Persistent Feed Intolerance -Harbinger of Underlying Novel MYH11 Mutation and Visceral Myopathy Type2


Authors : Arpita Roy Ghatak; Abhishek S Aradhya; Venugopal Reddy I; Vedarth Dash; Vuppu Dinesh Kumar

Volume/Issue : Volume 10 - 2025, Issue 6 - June


Google Scholar : https://tinyurl.com/59zhkfne

DOI : https://doi.org/10.38124/ijisrt/25jun1399

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.


Abstract : Feed intolerance is a common clinical concern in preterm neonates. These infants are expected to outgrow this phase but may require varying degrees of pharmacological and non-pharmacological support. In rare cases, feed intolerance may be linked to a surgical condition and could involve an underlying genetic mutation. In such instances, managing these infants poses unique challenges. We report a clinical case of feeding intolerance, congenital hypertrophic pyloric stenosis, intestinal dysmotility, cryptorchidism, and thickened skin in a preterm neonate associated with a novel mutation in the MYH11 gene. This preterm infant presented with feeding intolerance initially attributed to congenital hypertrophic pyloric stenosis. Following surgery, he continued to experience feeding intolerance despite receiving nutrition through a jejunostomy tube, raising concerns about a potential functional obstruction. This intestinal dysmotility was genetically confirmed due to a mutation in the myosin heavy chain (MYH11 gene).

Keywords : Feed Intolerance, MYH11 Gene, Chronic Intestinal Pseudoobstruction, Intestinal Dysmotility.

References :

  1. Dong W, Baldwin C, Choi J, et al. Identification of a dominant MYH11 causal variant in chronic intestinal pseudo-obstruction: Results of whole-exome sequencing. Clin Genet. 2019;96(5):473-477. doi:10.1111/cge.13617
  2. Gilbert MA, Schultz-Rogers L, Rajagopalan R, et al. Protein-elongating mutations in MYH11 are implicated in a dominantly inherited smooth muscle dysmotility syndrome with severe esophageal, gastric, and intestinal disease. Hum Mutat. 2020;41(5):973-982. doi:10.1002/humu.23986
  3. Wang Q, Zhang J, Wang H, Feng Q, Luo F, Xie J. Compound heterozygous variants in MYH11 underlie autosomal recessive megacystis-microcolon-intestinal hypoperistalsis syndrome in a Chinese family. J Hum Genet. 2019 Nov;64(11):1067-1073. doi: 10.1038/s10038-019-0651-z.
  4. Schuffler MD, Pagon RA, Schwartz R, Bill AH. Visceral myopathy of the gastrointestinal and genitourinary tracts in infants. Gastroenterology. 1988;94(4):892-898. doi:10.1016/0016-5085(88)90544-6
  5. Thapar N, Saliakellis E, Benninga MA, et al. Paediatric Intestinal Pseudo-obstruction: Evidence and Consensus-based Recommendations From an ESPGHAN-Led Expert Group. J Pediatr Gastroenterol Nutr. 2018;66(6):991-1019. doi:10.1097/MPG.0000000000001982
  6. Klar J, Raykova D, Gustafson E, et al. Phenotypic expansion of visceral myopathy associated with ACTG2 tandem base substitution. Eur J Hum Genet. 2015;23(12):1679-1683. doi:10.1038/ejhg.2015.49
  7. Online Mendelian Inheritance in Man (OMIM), Johns Hopkins University, Baltimore, MD. MIM Number:155310: August 12, 2021 [May 25,2025].
  8. Online Mendelian Inheritance in Man (OMIM), Johns Hopkins University, Baltimore, MD. MIM Number:619350: May 13, 2025 [May 25,2025].
  9. Harakalova M, van der Smagt J, de Kovel CGF, et al. Incomplete segregation of MYH11 variants with thoracic aortic aneurysms and dissections and patent ductus arteriosus. Eur J Hum Genet. 2013;21(5):487-493. doi:10.1038/ejhg.2012.206
  10. Milewicz DM, Guo DC, Tran-Fadulu V, et al. Genetic basis of thoracic aortic aneurysms and dissections: focus on smooth muscle cell contractile dysfunction. Annu Rev Genomics Hum Genet. 2008;9:283-302.  doi:10.1146/annurev.genom.8.080706.092303
  11. Pannu H, Tran-Fadulu V, Papke CL, et al. MYH11 mutations result in a distinct  vascular pathology driven by insulin-like growth factor 1 and angiotensin II. Hum Mol Genet. 2007;16(20):2453-2462. doi:10.1093/hmg/ddm201
  12. Renard M, Callewaert B, Baetens M, et al. Novel MYH11 and ACTA2 mutations reveal a role for enhanced TGFβ signaling in FTAAD. Int J Cardiol. 2013;165(2):314-321. doi:10.1016/j.ijcard.2011.08.079
  13. Zhu L, Vranckx R, Khau Van Kien P, et al. Mutations in myosin heavy chain 11 cause a syndrome associating thoracic aortic aneurysm/aortic dissection and patent ductus arteriosus. Nat Genet. 2006;38(3):343-349. doi:10.1038/ng1721
  14. White JS, Clements WDB, Heggarty P, Sidhu S, Mackle E, Stirling I. Treatment of infantile hypertrophic pyloric stenosis in a district general hospital: a review of 160 cases. J Pediatr Surg. 2003;38(9):1333-1336. doi:10.1016/s0022-3468(03)00391-9
  15. Viti F, De Giorgio R, Ceccherini I, et al. Multi-disciplinary Insights from the First European Forum on Visceral Myopathy 2022 Meeting. Dig Dis Sci. 2023;68(10):3857-3871. doi:10.1007/s10620-023-08066-1

Feed intolerance is a common clinical concern in preterm neonates. These infants are expected to outgrow this phase but may require varying degrees of pharmacological and non-pharmacological support. In rare cases, feed intolerance may be linked to a surgical condition and could involve an underlying genetic mutation. In such instances, managing these infants poses unique challenges. We report a clinical case of feeding intolerance, congenital hypertrophic pyloric stenosis, intestinal dysmotility, cryptorchidism, and thickened skin in a preterm neonate associated with a novel mutation in the MYH11 gene. This preterm infant presented with feeding intolerance initially attributed to congenital hypertrophic pyloric stenosis. Following surgery, he continued to experience feeding intolerance despite receiving nutrition through a jejunostomy tube, raising concerns about a potential functional obstruction. This intestinal dysmotility was genetically confirmed due to a mutation in the myosin heavy chain (MYH11 gene).

Keywords : Feed Intolerance, MYH11 Gene, Chronic Intestinal Pseudoobstruction, Intestinal Dysmotility.

CALL FOR PAPERS


Paper Submission Last Date
31 - July - 2025

Video Explanation for Published paper

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe