Dreifuss muscular dystrophy can be inherited in an X-lined or autosomal manner and result from mutations in several different genes.

• Variations in the classical Emery-Dreifuss phenotype can occur as a result of mutations in the causative genes.

• Emery-Dreifuss muscular dystrophy should be considered in patients with muscular dystrophy and cardiac disease.

• Cardiomyopathy and conduction defects may require early intervention, and cardiologists should evaluate affected patients.

Historical note and terminology

Céstan and LeJonne at l'Hôpital de la Salpêtrière in Paris published what may have been the first case reports of Emery-Dreifuss muscular dystrophy at the beginning of the twentieth century (22). Emery and Dreifuss were the first to fully describe the X-linked form of the disease in a kindred from Virginia (43). Rowland and colleagues at Columbia University in New York reported an additional case in 1979 and applied the term "Emery-Dreifuss type” muscular dystrophy (114). Cases of autosomal inheritance were subsequently reported in the mid-1980s, showing this phenotype to derive from different genetic mutations (90; 125).

Toniolo and colleagues identified EMD (formerly called STA) as the gene on chromosome Xq28 mutated in X-linked Emery-Dreifuss muscular dystrophy (14). In 1999, Ketty Schwartz and collaborators demonstrated that mutations in LMNA on chromosome 1q21.3 cause autosomal dominant cases of Emery-Dreifuss muscular dystrophy (16). The protein products of these genes are localized to the nuclear envelope of virtually all somatic cells. Case reports have further implicated mutations in genes encoding other nuclear envelope proteins as causing Emery-Dreifuss-like phenotypes: mutations in SYNE1 and SYNE2 respectively encoding nesprin1 and nesprin2 (140; 29; 142), TMEM43 encoding LUMA (71), and TOR1AIP1 encoding lamina-associated polypeptide 1 (61), SUN1 and SUN2 (82). Hence, although historically considered a specific disease, more recent advances in genetics have shown that Emery-Dreifuss muscular dystrophy is best considered a syndrome that can result from alterations in several different genes encoding nuclear envelope proteins.

Mutations in FHL1 encoding four-and-a-half-LIM protein 1, a protein localized to the sarcolemma, sarcomere, and nucleus of muscle cells, cause a scapuloperoneal myopathy (110). Some investigators have considered this to be Emery-Dreifuss muscular dystrophy (57). However, the associated cardiomyopathy is hypertrophic rather than dilated (57; 51). Although the distribution of affected skeletal muscle may therefore be similar, this is a distinction from Emery-Dreifuss muscular dystrophy and related phenotypes caused by mutations in genes encoding nuclear envelope proteins.

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