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Khodabukus A, Prabhu NK, Roberts T, Buldo M, Detwiler A, Fralish ZD, Kondash ME, Truskey GA, Koves TR, Bursac N. Bioengineered Model of Human LGMD2B Skeletal Muscle Reveals Roles of Intracellular Calcium Overload in Contractile and Metabolic Dysfunction in Dysferlinopathy. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2400188. [PMID: 38887849 DOI: 10.1002/advs.202400188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/19/2024] [Indexed: 06/20/2024]
Abstract
Dysferlin is a multi-functional protein that regulates membrane resealing, calcium homeostasis, and lipid metabolism in skeletal muscle. Genetic loss of dysferlin results in limb girdle muscular dystrophy 2B/2R (LGMD2B/2R) and other dysferlinopathies - rare untreatable muscle diseases that lead to permanent loss of ambulation in humans. The mild disease severity in dysferlin-deficient mice and diverse genotype-phenotype relationships in LGMD2B patients have prompted the development of new in vitro models for personalized studies of dysferlinopathy. Here the first 3-D tissue-engineered hiPSC-derived skeletal muscle ("myobundle") model of LGMD2B is described that exhibits compromised contractile function, calcium-handling, and membrane repair, and transcriptomic changes indicative of impaired oxidative metabolism and mitochondrial dysfunction. In response to the fatty acid (FA) challenge, LGMD2B myobundles display mitochondrial deficits and intracellular lipid droplet (LD) accumulation. Treatment with the ryanodine receptor (RyR) inhibitor dantrolene or the dissociative glucocorticoid vamorolone restores LGMD2B contractility, improves membrane repair, and reduces LD accumulation. Lastly, it is demonstrated that chemically induced chronic RyR leak in healthy myobundles phenocopies LGMD2B contractile and metabolic deficit, but not the loss of membrane repair capacity. Together, these results implicate intramyocellular Ca2+ leak as a critical driver of dysferlinopathic phenotype and validate the myobundle system as a platform to study LGMD2B pathogenesis.
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Affiliation(s)
- Alastair Khodabukus
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - Neel K Prabhu
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - Taylor Roberts
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - Meghan Buldo
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - Amber Detwiler
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - Zachary D Fralish
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - Megan E Kondash
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - George A Truskey
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - Timothy R Koves
- Duke Molecular Physiology Institute, Duke University, Durham, NC, 27708, USA
| | - Nenad Bursac
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
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Cong Z, Wan T, Wang J, Feng L, Cao C, Li Z, Wang X, Han Y, Zhou Y, Gao Y, Zhang J, Qu Y, Guo X. Epidemiological and clinical features of malignant hyperthermia: A scoping review. Clin Genet 2024; 105:233-242. [PMID: 38148504 DOI: 10.1111/cge.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/22/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
Malignant hyperthermia (MH) is a potentially fatal inherited pharmacogenetic disorder related to pathogenic variants in the RYR1, CACNA1S, or STAC3 genes. Early recognition of the occurrence of MH and prompt medical treatment are indispensable to ensure a positive outcome. The purpose of this study was to provide valuable information for the early identification of MH by summarizing epidemiological and clinical features of MH. This scoping review followed the methodological framework recommended by Arksey and O'Malley. PubMed, Embase, and Web of science databases were searched for studies that evaluated the epidemical and clinical characteristics of MH. A total of 37 studies were included in this review, of which 26 were related to epidemiology and 24 were associated with clinical characteristics. The morbidity of MH varied from 0.18 per 100 000 to 3.9 per 100 000. The mortality was within the range of 0%-18.2%. Identified risk factors included sex, age, disorders associated with MH, and others. The most frequent initial clinical signs included hyperthermia, sinus tachycardia, and hypercarbia. The occurrence of certain signs, such as hypercapnia, delayed first temperature measurement, and peak temperature were associated with poor outcomes. The epidemiological and clinical features of MH varied considerably and some risk factors and typical clinical signs were identified. The main limitation of this review is that the treatment and management strategies were not assessed sufficiently due to limited information.
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Affiliation(s)
- Zhukai Cong
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
| | - Tingting Wan
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
| | - Jiechu Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
| | - Luyang Feng
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
| | - Cathy Cao
- Department of Anesthesiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
| | - Xiaoxiao Wang
- Research Center for Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yongzheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
| | - Yang Zhou
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
| | - Ya Gao
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
| | - Jing Zhang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
| | - Yinyin Qu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Beijing Center of Quality Control and lmprovement on Clinical Anesthesia, Beijing, China
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van den Bersselaar LR, van Alfen N, Kruijt N, Kamsteeg EJ, Fernandez-Garcia MA, Treves S, Riazi S, Yang CY, Malagon I, van Eijk LT, van Engelen BGM, Scheffer GJ, Jungbluth H, Snoeck MMJ, Voermans NC. Muscle Ultrasound Abnormalities in Individuals with RYR1-Related Malignant Hyperthermia Susceptibility. J Neuromuscul Dis 2023:JND230018. [PMID: 37154182 DOI: 10.3233/jnd-230018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Variants in RYR1, the gene encoding the ryanodine receptor-1, can give rise to a wide spectrum of neuromuscular conditions. Muscle imaging abnormalities have been demonstrated in isolated cases of patients with a history of RYR1-related malignant hyperthermia (MH) susceptibility. OBJECTIVE To provide insights into the type and prevalence of muscle ultrasound abnormalities and muscle hypertrophy in patients carrying gain-of-function RYR1 variants associated with MH susceptibility and to contribute to delineating the wider phenotype, optimizing the diagnostic work-up and care for of MH susceptible patients. METHODS We performed a prospective cross-sectional observational muscle ultrasound study in patients with a history of RYR1-related MH susceptibility (n = 40). Study procedures included a standardized history of neuromuscular symptoms and a muscle ultrasound assessment. Muscle ultrasound images were analyzed using a quantitative and qualitative approach and compared to reference values and subsequently subjected to a screening protocol for neuromuscular disorders. RESULTS A total of 15 (38%) patients had an abnormal muscle ultrasound result, 4 (10%) had a borderline muscle ultrasound screening result, and 21 (53%) had a normal muscle ultrasound screening result. The proportion of symptomatic patients with an abnormal result (11 of 24; 46%) was not significantly higher compared to the proportion of asymptomatic patients with an abnormal ultrasound result (4 of 16; 25%) (P = 0.182). The mean z-scores of the biceps brachii (z = 1.45; P < 0.001), biceps femoris (z = 0.43; P = 0.002), deltoid (z = 0.31; P = 0.009), trapezius (z = 0.38; P = 0.010) and the sum of all muscles (z = 0.40; P < 0.001) were significantly higher compared to 0, indicating hypertrophy. CONCLUSIONS Patients with RYR1 variants resulting in MH susceptibility often have muscle ultrasound abnormalities. Frequently observed muscle ultrasound abnormalities include muscle hypertrophy and increased echogenicity.
