- Swaggart, Kayleigh A;
- Demonbreun, Alexis R;
- Vo, Andy H;
- Swanson, Kaitlin E;
- Kim, Ellis Y;
- Fahrenbach, John P;
- Holley-Cuthrell, Jenan;
- Eskin, Ascia;
- Chen, Zugen;
- Squire, Kevin;
- Heydemann, Ahlke;
- Palmer, Abraham A;
- Nelson, Stanley F;
- McNally, Elizabeth M
Many monogenic disorders, including the muscular dystrophies, display phenotypic variability despite the same disease-causing mutation. To identify genetic modifiers of muscular dystrophy and its associated cardiomyopathy, we used quantitative trait locus mapping and whole genome sequencing in a mouse model. This approach uncovered a modifier locus on chromosome 11 associated with sarcolemmal membrane damage and heart mass. Whole genome and RNA sequencing identified Anxa6, encoding annexin A6, as a modifier gene. A synonymous variant in exon 11 creates a cryptic splice donor, resulting in a truncated annexin A6 protein called ANXA6N32. Live cell imaging showed that annexin A6 orchestrates a repair zone and cap at the site of membrane disruption. In contrast, ANXA6N32 dramatically disrupted the annexin A6-rich cap and the associated repair zone, permitting membrane leak. Anxa6 is a modifier of muscular dystrophy and membrane repair after injury.