Late adult-onset of X-linked myopathy with excessive autophagy

Cameron D. Crockett, Alessandra Ruggieri, Meena Gujrati, Christopher M. Zallek, Nivetha Ramachandran, Berge A. Minassian, Steven A. Moore

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Introduction: X-linked myopathy with excessive autophagy (XMEA) is characterized by autophagic vacuoles with sarcolemmal features. Mutations in VMA21 result in insufficient lysosome acidification, causing progressive proximal weakness with onset before age 20 years and loss of ambulation by middle age. Methods: We describe a patient with onset of slowly progressive proximal weakness of the lower limbs after age 50, who maintains ambulation with the assistance of a cane at age 71. Results: Muscle biopsy at age 66 showed complex muscle fiber splitting, internalized capillaries, and vacuolar changes characteristic of autophagic vacuolar myopathy. Vacuoles stained positive for sarcolemmal proteins, LAMP2, and complement C5b-9. Ultrastructural evaluation further revealed basal lamina reduplication and extensive autophagosome extrusion. Sanger sequencing identified a known pathologic splice site mutation in VMA21 (c.164-7T>G). Conclusions: This case expands the clinical phenotype of XMEA and suggests VMA21 sequencing be considered in evaluating men with LAMP2-positive autophagic vacuolar myopathy.

Original languageEnglish (US)
Pages (from-to)138-144
Number of pages7
JournalMuscle and Nerve
Issue number1
StatePublished - Jul 2014


  • Autophagic vacuolar myopathy
  • Autophagic vacuoles with sarcolemmal features
  • Progressive proximal muscle weakness
  • VMA21
  • X-linked myopathy with excessive autophagy

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Physiology (medical)


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