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Affiliation(s)
- Luuk R van den Bersselaar
- Department of Anesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Institutefor Brain, Cognition and Behaviour, Radboud University MedicalCenter, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Institutefor Brain, Cognition and Behaviour, Radboud University MedicalCenter, Nijmegen, The Netherlands
| | - Nick Kruijt
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Institutefor Brain, Cognition and Behaviour, Radboud University MedicalCenter, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Miguel A Fernandez-Garcia
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Susan Treves
- Departments of Biomedicine and Neurology, Neuromuscular research Group, University Hospital Basel, Basel, Switzerland
| | - Sheila Riazi
- Department of Anesthesia, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Chu-Ya Yang
- Department of Anesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Ignacio Malagon
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lucas T van Eijk
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Institutefor Brain, Cognition and Behaviour, Radboud University MedicalCenter, Nijmegen, The Netherlands
| | - Gert-Jan Scheffer
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
- Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Marc M J Snoeck
- Department of Anesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Institutefor Brain, Cognition and Behaviour, Radboud University MedicalCenter, Nijmegen, The Netherlands
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Moreno CAI, Kraeva N, Zvaritch E, Jungbluth H, Voermans NC, Riazi S. Oral Dantrolene for Myopathic Symptoms in Malignant Hyperthermia-Susceptible Patients: A 25-Year Retrospective Cohort Study of Adverse Effects and Tolerability. Anesth Analg 2023; 136:569-577. [PMID: 36201369 PMCID: PMC9974786 DOI: 10.1213/ane.0000000000006207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients susceptible to malignant hyperthermia (MH) may experience disabling manifestations of an unspecified myopathy outside the context of anesthesia, including myalgia, fatigue, or episodic rhabdomyolysis. Clinical observations suggest that oral dantrolene may relief myopathic symptoms in MH-susceptible (MHS) patients. However, high-dose oral dantrolene has been associated with severe hepatotoxicity. METHODS In a retrospective database review (1994-2018), we investigated a cohort of patients who were diagnosed as MHS by a positive caffeine-halothane contracture test (CHCT), had myopathic manifestations, and received oral dantrolene. Our aim was to investigate the occurrence of serious adverse effects and the adherence to oral dantrolene therapy. We also explored factors associated with self-reported clinical improvement, considering as nonresponders patients with intolerable adverse effects or who reported no improvement 8 weeks after starting treatment. RESULTS Among 476 MHS patients with positive CHCT, 193 had muscle symptoms, 164 started oral dantrolene, 27 refused treatment, and 2 were excluded due to abnormal liver function before starting therapy. There were no serious adverse effects reported. Forty-six of 164 patients (28%; 95% confidence interval [CI], 22%-35%) experienced mild to moderate adverse effects. Twenty-two patients (22/164, 13%; 95% CI, 9%-19%) discontinued treatment, among which 16 due to adverse effects and 6 due to lack of improvement. One hundred forty-two patients (87%; 95% CI, 80%-90%) adhered to therapy and reported improvement of myalgia (n = 78), fatigue (n = 32), or rhabdomyolysis/hiperCKemia (n = 32). The proportion of responders was larger among patients with MH history than among those referred due to a clinical myopathy with nonpertinent anesthetic history (97% vs 79%, respectively; 95% CI of the difference, 8.5-28; P < .001). Patients with a sarcoplasmic reticulum Ca2+ release channel ryanodine receptor gene ( RYR1 ) variant had higher odds of responding to dantrolene treatment (OR, 6.4; 95% CI, 1.3-30.9; P = .013). Dantrolene median dose was 50 (25-400) and 200 (25-400) mg·day -1 in responders and nonresponders, respectively. CONCLUSIONS We found that oral dantrolene produced no serious adverse effects within the reported dose range, and was well tolerated by most MH-susceptible patients presenting myopathic symptoms. Our study provides dosing and adverse effect data as a basis for further randomized controlled clinical trials to determine the efficacy of oral dantrolene for symptomatic relief in MHS-related myopathies.
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Affiliation(s)
- Carlos A. Ibarra Moreno
- Department of Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, Toronto General Hospital–University Health Network, Toronto, Ontario, Canada
| | - Natalia Kraeva
- Department of Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, Toronto General Hospital–University Health Network, Toronto, Ontario, Canada
| | - Elena Zvaritch
- Department of Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, Toronto General Hospital–University Health Network, Toronto, Ontario, Canada
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children’s Hospital, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom, Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine, King’s College, London, United Kingdom
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sheila Riazi
- Department of Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, Toronto General Hospital–University Health Network, Toronto, Ontario, Canada
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de Mello JM, Andrade PV, Santos JM, Oliveira ASB, Vainzof M, do Amaral JLG, Almeida da Silva HC. Predictive factors of the contracture test for diagnosing malignant hyperthermia in a Brazilian population sample: a retrospective observational study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:145-152. [PMID: 35835312 PMCID: PMC10068564 DOI: 10.1016/j.bjane.2022.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Malignant Hyperthermia (MH) is a pharmacogenetic, hereditary and autosomal dominant syndrome triggered by halogenates/succinylcholine. The In Vitro Contracture Test (IVCT) is the gold standard diagnostic test for MH, and it evaluates abnormal skeletal muscle reactions of susceptible individuals (earlier/greater contracture) when exposed to caffeine/halothane. MH susceptibility episodes and IVCT seem to be related to individual features. OBJECTIVE To assess variables that correlate with IVCT in Brazilian patients referred for MH investigation due to a history of personal/family MH. METHODS We examined IVCTs of 80 patients investigated for MH between 2004‒2019. We recorded clinical data (age, sex, presence of muscle weakness or myopathy with muscle biopsy showing cores, genetic evaluation, IVCT result) and IVCT features (initial and final maximum contraction, caffeine/halothane concentration triggering contracture of 0.2g, contracture at caffeine concentration of 2 and 32 mmoL and at 2% halothane, and contraction after 100 Hz stimulation). RESULTS Mean age of the sample was 35±13.3 years, and most of the subjects were female (n=43 or 54%) and MH susceptible (60%). Of the 20 subjects undergoing genetic investigation, 65% showed variants in RYR1/CACNA1S genes. We found no difference between the positive and negative IVCT groups regarding age, sex, number of probands, presence of muscle weakness or myopathy with muscle biopsy showing cores. Regression analysis revealed that the best predictors of positive IVCT were male sex (+12%), absence of muscle weakness (+20%), and personal MH background (+17%). CONCLUSIONS Positive IVCT results have been correlated to male probands, in accordance with early publications. Furthermore, normal muscle strength has been confirmed as a significant predictor of positive IVCT while investigating suspected MH cases.
