Nemaline myopathy. I. Histochemical study

Nemaline rods in canine myopathies: 4 case reports and literature review

The diagnosis of nemaline rod myopathy (NM) is based on the presence of numerous pathognomonic rods within a fresh frozen muscle biopsy specimen. Three forms of congenital NM have been described in humans, and rods have been found to occur in various other conditions. A similar myopathy was described in 1986 in a family of cats. In this report, we describe a case of congenital NM in a 10-month-old Border Collie, an adult-onset NM in an 11-year-old Schipperke, and 2 acquired myopathies with nemaline rods in adult dogs associated with hypothyroidism and Cushing's syndrome. Common clinical features included exercise intolerance, abnormal electromyography, and the presence of nemaline rods in fresh, frozen, and glutaraldehyde-fixed biopsies from proximal appendicular limb muscles. Staining of cryostat sections of muscle biopsy specimens by the modified Gomori trichrome technique disclosed numerous rod bodies that were localized to type 1 fibers by the histochemical adenosine triphosphatase reaction. Accumulation of rods also was demonstrated by electron microscopy in 2 of the cases with localized enlargement and streaming of Z lines. Documentation of NM in a young Border Collie and the adult-onset form in the Schipperke alerts clinicians to the existence of this disorder in these breeds.

Electromyography in congenital nemaline myopathy

To clarify the discrepancies between earlier reports of electromyography (EMG) in congenital nemaline myopathy (CNM), conventional electromyography was done on 13 patients with CNM, and results were compared with those of 18 earlier EMG examinations of the same patients. Fiber density was measured in 10 patients with a computerized method and neuromuscular jitter in 3 with single-fiber EMG. With age, the EMG abnormality progressed, and "neuropathic" EMG features developed in distal muscles. In 9 of 10 patients fiber density was higher than normal. In two of three patients jitter was abnormal. Motor (13 of 13 patients) and sensory (3 of 3 patients) nerve conduction velocities were normal. Our results seem to explain the conflicting reports of EMG in CNM. We conclude that active degeneration and regeneration of muscle fibers takes place in CNM and suggest that the "neuropathic" motor unit potentials seen in our patients may be secondary to myopathic disease activity.

Pathology of congenital nemaline myopathy. A follow-up study

This study was undertaken to review the development over 5-18 years of pathologic changes in 13 patients (4 male and 9 female) with congenital nemaline myopathy. Follow-up biopsies were compared with earlier biopsies and with published normal values as to quantity and location of nemaline bodies, secondary signs of myopathy, and in 6 patients as to muscle fiber type and size. Biopsy findings were correlated with the mobility and muscle power of the patient. The main differences in myofiber maturation in the patients as compared with normal myofiber maturation were: (1) deficient differentiation of type 2 fibers, (2) further increase of variation in fiber size with age, and (3) skewing in early adulthood of fiber size distribution curves toward the atrophic end. In ambulant patients, this skew seemed to be compensated with a population of hypertrophic fibers. The nemaline bodies tended to be located beneath the sarcolemma in the younger patients and inside the muscle fibers in the older patients. The quantity of nemaline bodies seemed to have increased with age. The clinical deterioration and the defective myofiber maturation in the patients together with an increase in internal nuclei and endomysial fat or fibrosis indicate an active disease process. This speaks against the generally held view that congenital nemaline myopathy is static.

Nemaline myopathy of cats

An apparently inherited myopathy, characterized by the presence of large numbers of nemaline rods in skeletal muscle fibers, was investigated in five cats. Onset of signs varied from 6 months to 1.5 years of age and consisted of reluctance to move, jerky gait and muscle twitching, hyporeflexia, and muscle wasting, which was most prominent in the proximal muscles of the forelimbs. All of the cats, three males and two females, were from the same dam. In addition to the presence of rods, the myopathy was characterized by marked fiber size variation, with atrophy of type 1 and type 2a muscle fibers. In addition, there was infolding of the sarcolemma and fiber splitting. Ultrastructurally, the rods closely resembled those described in human nemaline myopathy.

