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The importance of seeking ALMS1 mutations in infants with dilated cardiomyopathy
  1. J Bond1,*,
  2. K Flintoff2,*,
  3. J Higgins1,
  4. S Scott1,
  5. C Bennet3,
  6. J Parsons4,
  7. J Mannon5,
  8. H Jafri6,
  9. Y Rashid7,
  10. M Barrow8,
  11. R Trembath8,
  12. G Woodruff9,
  13. E Rossa10,
  14. S Lynch11,
  15. J Sheilds12,
  16. R Newbury-Ecob13,
  17. A Falconer14,
  18. P Holland15,
  19. D Cockburn2,
  20. G Karbani3,
  21. S Malik3,
  22. M Ahmed3,
  23. E Roberts1,
  24. G Taylor2,
  25. C G Woods1,3
  1. 1Molecular Medicine Unit, St James’s University Hospital, Leeds, UK
  2. 2Regional DNA Laboratory, St James’s University Hospital, Leeds, UK
  3. 3Department of Clinical Genetics, St James’s University Hospital, Leeds, UK
  4. 4Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, UK
  5. 5Department of Paediatrics, Fatima Jinah Hospital, Lahore, Pakistan
  6. 6Genetech Laboratory, Jail Road, Lahore, Pakistan
  7. 7Department of Obstetrics and Gynaecology, Lady Wellington Hospital, Lahore, Pakistan
  8. 8Department of Clinical Genetics, Leicester Royal Infirmary, Leicester, UK
  9. 9Department of Ophthalmology, Leicester Royal Infirmary, Leicester, UK
  10. 10Department of Clinical Genetics, Great Ormond Street Hospital, London, UK
  11. 11Department of Clinical Genetics, Centre For Life, Newcastle-upon-Tyne, UK
  12. 12Department of Paediatrics, Bristol Children’s Hospital, Bristol, UK
  13. 13Department of Clinical Genetics, Bristol Children’s Hospital, Bristol, UK
  14. 14Department of Paediatrics, Scarborough General Hospital, Scarborough, UK
  15. 15Department of Paediatrics, Leeds General Infirmary, Leeds, UK
  1. Correspondence to:
 Dr J Bond
 Molecular Medicine Unit, Clinical Sciences Building, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK;

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As part of a clinical study of Alström syndrome (MIM 203800) we sequentially ascertained seven families. Four of the families, pedigrees A–D (table 1), were consanguineous. In total there were 16 living affected individuals, aged 3–25 years. All had cone rod dystrophy that presented in the first 3 months of life with photophobia and nystagmus. The cone rod dystrophy progressed and all were registered blind by the end of the first decade. By the middle of the first decade a characteristic appearance of sunken eyes and a prominent supra-orbital ridge had developed (fig 1A). Truncal obesity became apparent in the first few years of life and all exhibited acanthosis nigricans in their teenage years. None has yet developed symptomatic diabetes. All males of sufficient age failed to enter puberty without hormone support and thereafter developed a female fat distribution (fig 1B). Deafness developed in all cases by the end of the first decade, but varied in severity and symmetry within and between families. All affected individuals were of normal intelligence though they experienced educational difficulties because of their combined and progressive sensory deficits. In all seven families other diagnoses had been made prior to the final diagnosis of Alström syndrome, presumably because of the rarity of the condition and the sequential presentation of disease features.1,2

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Table 1

 Mutations in ALMS1 causing premature protein truncation in Alström syndrome patients exhibiting early onset cardiomyopathy

Figure 1

 Face and body habitus of a study patient with Alström syndrome. (A) The face showing the deep set eyes, a feature that develops in the first few years. (B) The body of a teenage affected male, showing obesity and a female pattern of fat distribution. (Photographs reproduced with permission.)

In all seven families the index case had presented with symptoms …

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  • * These authors contributed equally to the paper.

  • JB, JH, SS, ER, and CGW are funded by the Wellcome Trust.

  • Conflict of interest: none declared.

  • Ethical approval: the study was approved by the Ethical Committee of the Combined Leeds Health Care Trusts. Informed consent was obtained from all subjects involved in the study and when under 18 years of age, also from their parents.

    Primer sequences used for sequencing ALMS1 and for confirming the exon 9 deletion are available from the corresponding author.