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Affiliation(s)
- Jean Marcel de Mello
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Centro de Hipertermia Maligna, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil
| | - Pamela Vieira Andrade
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Centro de Hipertermia Maligna, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil
| | - Joilson Moura Santos
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Centro de Hipertermia Maligna, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil
| | | | - Mariz Vainzof
- Universidade de São Paulo, Instituto de Biociências, Departamento de Genética e Biologia Evolutiva, São Paulo, SP, Brazil
| | - José Luiz Gomes do Amaral
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Centro de Hipertermia Maligna, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil
| | - Helga Cristina Almeida da Silva
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Centro de Hipertermia Maligna, Disciplina de Anestesiologia, Dor e Terapia Intensiva, São Paulo, SP, Brazil.
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Using Cluster Analysis to Overcome the Limits of Traditional Phenotype-Genotype Correlations: The Example of RYR1-Related Myopathies. Genes (Basel) 2023; 14:genes14020298. [PMID: 36833224 PMCID: PMC9956305 DOI: 10.3390/genes14020298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Thanks to advances in gene sequencing, RYR1-related myopathy (RYR1-RM) is now known to manifest itself in vastly heterogeneous forms, whose clinical interpretation is, therefore, highly challenging. We set out to develop a novel unsupervised cluster analysis method in a large patient population. The objective was to analyze the main RYR1-related characteristics to identify distinctive features of RYR1-RM and, thus, offer more precise genotype-phenotype correlations in a group of potentially life-threatening disorders. We studied 600 patients presenting with a suspicion of inherited myopathy, who were investigated using next-generation sequencing. Among them, 73 index cases harbored variants in RYR1. In an attempt to group genetic variants and fully exploit information derived from genetic, morphological, and clinical datasets, we performed unsupervised cluster analysis in 64 probands carrying monoallelic variants. Most of the 73 patients with positive molecular diagnoses were clinically asymptomatic or pauci-symptomatic. Multimodal integration of clinical and histological data, performed using a non-metric multi-dimensional scaling analysis with k-means clustering, grouped the 64 patients into 4 clusters with distinctive patterns of clinical and morphological findings. In addressing the need for more specific genotype-phenotype correlations, we found clustering to overcome the limits of the "single-dimension" paradigm traditionally used to describe genotype-phenotype relationships.
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O’Connor TN, van den Bersselaar LR, Chen YS, Nicolau S, Simon B, Huseth A, Todd JJ, Van Petegem F, Sarkozy A, Goldberg MF, Voermans NC, Dirksena RT. RYR-1-Related Diseases International Research Workshop: From Mechanisms to Treatments Pittsburgh, PA, U.S.A., 21-22 July 2022. J Neuromuscul Dis 2023; 10:135-154. [PMID: 36404556 PMCID: PMC10023165 DOI: 10.3233/jnd-221609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Thomas N. O’Connor
- Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Luuk R. van den Bersselaar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Malignant Hyperthermia Investigation Unit, Department of Anaesthesia, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Yu Seby Chen
- Department of Biochemistry and Molecular Biology, The Life Sciences Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Stefan Nicolau
- Center for Gene Therapy, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | | | - Joshua J. Todd
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Filip Van Petegem
- Department of Biochemistry and Molecular Biology, The Life Sciences Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Anna Sarkozy
- The Dubowitz Neuromuscular Centre, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | | | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robert T. Dirksena
- Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Janssens L, De Puydt J, Milazzo M, Symoens S, De Bleecker JL, Herdewyn S. Risk of malignant hyperthermia in patients carrying a variant in the skeletal muscle ryanodine receptor 1 gene. Neuromuscul Disord 2022; 32:864-869. [PMID: 36283893 DOI: 10.1016/j.nmd.2022.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
Malignant hyperthermia is a life-threatening disorder, which can be prevented by avoiding certain anesthetic agents. Pathogenic variants in the skeletal muscle ryanodine receptor 1-gene are linked to malignant hyperthermia. We retrospectively studied 15 patients who presented to our clinic with symptoms of muscle dysfunction (weakness, myalgia or cramps) and were later found to have a variant in the skeletal muscle ryanodine receptor 1-gene. Symptoms, creatine kinase levels, electromyography, muscle biopsy and in vitro contracture test results were reviewed. Six out of the eleven patients, with a variant of unknown significance in the skeletal muscle ryanodine receptor 1-gene, had a positive in vitro contracture test, indicating malignant hyperthermia susceptibility. In one patient, with two variants of unknown significance, both variants were required to express the malignant hyperthermia-susceptibility trait. Neurologists should consider screening the skeletal muscle ryanodine receptor 1-gene in patients with myalgia or cramps, even when few to no abnormalities on ancillary testing.
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Affiliation(s)
- Lise Janssens
- Faculty of medical and health sciences, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Joris De Puydt
- University Hospital of Antwerp, Drie Eikenstraat 655, Edegem 2650, Belgium; Faculty of medical and health sciences, Antwerp University, Prinsstraat 13, Antwerp 2000, Belgium
| | - Mauro Milazzo
- Center for Medical Genetics Ghent, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Sofie Symoens
- Faculty of medical and health sciences, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium; Center for Medical Genetics Ghent, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Jan L De Bleecker
- Faculty of medical and health sciences, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Sarah Herdewyn
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium.
