Mutations in the NEB gene cause Fetal Akinesia/Arthrogryposis Multiplex Congenita.

OBJECTIVE:We studied a series of patients with fetal akinesia deformation sequence (FADS)/arthrogryposis multiplex congenita (AMC), with nemaline bodies on muscle specimens, that revealed mutations in the NEB gene. METHOD:We pathologically assessed seven cases from three families, who presented with AMC/FADS. Targeted genetic analysis for Ashkenazi Jewish (AJ) mutation (in relevant patients) was followed by next generation sequencing and Multiplex Ligation-dependent Probe Amplification. RESULTS:All cases were detected on prenatal ultrasound. Characteristic nemaline bodies on muscle specimens were demonstrated in at least one case in each of the nuclear families. In the AJ family, the known founder mutation was compounded by one recurrent novel splice-site. The other two families were of Chinese and Korean origins, and only one pathogenic heterozygous mutation was detected in each. CONCLUSIONS:Nemaline myopathy due to NEB mutation(s), leads to FADS/AMC. Currently, mutated NEB is under recognized as a cause for AMC/FADS. Our study attempts to raise recognition of this gene as a cause, suggesting the NEB gene should be included in genetic panels used for FADS/AMC cases and be fully covered when EXOME sequencing is utilized. Heterozygous mutation may suggest either compounding undetected one or di-genic interaction that requires further genetic analyses.

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