In myotonic dystrophy, muscleblind-like protein 1 (MBNL1) protein binds specifically to expanded CUG or CCUG repeats, which accumulate as discrete nuclear foci, and this is thought to prevent its function in the regulation of alternative splicing of pre-mRNAs. There is strong evidence for the role of the MBNL1 gene in disease pathology, but the roles of two related genes, MBNL2 and MBNL3, are less clear. Using new monoclonal antibodies specific for each of the three gene products , we found that MBNL2 decreased during human fetal development and myoblast culture , while MBNL1 was unchanged. In Duchenne muscular dystrophy muscle , MBNL2 was elevated in immature , regenerating fibres compared with mature fibres , supporting some developmental role for MBNL2. MBNL3 was found only in C2C12 mouse myoblasts. Both MBNL1 and MBNL2 were partially sequestered by nuclear foci of expanded repeats in adult muscle and cultured cells from myotonic dystrophy patients. In adult muscle nucleoplasm , both proteins were reduced in myotonic dystrophy type 1 compared with an age-matched control. In normal human myoblast cultures , MBNL1 and MBNL2 always co-distributed but their distribution could change rapidly from nucleoplasmic to cytoplasmic. Myotonic dystrophy type 1 (DM1) is a progressive multisystemic disorder showing considerable clinical variation between individuals. DM1 is characterized by skeletal muscle weakness, wasting and pain, as well as myotonia.1 Other symptoms may include cardiac arrhythmias, cataracts, insulin resistance, hypogonadism, neurological problems and premature male balding.1-4 The genetic mutation responsible for DM1 has been identified as the expansion of a CTG repeat in exon 15 in the 3Ј-untranslated region of the DM protein kinase (DMPK) gene on chromosome 19q13.3. [5][6][7] The largest germline expansions occur during maternal transmission but the length of repeats may also increase somatically in affected individuals. 8 The size of the CTG expansion is related to the disease severity. More than 50 CTG repeats cause mild to classical adult-onset DM and 700 to greater than 3000 repeats often result in the severe congenital form of the disease. However, repeat size in muscle and other tissues can be much higher than in lymphocytes.9 A second form of DM (DM2) is due to a CCTG repeat in intron 1 of the ZNF9 gene on chromosome 3q21.3.
10Clinical features of DM1 and DM2 are similar but not identical. DM2 patients may show proximal rather than distal muscle involvement, and the severe congenital form occurs in DM1 only. The number of repeats in DM2 may be 10-fold greater than in DM1.