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van den Bersselaar LR, Jungbluth H, Kruijt N, Kamsteeg EJ, Fernandez-Garcia MA, Treves S, Riazi S, Malagon I, van Eijk LT, van Alfen N, van Engelen BGM, Scheffer GJ, Snoeck MMJ, Voermans NC. Neuromuscular symptoms in patients with RYR1-related malignant hyperthermia and rhabdomyolysis. Brain Commun 2022; 4:fcac292. [PMID: 36751502 PMCID: PMC9897183 DOI: 10.1093/braincomms/fcac292] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/21/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022] Open
Abstract
Malignant hyperthermia and exertional rhabdomyolysis have conventionally been considered episodic phenotypes that occur in otherwise healthy individuals in response to an external trigger. However, recent studies have demonstrated a clinical and histopathological continuum between patients with a history of malignant hyperthermia susceptibility and/or exertional rhabdomyolysis and RYR1-related congenital myopathies. We hypothesize that patients with a history of RYR1-related exertional rhabdomyolysis or malignant hyperthermia susceptibility do have permanent neuromuscular symptoms between malignant hyperthermia or exertional rhabdomyolysis episodes. We performed a prospective cross-sectional observational clinical study of neuromuscular features in patients with a history of RYR1-related exertional rhabdomyolysis and/or malignant hyperthermia susceptibility (n = 40) compared with healthy controls (n = 80). Patients with an RYR1-related congenital myopathy, manifesting as muscle weakness preceding other symptoms as well as other (neuromuscular) diseases resulting in muscle weakness were excluded. Study procedures included a standardized history of neuromuscular symptoms, a review of all relevant ancillary diagnostic tests performed up to the point of inclusion and a comprehensive, standardized neuromuscular assessment. Results of the standardized neuromuscular history were compared with healthy controls. Results of the neuromuscular assessment were compared with validated reference values. The proportion of patients suffering from cramps (P < 0.001), myalgia (P < 0.001) and exertional myalgia (P < 0.001) was higher compared with healthy controls. Healthcare professionals were consulted because of apparent neuromuscular symptoms by 17/40 (42.5%) patients and 7/80 (8.8%) healthy controls (P < 0.001). Apart from elevated creatine kinase levels in 19/40 (47.5%) patients and mild abnormalities on muscle biopsies identified in 13/16 (81.3%), ancillary investigations were normal in most patients. The Medical Research Council sum score, spirometry and results of functional measurements were also mostly normal. Three of 40 patients (7.5%) suffered from late-onset muscle weakness, most prominent in the proximal lower extremity muscles. Patients with RYR1 variants resulting in malignant hyperthermia susceptibility and/or exertional rhabdomyolysis frequently report additional neuromuscular symptoms such as myalgia and muscle cramps compared with healthy controls. These symptoms result in frequent consultation of healthcare professionals and sometimes in unnecessary invasive diagnostic procedures. Most patients do have normal strength at a younger age but may develop muscle weakness later in life.
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Affiliation(s)
- Luuk R van den Bersselaar
- Correspondence to: Luuk R van den Bersselaar Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands E-mail:
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy’s and St Thomas’ Hospital NHS Foundation Trust, SE1 7EH London, UK,Randall Centre of Cell and Molecular Biophysics, Muscle Signaling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College, WC2R 2LS London, UK
| | - Nick Kruijt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Miguel A Fernandez-Garcia
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy’s and St Thomas’ Hospital NHS Foundation Trust, SE1 7EH London, UK
| | - Susan Treves
- Departments of Biomedicine and Neurology, Neuromuscular research Group, University Hospital Basel, 4031 Basel, Switzerland
| | - Sheila Riazi
- Department of Anesthesia, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, M5s 1a4 Toronto, Ontario, Canada
| | - Ignacio Malagon
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Lucas T van Eijk
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Gert-Jan Scheffer
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
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10
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Cabrera-Serrano M, Ravenscroft G. Recent advances in our understanding of genetic rhabdomyolysis. Curr Opin Neurol 2022; 35:651-657. [PMID: 35942668 DOI: 10.1097/wco.0000000000001096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW This review summarizes recent advances in our understanding of the genetics of rhabdomyolysis. RECENT FINDINGS Rhabdomyolysis is the acute breakdown of myofibres resulting in systemic changes that can be life-threatening. Environmental triggers, including trauma, exercise, toxins and infections, and/or gene defects can precipitate rhabdomyolysis. A schema (aptly titled RHABDO) has been suggested for evaluating whether a patient with rhabdomyolysis is likely to harbour an underlying genetic defect. It is becoming increasingly recognized that defects in muscular dystrophy and myopathy genes can trigger rhabdomyolysis, even as the sole or presenting feature. Variants in genes not previously associated with human disease have been identified recently as causative of rhabdomyolysis, MLIP , MYH1 and OBSCN . Our understanding of the pathomechanisms contributing to rhabdomyolysis have also improved with an increased awareness of the role of mitochondrial dysfunction in LPIN1 , FDX2 , ISCU and TANGO2 -mediated disease. SUMMARY An accurate genetic diagnosis is important for optimal clinical management of the patient, avoiding associated triggers and genetic counselling and cascade screening. Despite recent advances in our understanding of the genetics contributing to rhabdomyolysis, many patients remain without an accurate genetic diagnosis, suggesting there are many more causative genes, variants and disease mechanisms to uncover.
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Affiliation(s)
- Macarena Cabrera-Serrano
- Harry Perkins Institute of Medical Research
- Centre for Medical Research, University of Western Australia, Nedlands, Western Australia, Australia
- Unidad de Enfermedades Neuromusculares, Servicio de Neurologia y Neurofisiologia and Instituto de Biomedicina de Sevilla (IBiS)., Hospital Virgen del Rocio, Sevilla, Spain
| | - Gianina Ravenscroft
- Harry Perkins Institute of Medical Research
- Centre for Medical Research, University of Western Australia, Nedlands, Western Australia, Australia
- School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
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11
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Rossi D, Catallo MR, Pierantozzi E, Sorrentino V. Mutations in proteins involved in E-C coupling and SOCE and congenital myopathies. J Gen Physiol 2022; 154:213407. [PMID: 35980353 PMCID: PMC9391951 DOI: 10.1085/jgp.202213115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
In skeletal muscle, Ca2+ necessary for muscle contraction is stored and released from the sarcoplasmic reticulum (SR), a specialized form of endoplasmic reticulum through the mechanism known as excitation–contraction (E-C) coupling. Following activation of skeletal muscle contraction by the E-C coupling mechanism, replenishment of intracellular stores requires reuptake of cytosolic Ca2+ into the SR by the activity of SR Ca2+-ATPases, but also Ca2+ entry from the extracellular space, through a mechanism called store-operated calcium entry (SOCE). The fine orchestration of these processes requires several proteins, including Ca2+ channels, Ca2+ sensors, and Ca2+ buffers, as well as the active involvement of mitochondria. Mutations in genes coding for proteins participating in E-C coupling and SOCE are causative of several myopathies characterized by a wide spectrum of clinical phenotypes, a variety of histological features, and alterations in intracellular Ca2+ balance. This review summarizes current knowledge on these myopathies and discusses available knowledge on the pathogenic mechanisms of disease.
