Figure 2. Clinical features and inheritance of ACTG2 mutations in de novo and familial cases.

Family pedigrees with clinical features correlated with the severity of smooth muscle dysfunction are shown. The most severe features of TPN dependence and megacystic bladder noted as dark squares within the upper quarters. The diagnosis of MMIHS (orange) was made in all but one subject with de novo ACTG2 mutations. One subject (Fam 12-1) was diagnosed with gastrointestinal hollow visceral myopathy but had megacystis prenatally. Three families exhibiting dominant inheritance patterns are depicted below. One subject (Fam 13-1) suffered from a megacystic bladder but had later onset functional GI pseudo-obstruction. Another family (Fam19) is shown with two affected siblings with functional GI obstruction. Both carry a nonsynonymous mutation in alternate exon 4 of a predicted short ACTG2 isoform (Uc010fex.1 indicated by *). Another family exhibited more extensive dominant inheritance (Fam34) consistent with familial visceral myopathy. Multiple paternal relatives suffer from episodes of gastrointestinal obstruction, constipation, gastrointestinal dysmotility, and bladder dysmotility segregating with the same mutation.