Genetics of congenital nemaline myopathy

Family patterns for 50 reported probands with congenital nemaline myopathy were compared with expected patterns derived from various possible genetic hypotheses. The disease had a high mortality in childhood but remained clinically stationary after this period. Some normal relatives showed nemaline rods on muscle biopsy. Chromosomes were normal in the two cases in which they were examined. Prenatal exposures appeared irrelevant to this disease. Autosomal recessive and X-linked recessive or dominant modes of inheritance were not compatible with the observed patterns, which could be explained by an autosomal dominant mode with a reduced penetrance. Normal relatives who carried rods were presumably unaffected heterozygotes of the same gene. The genetic ratio (the proportion of affected siblings) was 0.3, being short of the expected value, 0.5, probably because of the presence of these asymptomatic rod-bearing heterozygotes. While the pressure of natural selection was great in the patients who died or were severely disabled, the gene could be passed to the next generation by mildly affected patients or heterozygotes who remained unaffected.

Fatal neonatal nemaline myopathy with multiple congenital anomalies

The clinical course and autopsy findings in a patient with fatal neonatal nemaline myopathy are described. A hypotonic infant required mechanical ventilatory support immediately following delivery and developed progressive congestive heart failure. He had mild facial dysmorphism, a high-arched palate, clinodactyly, short first metacarpals, abnormal dermatoglyphics, simian creases, and bilateral talipes varus. Light and electron microscopic study of a muscle biopsy was diagnostic of nemaline myopathy. Autopsy revealed a papillary muscle anomaly, myocardial scarring, and hepatic fibrosis. The severe clinical impairment in this infant and the unusual associated anomalies are compared with other examples of nemaline myopathy. Nemaline myopathy is a cause of respiratory insufficiency in the neonatal period.

Nemaline bodies in a progressive infantile neuromuscular disorder

Nemaline bodies are described in a case of a progressive neuromuscular disorder, which is difficult to classify. The clinical syndrome is not characteristic of a nemaline myopathy. It is argued that the finding of nemaline bodies is in itself not specific of any neuromuscular disease.

Nemaline myopathy: histological, histochemical and ultrastructural studies

Histological, histochemical and ultrastructural studies were performed on muscle biopsies from three siblings with congenital nemaline myopathy. Histological studies revealed type I fibre atrophy and type II fibre paucity. Ultrastructural studies of intramuscular nerves showed that the axonal diameters were very narrow compared with the width of myelin lamellae. Granular or membranous osmiophilic material occurred in the adaxonal Schwann cell cytoplasm and had a periodicity of 33--38 A. The neuromuscular junctions showed degenerative features such as glycogen granules or myelin figures in 27.1% of total terminal axons. The secondary synaptic clefts were markedly decreased in number and short in length. Myotendinous junction-like structures were found in 5.5% of the muscle fibres near the neuromuscular junctions, and often near sites of fibre-splitting. Rods in nemaline myopathy might be caused as a result of longitudinal splitting and disruption of fibres due to deficient regeneration of the muscle fibres associated with neurotrophic abnormalities.

Characteristics of myosin in nemaline myopathy

Electron-microscopic, morphometric, histochemical and biochemical studies were carried out on muscle biopsies from a patient with the characteristic clinical and pathological findings of nemaline myopathy. The mean fiber diameter was decreased, and the vastus lateralis muscle biopsy consisted exclusively of slow twitch (Type I) fibers. Quantitative biochemical investigations revealed significantly low calcium uptake and ATPase activity of the fragmented sarcoplasmic reticulum and decreased myosin ATPase activity. The electrophoretogram of myosin showed an abnormality in the light chain pattern which could not be explained by a disproportion of normal fiber types.

"Myotubular Myopathy" and "type I fiber atrophy" in a family

An 11-month-old girl and her mother had similar muscular weakness and wasting shich started in early life and were non-progressive throughout the course of the illness. Muscle biopsy in the girl revealed muscle fibers with central nuclei and surrounding clear areas compatible with myotubular, centronuclear or peri-centri-nuclear myopathy, whereas the biopsy from the mother showed a selective atrophy of Type I fibers without central nuclei. Since the grandfather also had similar clinical features, a heredofamilial neuromuscular disease was thought likely, and it is postulated that the pathological change in the girl represented an earlier, and in the mother a later manifestation of the same disease.

Familial type I fiber atrophy

An 11-year-old boy and his 40-year-old mother with congenital, non-progressive muscular weakness and wasting are described. Muscle biopsies from both cases showed a selective atrophy of Type I fibers without any structural change except for very few nemaline bodies. Probably, the neuromuscular disorder in this family is identical to the congenital fiber type disproportion described by Dubowitz and Brooke, but familial Type I fiber atrophy (hypotrophy, or hypoplasia) is considered to be a more appropriate descriptive term for a family with such distinct histochemical characteristics.