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Affiliation(s)
- Daniela Rossi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.,Interdepartmental Program of Molecular Diagnosis and Pathogenetic Mechanisms of Rare Genetic Diseases, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Maria Rosaria Catallo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Enrico Pierantozzi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Vincenzo Sorrentino
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.,Interdepartmental Program of Molecular Diagnosis and Pathogenetic Mechanisms of Rare Genetic Diseases, Azienda Ospedaliero Universitaria Senese, Siena, Italy
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12
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Vattemi GNA, Rossi D, Galli L, Catallo MR, Pancheri E, Marchetto G, Cisterna B, Malatesta M, Pierantozzi E, Tonin P, Sorrentino V. Ryanodine receptor 1 (RYR1) mutations in two patients with tubular aggregate myopathy. Eur J Neurosci 2022; 56:4214-4223. [PMID: 35666680 PMCID: PMC9539902 DOI: 10.1111/ejn.15728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
Two likely causative mutations in the RYR1 gene were identified in two patients with myopathy with tubular aggregates, but no evidence of cores or core‐like pathology on muscle biopsy. These patients were clinically evaluated and underwent routine laboratory investigations, electrophysiologic tests, muscle biopsy and muscle magnetic resonance imaging (MRI). They reported stiffness of the muscles following sustained activity or cold exposure and had serum creatine kinase elevation. The identified RYR1 mutations (p.Thr2206Met or p.Gly2434Arg, in patient 1 and patient 2, respectively) were previously identified in individuals with malignant hyperthermia susceptibility and are reported as causative according to the European Malignant Hyperthermia Group rules. To our knowledge, these data represent the first identification of causative mutations in the RYR1 gene in patients with tubular aggregate myopathy and extend the spectrum of histological alterations caused by mutation in the RYR1 gene.
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Affiliation(s)
- Gaetano Nicola Alfio Vattemi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Daniela Rossi
- Department of Molecular and Developmental Medicine, Molecular Medicine Section, University of Siena, Siena, Italy.,Interdepartmental Program of Molecular Diagnosis and Pathogenetic Mechanisms of Rare Genetic Diseases, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Lucia Galli
- Interdepartmental Program of Molecular Diagnosis and Pathogenetic Mechanisms of Rare Genetic Diseases, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Maria Rosaria Catallo
- Department of Molecular and Developmental Medicine, Molecular Medicine Section, University of Siena, Siena, Italy
| | - Elia Pancheri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Giulia Marchetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Barbara Cisterna
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Anatomy and Histology, University of Verona, Verona, Italy
| | - Manuela Malatesta
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Anatomy and Histology, University of Verona, Verona, Italy
| | - Enrico Pierantozzi
- Department of Molecular and Developmental Medicine, Molecular Medicine Section, University of Siena, Siena, Italy
| | - Paola Tonin
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Anatomy and Histology, University of Verona, Verona, Italy
| | - Vincenzo Sorrentino
- Department of Molecular and Developmental Medicine, Molecular Medicine Section, University of Siena, Siena, Italy.,Interdepartmental Program of Molecular Diagnosis and Pathogenetic Mechanisms of Rare Genetic Diseases, Azienda Ospedaliero Universitaria Senese, Siena, Italy
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13
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Cabrera-Serrano M, Caccavelli L, Savarese M, Vihola A, Jokela M, Johari M, Capiod T, Madrange M, Bugiardini E, Brady S, Quinlivan R, Merve A, Scalco R, Hilton-Jones D, Houlden H, Ibrahim Aydin H, Ceylaner S, Vockley J, Taylor RL, Folland C, Kelly A, Goullee H, Ylikallio E, Auranen M, Tyynismaa H, Udd B, Forrest ARR, Davis MR, Bratkovic D, Manton N, Robertson T, McCombe P, Laing NG, Phillips L, de Lonlay P, Ravenscroft G. Bi-allelic loss-of-function OBSCN variants predispose individuals to severe recurrent rhabdomyolysis. Brain 2021; 145:3985-3998. [DOI: 10.1093/brain/awab484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Rhabdomyolysis is the acute breakdown of skeletal myofibres in response to an initiating factor, most commonly toxins and over exertion. A variety of genetic disorders predispose to rhabdomyolysis through different pathogenic mechanisms, particularly in patients with recurrent episodes. However, most cases remain without a genetic diagnosis. Here we present six patients who presented with severe and recurrent rhabdomyolysis, usually with onset in the teenage years; other features included a history of myalgia and muscle cramps. We identified ten bi-allelic loss-of-function variants in the gene encoding obscurin (OBSCN) predisposing individuals to recurrent rhabdomyolysis. We show reduced expression of OBSCN and loss of obscurin protein in patient muscle. Obscurin is proposed to be involved in SR function and Ca2+ handling. Patient cultured myoblasts appear more susceptible to starvation as evidenced by a greater decreased in SR Ca2+ content compared to control myoblasts. This likely reflects a lower efficiency when pumping Ca2+ back into the SR and/or a decrease in Ca2+ SR storage ability when metabolism is diminished. OSBCN variants have previously been associated with cardiomyopathies. None of the patients presented with a cardiomyopathy and cardiac examinations were normal in all cases in which cardiac function was assessed. There was also no history of cardiomyopathy in first degree relatives, in particular in any of the carrier parents. This cohort is relatively young, thus follow-up studies and the identification of additional cases with bi-allelic null OBSCN variants will further delineate OBSCN-related disease and the clinical course of disease.
