Hypertrophic cardiomyopathy (HCM) is caused by mutations in genes encoding sarcomere proteins. Mutations in MYL3, encoding the essential light chain of myosin, are rare and have been associated with sudden death. Both recessive and dominant patterns of inheritance have been suggested. We studied a large family with a 38-year-old asymptomatic HCM-affected male referred because of a murmur. The patient had HCM with left ventricular hypertrophy (max WT？21？mm), a resting left ventricular outflow gradient of 36？mm？Hg, and left atrial dilation (54？mm). Genotyping revealed heterozygosity for a novel missense mutation, p.V79I, in MYL3. The mutation was not found in 300 controls, and the patient had no mutations in 10 sarcomere genes. Cascade screening revealed a further nine heterozygote mutation carriers, three of whom had ECG and/or echocardiographic abnormalities but did not fulfil diagnostic criteria for HCM. The penetrance, if we consider this borderline HCM the phenotype of the p.V79I mutation, was 40%, but the mean age of the nonpenetrant mutation carriers is 15, while the mean age of the penetrant mutation carriers is 47. The mutation affects a conserved valine replacing it with a larger isoleucine residue in the region of contact between the light chain and the myosin lever arm. In conclusion, MYL3 mutations can present with low expressivity and late onset. 1. Introduction Hypertrophic cardiomyopathy (HCM) is an autosomal dominant genetic disease caused by mutations in genes which encode sarcomeric proteins [1–4]. The most frequently affected genes are MYH7 [5], MYBPC3 [6], and TNNT2 [7], coding for the heavy chain of myosin, the myosin-binding protein-C, and troponin T, respectively. More than 200 mutations have been described in these genes. Furthermore, mutations in a number of other genes, for example, mitochondrial genes [8] have been associated with HCM, albeit at a much lower frequency. Among the rare causes of HCM [9] are mutations in MYL3 which encodes the myosin essential light chain (ELC) of the sarcomere [4, 10–19]. The ELC is located at the lever arm of the myosin head and stabilises this region (Figure 1) through interaction with the IQ1 motif [20, 21] at aminoacid residues 781–810 [22] in beta myosin. The N-terminus of ELC interacts with actin [23]. Although the precise functional role of ELC has not been defined [24], the protein belongs to the EF-hand family of Ca2+-binding proteins [25] and appears to be involved in force development and fine tuning of muscle contraction [26, 27]. The phosphorylation of a C-terminal serine residue has
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