Vacuolar aggregate myopathy (VAM, OMIM# 616231) is a rare human muscle disorder, linked to mutations in CASQ1 and presents with elevated serum creatine kinase, fatigue, myalgia, muscle cramps, lower limb hypertrophy, and muscle weakness. [1][2][3][4] Muscles from VAM patients frequently contain protein aggregates and an increased number of vacuoles. [1][2][3][4] Mutation of a conserved aspartic acid at position D244 to glycine (D244G, DG) in CASQ1 associated with VAM in humans slows sarcoplasmic reticulum (SR) Ca 2+ release and impairs polymerization of CASQ1. [1][2][3]5 Although the age at which VAM is diagnosed is variable, adults in their sixth decade are the most likely to experience muscle weakness and exercise intolerance. 1,3 Vacuoles and protein aggregates form mainly in Type II muscle fibers which stain positive for both the mutated protein and several non-mutated proteins, 1-4 suggesting the mutated proteins cause misfolding and aggregation of normal proteins. 6