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Affiliation(s)
- Macarena Cabrera-Serrano
- Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
- Centre of Medical Research, University of Western Australia, Nedlands, WA, Australia
- Unidad de Enfermedades Neuromusculares. Servicio de Neurologia y Neurofisiologia. Hospital Virgen del Rocio, Sevilla, Spain
| | - Laure Caccavelli
- Inserm U1151, Institut Necker Enfants-Malades, Reference Center of Inherited Metabolic Diseases and MetabERN, Necker-Enfants-Malades Hospital, Paris University, Paris, France
| | - Marco Savarese
- Folkhälsan Research Center, Helsinki, Finland and Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Anna Vihola
- Folkhälsan Research Center, Helsinki, Finland and Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
| | - Manu Jokela
- Neuromuscular Research Center, Department of Neurology, Tampere University and University Hospital, Tampere, Finland
- Neurocenter, Department of Neurology, Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Mridul Johari
- Folkhälsan Research Center, Helsinki, Finland and Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Thierry Capiod
- Inserm U1151, Institut Necker Enfants-Malades, Reference Center of Inherited Metabolic Diseases and MetabERN, Necker-Enfants-Malades Hospital, Paris University, Paris, France
| | - Marine Madrange
- Inserm U1151, Institut Necker Enfants-Malades, Reference Center of Inherited Metabolic Diseases and MetabERN, Necker-Enfants-Malades Hospital, Paris University, Paris, France
| | - Enrico Bugiardini
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Stefen Brady
- Department of Neurology, Southmead Hospital, Bristol, UK
| | - Rosaline Quinlivan
- MRC Centre for Neuromuscular Diseases, University College Hospitals, London, UK
| | - Ashirwad Merve
- MRC Centre for Neuromuscular Diseases, University College Hospitals, London, UK
| | - Renata Scalco
- MRC Centre for Neuromuscular Diseases, University College Hospitals, London, UK
| | - David Hilton-Jones
- Neurosciences Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Henry Houlden
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, London, UK
| | | | - Serdar Ceylaner
- Intergen Genetic Diagnosis and Research Center, Ankara, Turkey
| | - Jerry Vockley
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rhonda L. Taylor
- Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
- Centre of Medical Research, University of Western Australia, Nedlands, WA, Australia
| | - Chiara Folland
- Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
- Centre of Medical Research, University of Western Australia, Nedlands, WA, Australia
| | - Aasta Kelly
- Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
| | - Hayley Goullee
- Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
- Centre of Medical Research, University of Western Australia, Nedlands, WA, Australia
| | - Emil Ylikallio
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, 00290 Helsinki, Finland
| | - Mari Auranen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henna Tyynismaa
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, 00290 Helsinki, Finland
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Bjarne Udd
- Folkhälsan Research Center, Helsinki, Finland and Department of Medical Genetics, Medicum, University of Helsinki, Helsinki, Finland
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
| | - Alistair R. R. Forrest
- Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
- Centre of Medical Research, University of Western Australia, Nedlands, WA, Australia
| | - Mark R. Davis
- Department of Diagnostic Genomics, PathWest Laboratory Medicine WA, Nedlands, WA, Australia
| | - Drago Bratkovic
- Metabolic Clinic, Women and Children’s Hospital, North Adelaide, SA, Australia
| | - Nicholas Manton
- SA Pathology, Women and Children’s Hospital, North Adelaide, SA, Australia
| | - Thomas Robertson
- Anatomical Pathology, Queensland Pathology, Brisbane, Queensland, Australia
| | - Pamela McCombe
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Centre for Clinical Research, The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Nigel G. Laing
- Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
- Centre of Medical Research, University of Western Australia, Nedlands, WA, Australia
- Department of Diagnostic Genomics, PathWest Laboratory Medicine WA, Nedlands, WA, Australia
| | - Liza Phillips
- SA Pathology, Women and Children’s Hospital, North Adelaide, SA, Australia
- The University of Adelaide, Adelaide, SA, Australia
| | - Pascale de Lonlay
- Inserm U1151, Institut Necker Enfants-Malades, Reference Center of Inherited Metabolic Diseases and MetabERN, Necker-Enfants-Malades Hospital, Paris University, Paris, France
| | - Gianina Ravenscroft
- Harry Perkins Institute of Medical Research, Nedlands, WA, Australia
- Centre of Medical Research, University of Western Australia, Nedlands, WA, Australia
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14
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Siniscalchi A, Mintzer S, De Sarro G, Gallelli L. Myotoxicity Induced by Antiepileptic Drugs: Could be a Rare but Serious Adverse Event? PSYCHOPHARMACOLOGY BULLETIN 2021; 51:105-116. [PMID: 34887602 PMCID: PMC8601760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Antiepileptic drugs (AEDs) are used in various pathologies such as including epilepsy, migraine, neuropathic pain, etc. They can improve symptoms but cause adverse events (ADRs). Case reports have reported that one rare but serious AED-induced adverse reaction that has appeared in case reports is myotoxicity from rhabdomyolysis. Rhabdomyolysis can be induced by a therapeutically dosed occur with therapeutic doses of antiepileptic drugs and is in most cases reversible, although rarely it can cause serious complications. Clinical manifestations of rhabdomyolysis range from a single isolated asymptomatic rise in serum CK levels to severe electrolyte imbalances, cardiac arrhythmia, acute and disseminated renal failure, intravascular coagulation, and other symptoms. Many clinical cases reported that both conventional older and newer AEDs, as well as propofol, can cause rhabdomyolysis, even if there are no conclusive data. It has recently been shown that genetic factors certainly contribute to adverse reactions of antiepileptic drugs. A study of genetic polymorphism in patients with AED-induced rhabdomyolysis may be useful to explain the rarity of this adverse event and to improve the treatment of these AED patients, in terms of AED type and dose adjustment.
