Circ J 2009; 73: 158 -161 diopathic cardiomyopathy (ICM), which is mainly classified into 2 clinical phenotypes; hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM), is a primary heart muscle disorder caused by functional abnormalities in the cardiomyocytes and a major cause of sudden cardiac death and progressive heart failure. 1 Although the etiology of ICM has not been completely elucidated, recent molecular genetic studies have shown that ICM can be caused by a variety of genetic abnormalities. 1 Inheritance of familial HCM is usually autosomal dominant, whereas that of familial DCM is autosomal dominant, autosomal recessive, or X-linked recessive, ie, various type of disease inheritance can be found in DCM cases. 2,3 It also should be noted that causative gene mutations could be found not only in familial cases but also in sporadic cases, indicating that the absence of family history cannot exclude a possibility of causative gene mutation in ICM cases. 3 In addition, mutations in muscular dystrophy-causing genes might also lead to ICM phenotype, as exemplified that titin/connectin gene (TTN) mutations were found in patients with HCM, 4 DCM 5 or tibial musclular dystrophy and limb-girdle type muscular dystrophy (LGMD) 6 and that Tcap gene (TCAP) mutations were found in HCM and DCM, 7 as well as in LGMD. 8 These observations indicate that there is an etiological overlap between ICM, and the skeletal muscle disorders. 9 Mutations in FKTN encoding for fukutin cause Fukuyamatype congenital muscular dystrophy (FCMD; MIM253800), the second most common muscular dystrophy in Japan after Duchenne muscular dystrophy. FCMD is an autosomal recessive disease manifested with severe muscle wasting and mental retardation. 10,11 The majority of the FCMD patients were homozygous for a 3-kb insertion in the 3' non-coding region of FKTN, whereas a small population of FCMD patients were compound heterozygotes of the 3-kb insertion and a missense mutation. 12,13 In addition, we recently identified compound heterozygotes of the insertion and a missense mutation in 2 sibling cases and 2 sporadic cases of DCM, who manifested with minimal muscle weakness and elevated serum creatine kinase (CK) concentration, hyperCKemia, but not mental retardation. 14 However, it remains unknown whether FKTN mutation can be associated with ICM not accompanied by signs of muscular dystrophy and in which type of ICM patients who should be examined for FKTN mutations as a disease-causing gene.In the present study, we searched for FKTN mutations in a large panel of patients with DCM or HCM. We found a compound heterozygote of FKTN mutations in 1 out of 172 DCM patients, who also had mild muscular dystrophy and hyper-CKemia. There was a DCM patient who was a compound heterozygote of a 3-kb insertion mutation and a missense mutation Cys101Phe. The patient showed hyper-CKemia with mild muscle involvement and no brain involvement. In contrast, 2 other DCM patients and 3 controls were heterozygous for the insertion mutation and normal alle...