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The Bethlem myopathy is a rare autosomal dominant proximal myopathy characterized by early childhood onset and joint contractures. Evidence for linkage and genetic heterogeneity has been established, with the majority of families linked to 21q22.3 and one large family linked to 2q37, implicating the three type VI collagen subunit genes,  COL6A1  (chromosome 21),  COL6A2  (chromosome 21) and  COL6A3  (chromosome 2) as candidate genes. Mutations of the invariant glycine residues in the triple-helical domain-coding region of  COL6A1  and  COL6A2  have been reported previously in the chromosome 21-linked families. We report here the identification of a G→A mutation in the N-terminal globular domain-coding region of  COL6A3  in a large American pedigree (19 affected, 12 unaffected), leading to the substitution of glycine by glutamic acid in the N2 motif, which is homologous to the type A domains of the von Willebrand factor. This mutation segregated to all affected family members, to no unaffected family members, and was not identified in 338 unrelated Caucasian control chromosomes. Thus mutations in either the triple-helical domain or the globular domain of type VI collagen appear to cause Bethlem myopathy.

Missense Mutation in a Von Willebrand Factor Type a Domain of the α3(VI) Collagen Gene ( COL6A3 ) in a Family with Bethlem Myopathy