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Affiliation(s)
- Antonio Siniscalchi
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Mintzer, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA. De Sarro, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital - Chair of Pharmacology, Department of Health Science, School of Medicine, Catanzaro, Italy; FAS@umg Research Center, University of Catanzaro, Catanzaro, Italy. Gallelli, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital - Chair of Pharmacology, Department of Health Science, School of Medicine, Catanzaro, Italy; FAS@umg Research Center, University of Catanzaro, Catanzaro, Italy
| | - Scott Mintzer
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Mintzer, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA. De Sarro, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital - Chair of Pharmacology, Department of Health Science, School of Medicine, Catanzaro, Italy; FAS@umg Research Center, University of Catanzaro, Catanzaro, Italy. Gallelli, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital - Chair of Pharmacology, Department of Health Science, School of Medicine, Catanzaro, Italy; FAS@umg Research Center, University of Catanzaro, Catanzaro, Italy
| | - Giovambattista De Sarro
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Mintzer, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA. De Sarro, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital - Chair of Pharmacology, Department of Health Science, School of Medicine, Catanzaro, Italy; FAS@umg Research Center, University of Catanzaro, Catanzaro, Italy. Gallelli, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital - Chair of Pharmacology, Department of Health Science, School of Medicine, Catanzaro, Italy; FAS@umg Research Center, University of Catanzaro, Catanzaro, Italy
| | - Luca Gallelli
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Mintzer, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA. De Sarro, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital - Chair of Pharmacology, Department of Health Science, School of Medicine, Catanzaro, Italy; FAS@umg Research Center, University of Catanzaro, Catanzaro, Italy. Gallelli, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital - Chair of Pharmacology, Department of Health Science, School of Medicine, Catanzaro, Italy; FAS@umg Research Center, University of Catanzaro, Catanzaro, Italy
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15
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van den Bersselaar LR, Kruijt N, Scheffer GJ, van Eijk L, Malagon I, Buckens S, Custers JAE, Helder L, Greco A, Joosten LAB, van Engelen BGM, van Alfen N, Riazi S, Treves S, Jungbluth H, Snoeck MMJ, Voermans NC. The neuromuscular and multisystem features of RYR1-related malignant hyperthermia and rhabdomyolysis: A study protocol. Medicine (Baltimore) 2021; 100:e26999. [PMID: 34414986 PMCID: PMC8376301 DOI: 10.1097/md.0000000000026999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Malignant hyperthermia (MH) and exertional rhabdomyolysis (ERM) have long been considered episodic phenotypes occurring in response to external triggers in otherwise healthy individuals with variants in RYR1. However, recent studies have demonstrated a clinical and histopathological continuum between patients with RYR1-related congenital myopathies and those with ERM or MH susceptibility. Furthermore, animal studies have shown non-neuromuscular features such as a mild bleeding disorder and an immunological gain-of-function associated with MH/ERM related RYR1 variants raising important questions for further research. Awareness of the neuromuscular disease spectrum and potential multisystem involvement in RYR1-related MH and ERM is essential to optimize the diagnostic work-up, improve counselling and and future treatment strategies for patients affected by these conditions. This study will examine in detail the nature and severity of continuous disease manifestations and their effect on daily life in patients with RYR1-related MH and ERM. METHODS The study protocol consists of four parts; an online questionnaire study, a clinical observational study, muscle imaging, and specific immunological studies. Patients with RYR1-related MH susceptibility and ERM will be included. The imaging, immunological and clinical studies will have a cross-sectional design, while the questionnaire study will be performed three times during a year to assess disease impact, daily living activities, fatigue and pain. The imaging study consists of muscle ultrasound and whole-body magnetic resonance imaging studies. For the immunological studies, peripheral mononuclear blood cells will be isolated for in vitro stimulation with toll-like receptor ligands, to examine the role of the immune system in the pathophysiology of RYR1-related MH and ERM. DISCUSSION This study will increase knowledge of the full spectrum of neuromuscular and multisystem features of RYR1-related MH and ERM and will establish a well-characterized baseline cohort for future studies on RYR1-related disorders. The results of this study are expected to improve recognition of RYR1-related symptoms, counselling and a more personalized approach to patients affected by these conditions. Furthermore, results will create new insights in the role of the immune system in the pathophysiology of MH and ERM. TRIAL REGISTRATION This study was pre-registered at ClinicalTrials.gov (ID: NCT04610619).
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Affiliation(s)
- Luuk R. van den Bersselaar
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
| | - Nick Kruijt
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
| | - Gert-Jan Scheffer
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Lucas van Eijk
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Ignacio Malagon
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Stan Buckens
- Department of Radiology, Radboudumc, Nijmegen, The Netherlands
| | - José AE Custers
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Leonie Helder
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Anna Greco
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Leo AB Joosten
- Department of Internal Medicine, Radboud Institute of Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
- Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Baziel GM van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
| | - Sheila Riazi
- Department of Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Susan Treves
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas’ Hospital NHS Foundation Trust
- Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, United Kingdom
| | - Marc MJ Snoeck
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
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16
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Kruijt N, den Bersselaar LV, Snoeck M, Kramers K, Riazi S, Bongers C, Treves S, Jungbluth H, Voermans N. RYR1-related rhabdomyolysis: a spectrum of hypermetabolic states due to ryanodine receptor dysfunction. Curr Pharm Des 2021; 28:2-14. [PMID: 34348614 DOI: 10.2174/1381612827666210804095300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022]
Abstract
Variants in the ryanodine receptor-1 gene (RYR1) have been associated with a wide range of neuromuscular conditions, including various congenital myopathies and malignant hyperthermia (MH). More recently, a number of RYR1 variants, mostly MH-associated, have been demonstrated to contribute to rhabdomyolysis events not directly related to anesthesia in otherwise healthy individuals. This review focuses on RYR1-related rhabdomyolysis, in the context of several clinical presentations (i.e., exertional rhabdomyolysis, exertional heat illnesses and MH), and conditions involving a similar hypermetabolic state, in which RYR1 variants may be present (i.e., neuroleptic malignant syndrome and serotonin syndrome). The variety of triggers that can evoke rhabdomyolysis, on their own or in combination, as well as the number of potentially associated complications, illustrates that this is a condition relevant to several medical disciplines. External triggers include but are not limited to strenuous physical exercise, especially if unaccustomed or performed under challenging environmental conditions (e.g., high ambient temperature or humidity), alcohol/illicit drugs, prescription medication (in particular statins, other anti-lipid agents, antipsychotics and antidepressants) infection, or heat. Amongst all patients presenting with rhabdomyolysis, a genetic susceptibility is present in a proportion, with RYR1 being one of the most common genetic causes. Clinical clues for a genetic susceptibility include recurrent rhabdomyolysis, creatine kinase (CK) levels above 50 times the upper limit of normal, hyperCKemia lasting for 8 weeks or longer, drug/medication doses insufficient to explain the rhabdomyolysis event, and a positive family history. For the treatment or prevention of RYR1-related rhabdomyolysis, the RYR1 antagonist dantrolene can be administered, both in the acute phase, or prophylactically in patients with a history of muscle cramps and/or recurrent rhabdomyolysis events. Aside from dantrolene, several other drugs are being investigated for their potential therapeutic use in RYR1-related disorders. These findings offer further therapeutic perspectives for humans, suggesting an important area for future research.
