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Neuromuscul Disord. 2018 Aug;28(8):625-632. doi: 10.1016/j.nmd.2018.05.005. Epub 2018 May 17.

Limb girdle muscular dystrophy 2G in a religious minority of Bulgarian Muslims homozygous for the c.75G>A, p.Trp25X mutation.

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Department of Neurology, University Hospital "Alexandrovska", Medical University, Sofia, Bulgaria. Electronic address:
National Genetics Laboratory, Medical University, Sofia, Bulgaria.
Genetic Medico-Diagnostic Laboratory 'Genica", Sofia, Bulgaria.
Department of Cardiology, Medical Institute of Ministry of Interior Affairs, Sofia, Bulgaria.
Department of Neurology, University Hospital "Alexandrovska", Medical University, Sofia, Bulgaria.
Department of Diagnostic Imaging, University Hospital "Alexandrovska", Medical University, Sofia, Bulgaria.
Department of Neurology, Multiprofile hospital, Smolian, Bulgaria.
Clinic of Neurology, University Hospital Sofiamed, Sofia, Bulgaria.
Department of Medical genetic, University Hospital "St. George", Plovdiv, Bulgaria.
Department of Anesthesiology and Intensive Care, University Hospital "Alexandrovska", Sofia, Bulgaria.
Children's Hospital Technical University Dresden, Germany.
Friedrich-Baur-Institut, Neurologische Klinik, Klinikum der Universität München, München, Germany.
Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Catalonia, Spain.
Genetic Medico-Diagnostic Laboratory 'Genica", Sofia, Bulgaria; Department of Medical Chemistry and Biochemistry, Sofia, Bulgaria.
Department of Neurology, University Hospital "Alexandrovska", Medical University, Sofia, Bulgaria; Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria.


Mutations in TCAP gene cause autosomal recessive limb-girdle muscular dystrophy type 2G (LGMD2G), congenital muscular dystrophy and autosomal dominant dilated and hypertrophic cardiomyopathy. We studied 18 affected individuals from 12 pedigrees, belonging to a Bulgarian Muslim minority from the South-West of Bulgaria, homozygous for the c.75G>A, p.Trp25X mutation in TCAP gene. The heterozygous carrier rate of p.Trp25X among 100 newborns in this region was found to be 2%. The clinical features in the Bulgarian TCAP group include disease onset in the first to the third decade of life, proximal muscle weakness in the lower limbs, followed or accompanied by difficulties in ankle dorsiflexion and involvement of the proximal muscles of the upper limbs 5-9 years after the disease onset. Asymmetry between left and right was present in more than 20% of the affected. Respiratory and cardiac functions were not affected. On the MRI the muscles of the posterior pelvic area, thigh and anterior leg were predominantly affected, while sartorius, gracilis and biceps femoris muscles remained relatively spared. In conclusion, LGMD2G appears to be a common form among Bulgarian Muslims. Homozygosity for c.75G>A, p.Trp25X is associated with a homogeneous clinical presentation, but the clinical course and severity of the disease show inter- and intra-familial variation.


Asymmetry; Bulgarian Muslims; LGMD2G; TCAP gene


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