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FLNC – Myofibrillar Myopathy 5

Filamin C (FLNC) encodes an actin-crosslinking protein critical for sarcomeric integrity in skeletal muscle. Heterozygous variants in FLNC are established causes of autosomal dominant myofibrillar myopathy 5 (Myofibrillar Myopathy 5), characterized by progressive muscle weakness and intracellular protein aggregates.

Genetic Evidence

Autosomal dominant inheritance is supported by segregation of FLNC variants in at least three unrelated families with >20 affected individuals. In a large Chinese kindred, an in-frame 18-nt deletion/6-nt insertion in exon 18 (c.2695_2712delinsGTTTGT causing p.Lys899_Glu904delinsValCys) co-segregated with myopathy and chronic diarrhea (HP:0002028) (PMID:20417099). Other pedigrees harbor truncating and missense mutations in Ig-like and dimerization domains.

Variant Spectrum

Reported variants include truncating alleles (e.g., c.8130G>A (p.Trp2710Ter)), in-frame indels, and missense changes clustering in rod and dimerization domains. These variants show co-segregation with myopathic features and typical myofibrillar pathology across kindreds.

Functional Evidence

Biochemical and cell-culture studies demonstrate that FLNC truncations and rod-domain mutations destabilize the dimerization domain, promote proteolysis, and lead to aggregates in muscle fibers (PMID:17412757). Knock-in mouse models of p.Trp2710X recapitulate protein aggregation and mechanosensing defects, confirming a dominant-negative mechanism.

Conflicting Evidence

No substantive refuting or alternative gene associations for MFM 5 have been reported to date.

Integration and Clinical Utility

Collectively, genetic and experimental data support a Strong FLNC–Myofibrillar Myopathy 5 association. FLNC testing should be included in diagnostic myopathy panels, and identification of pathogenic variants informs prognosis and familial risk.

Key Take-home: Autosomal dominant FLNC variants induce toxic protein aggregation and misfolding, underpinning myofibrillar myopathy 5 and warrant inclusion in genetic diagnostics.

References

  • Neuromuscular disorders • 2010 • A novel heterozygous deletion-insertion mutation (2695-2712 del/GTTTGT ins) in exon 18 of the filamin C gene causes filaminopathy in a large Chinese family. PMID:20417099
  • Human molecular genetics • 2007 • The pathomechanism of filaminopathy: altered biochemical properties explain the cellular phenotype of a protein aggregation myopathy. PMID:17412757
  • Neurology. Genetics • 2021 • FLNC-Associated Myofibrillar Myopathy: New Clinical, Functional, and Proteomic Data. PMID:34235269

Evidence Based Scoring (AI generated)

Gene–Disease Association

Strong

Three unrelated families with autosomal dominant FLNC variants in >20 probands, multi-family segregation, concordant functional data

Genetic Evidence

Strong

Multiple FLNC truncating and missense variants co-segregate with myofibrillar myopathy across kindreds; reached genetic evidence cap

Functional Evidence

Moderate

Biochemical and cellular models show mutant FLNc misfolding, aggregation, and impaired dimerization; mouse knock-in replicates pathology