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Affiliation(s)
- Nick Kruijt
- Department of Neurology, Radboud University Medical Centre, Nijmegen. Netherlands
| | | | - Marc Snoeck
- Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen. Netherlands
| | - Kees Kramers
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen. Netherlands
| | - Sheila Riazi
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, ON. Canada
| | - Coen Bongers
- Department of Physiology, Radboudumc, Nijmegen. Netherlands
| | - Susan Treves
- Department of Biomedicine, University Hospital Basel. Switzerland
| | - Heinz Jungbluth
- Department of Paediatric Neurology - Neuromuscular Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London. United Kingdom
| | - Nicol Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen. Netherlands
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17
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Zullo A, Frisso G, Carsana A. Influence of physical activity on structure and function of the RyR1 calcium channel: a systematic review. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.19.04238-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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HyperCKemia and rhabdomyolysis in the neuroleptic malignant and serotonin syndromes: A literature review. Neuromuscul Disord 2020; 30:949-958. [PMID: 33250373 DOI: 10.1016/j.nmd.2020.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022]
Abstract
Neuroleptic malignant syndrome and serotonin syndrome are two syndromes whose molecular bases remain poorly understood. The phenotypes of both syndromes overlap with other syndromes that have a clear genetic background, in particular RYR1-related malignant hyperthermia. Through a literature review, performed according to the PRISMA guidelines, we aimed to report the clinical features of both syndromes, and the results of genetic testing performed. 10 case series and 99 case reports were included, comprising 134 patients. A male predominance of 58% was found. The median age was 35 (range 4-84) years. Eight patients experienced recurrent episodes of rhabdomyolysis. Genetic analysis was performed in eleven patients (8%), revealing four RYR1 variants, three likely benign (p.Asp849Asn, p.Arg4645Gln, p.Arg4645Gln) and one variant of uncertain significance (p.Ala612Thr). This review underlines that a subset of patients with neuroleptic malignant syndrome and serotonin syndrome develop recurrent episodes of rhabdomyolysis. This recurrent pattern suggests a possible underlying (genetic) susceptibility. However, the genetic background of neuroleptic malignant syndrome and serotonin syndrome has only been investigated to a very limited degree so far. The increasing availability of next generation sequencing offers an opportunity to identify potentially associated genetic backgrounds, especially in patients with recurrent episodes or a positive family history.
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20
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What is in the Myopathy Literature? J Clin Neuromuscul Dis 2020; 21:7-13. [PMID: 31453849 DOI: 10.1097/cnd.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this issue, an article describing a newly defined entity, myoglobinopathy, is covered. This autosomal-dominant, adult-onset, proximal-predominant myopathy may be associated with cardiac involvement and is due to a mutation in MB. The presence of sarcoplasmic bodies is distinctive in muscle biopsy specimens. Next, variability in phenotypes and genotypes in patients with RYR1 and TTN mutations is described. Several articles address respiratory dysfunction in myotonic dystrophy type 1, reporting that its severity is associated with the CTG-repeat size, age, and degree of muscle weakness. Several articles focus on muscle pain, including myalgias in mitochondrial disorders and the presence of inflammation in muscle biopsy specimens from patients with myalgias and abnormal electrodiagnostic testing. Finally, a form of 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) myopathy mimicking limb-girdle muscular dystrophy is highlighted.
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21
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Papadimas GK, Xirou S, Kararizou E, Papadopoulos C. Update on Congenital Myopathies in Adulthood. Int J Mol Sci 2020; 21:ijms21103694. [PMID: 32456280 PMCID: PMC7279481 DOI: 10.3390/ijms21103694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022] Open
Abstract
Congenital myopathies (CMs) constitute a group of heterogenous rare inherited muscle diseases with different incidences. They are traditionally grouped based on characteristic histopathological findings revealed on muscle biopsy. In recent decades, the ever-increasing application of modern genetic technologies has not just improved our understanding of their pathophysiology, but also expanded their phenotypic spectrum and contributed to a more genetically based approach for their classification. Later onset forms of CMs are increasingly recognised. They are often considered milder with slower progression, variable clinical presentations and different modes of inheritance. We reviewed the key features and genetic basis of late onset CMs with a special emphasis on those forms that may first manifest in adulthood.
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Okano S, Shimada S, Tanaka R, Okayama A, Kajihama A, Suzuki N, Nakau K, Takahashi S, Matsumoto N, Saitsu H, Tanboon J, Nishino I, Azuma H. Life-threatening muscle complications of COL4A1-related disorder. Brain Dev 2020; 42:93-97. [PMID: 31540749 DOI: 10.1016/j.braindev.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
Abstract
COL4A1-related disorder is recognized as a systemic disease because the alpha 1 chain of type IV collagen, encoded by COL4A1, is essential for basement membrane stability. However, muscular manifestations related to this disorder are rarely reported. We report the case of a 2-year-old boy with porencephaly, who harbored a de novo COL4A1 mutation of c.1853G > A, p. (Gly618Glu) and exhibited recurrent rhabdomyolysis with viral or bacterial infections. Moreover, he developed obstructive hypertrophic cardiomyopathy which required surgical intervention. Skeletal muscle biopsy revealed findings compatible with fiber-type disproportion. Ultrastructural study demonstrated the similar findings previously reported in mice with Col4a1 mutation including collagen disarray and reduction of electron density in the basement membrane of capillary endothelial cells and muscle fibers. Dilated endoplasmic reticulum in the capillary endothelial cells is also noted. This report adds another disease spectrum of COL4A1 mutation which include porencephaly, hypertrophic cardiomyopathy, rhabdomyolysis and fiber-type disproportion.
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Affiliation(s)
- Satomi Okano
- Department of Pediatrics, Asahikawa Medical University, Japan.
| | - Sorachi Shimada
- Department of Pediatrics, Asahikawa Medical University, Japan
| | - Ryosuke Tanaka
- Department of Pediatrics, Asahikawa Medical University, Japan
| | - Akie Okayama
- Department of Pediatrics, Asahikawa Medical University, Japan
| | - Aya Kajihama
- Department of Pediatrics, Asahikawa Medical University, Japan
| | - Nao Suzuki
- Department of Pediatrics, Asahikawa Medical University, Japan
| | - Koichi Nakau
- Department of Pediatrics, Asahikawa Medical University, Japan
| | | | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Japan
| | - Hirotomo Saitsu
- Department of Biochemistry, Hamamatsu University School of Medicine, Japan
| | - Jantima Tanboon
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Japan; Departments of Genome Medicine Development and Clinical Genome Analysis, Medical Genome Center (MGC), NCNP, Japan
| | - Hiroshi Azuma
- Department of Pediatrics, Asahikawa Medical University, Japan
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