Mutations in the genes that code for collagen VI subunits, COL6A1, COL6A2, and COL6A3, are the cause of the autosomal dominant disorder, Bethlem myopathy. Although three different collagen VI structural mutations have previously been reported, the effect of these mutations on collagen VI assembly, structure, and function is currently unknown. We have characterized a new Bethlem myopathy mutation that results in skipping of COL6A1 exon 14 during pre-mRNA splicing and the deletion of 18 amino acids from the triple helical domain of the ␣1(VI) chain. Sequencing of genomic DNA identified a G to A transition in the ؉1 position of the splice donor site of intron 14 in one allele. The mutant ␣1(VI) chains associated intracellularly with ␣2(VI) and ␣3(VI) to form disulfide-bonded monomers, but further assembly into dimers and tetramers was prevented, and molecules containing the mutant chain were not secreted. This triple helical deletion thus resulted in production of half the normal amount of collagen VI. To further explore the biosynthetic consequences of collagen VI triple helical deletions, an ␣3(VI) cDNA expression construct containing a 202-amino acid deletion within the triple helix was produced and stably expressed in SaOS-2 cells. The transfected mutant ␣3(VI) chains associated with endogenous ␣1(VI) and ␣2(VI) to form collagen VI monomers, but dimers and tetramers did not form and the mutantcontaining molecules were not secreted. Thus, deletions within the triple helical region of both the ␣1(VI) and ␣3(VI) chains can prevent intracellular dimer and tetramer assembly and secretion. These results provide the first evidence of the biosynthetic consequences of structural collagen VI mutations and suggest that functional protein haploinsufficiency may be a common pathogenic mechanism in Bethlem myopathy.Bethlem myopathy is a mild dominantly inherited disorder characterized by early childhood onset of generalized muscle weakness and wasting and, commonly, contractures of multiple joints (1, 2). Mutations resulting in Bethlem myopathy have recently been identified in three genes, COL6A1, COL6A2, and COL6A3, that code for subunits of the extracellular matrix protein collagen VI (3-5). The constituent collagen VI chains, ␣1(VI), ␣2(VI), and ␣3(VI), each contain a central triple helixforming domain of repeating Gly-X-Y sequences, flanked by large N-and C-terminal regions primarily composed of ϳ200-amino acid subdomains that have homology to von Willibrand factor type A domains (6 -8). Stable collagen VI monomers are formed when the three chains associate intracellularly and assemble into disulfide-bonded helical heterotrimers (9). However, in contrast to other collagens, these molecules are not then secreted but assemble further within the cell into antiparallel overlapping dimers and then tetramers, which are stabilized by intermolecular disulfide bonds. Following secretion, tetramers link end-to-end to form characteristic beaded microfibrils (10, 11).Three of the described Bethlem myopathy mutations are glycine subs...