dHMN-5C

BSCL2 | 2004

What Is dHMN-5C?

dHMN-5C is a type of CMT caused by autosomal dominant mutations in the BSCL2 gene. This gene provides instructions for making seipin, a protein important to the function and survival of motor nerve cells. Mutations in the BSCL2 gene disrupt this function, leading to impaired nerve signal transmission.

dHMN-5C is autosomal dominant, meaning that just one of the gene’s two copies needs a mutation to cause this subtype.

Clinical Features

The age of symptom onset in dHMN-5C is variable, ranging from childhood to adulthood. As a motor neuropathy, dHMN-5C primarily affects the most distal points, with weakness and atrophy of the feet and hands, and little to no involvement of the sensory nerves. Nerve conduction studies usually show somewhat slowed conduction velocities and reduced amplitudes, consistent with an axonal form of CMT.

dHMN-5C symptoms may include:

  • Weakness and atrophy in the feet and lower legs
  • Foot drop
  • Brisk reflexes
  • A steppage-style walking pattern
  • Foot deformities, including high arches, and hammertoes (clawed toes)
  • Progressive involvement of the hands
  • Difficulty with fine motor skills and manual dexterity
  • Additional symptoms not listed here

Disease Course

dHMN-5C shows wide variability in severity and progression. Some individuals are mildly affected, while others develop a more severe disease. Disease progression is generally slow, and life expectancy is not reduced.

Clinical Basics

Subtype
dHMN-5C

Classification
dHMN/HMN

Neuropathy Type
Axonal

Inheritance Pattern
autosomal dominant

Genetic Context

HGNC-Approved Gene Symbol
BSCL2

Gene Full Name
BSCL2 lipid droplet biogenesis associated, seipin

Chromosome
11q12.3

Zygosity of Responsible Variant
Heterozygous

Variant Mechanism

Toxic Gain of Function (GoF)

Details

Mechanistic basis:
Neomorphic

Confidence:
High

Prediction:
The literature predicts a toxic gain-of-function mechanism for dHMN-5C: the dominant BSCL2 substitutions N88S and S90L abolish an N-glycosylation site in seipin, and the unglycosylated protein misfolds, is retained in the endoplasmic reticulum, forms inclusions, and triggers an ER stress response that motor neurons tolerate poorly. Biallelic BSCL2 loss instead causes Berardinelli-Seip congenital lipodystrophy, a disease of absent seipin rather than of a retained misfolded one, and adding normal seipin is not predicted to relieve the ER burden.

Rationale:
Stripping the glycosylation site turns seipin into an ER-retained aggregate, so the injury comes from what the mutant protein does inside the secretory pathway, not from what the cell is missing. The contrast at this locus is sharp: two null alleles give lipodystrophy with no motor involvement, while one misfolding allele gives distal motor degeneration with no lipodystrophy.

ClinVar Pathogenic Variants

View BSCL2 ClinVar Variants

dHMN-5C OMIM Entry

dHMN-5C OMIM

BSCL2 OMIM Entry

BSCL2 OMIM

More Info

dHMN-5C Research Opportunity

CMT Natural History Study

Original Discovery Publication

Publication Title

Heterozygous Missense Mutations in BSCL2 are Associated with Distal Hereditary Motor Neuropathy and Silver syndrome

Authors

Windpassinger, C., Auer-Grumbach, M., Irobi, J., Patel, H., Petek, E., Hörl, G., Malli, R., Reed, J. A., Dierick, I., Verpoorten, N., Warner, T. T., Proukakis, C., Van den Bergh, P., Verellen, C., Van Maldergem, L., Merlini, L., De Jonghe, P., Timmerman, V., Crosby, A. H., & Wagner, K.

Publication Date
February 22, 2004

Updated: July 18, 2026 | By: K. Raymond

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