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Lindsay-McGee V, Massey C, Li YT, Clark EL, Psifidi A, Piercy RJ. Characterisation of phenotypic patterns in equine exercise-associated myopathies. Equine Vet J 2024. [PMID: 38965932 DOI: 10.1111/evj.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/05/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Equine exercise-associated myopathies are prevalent, clinically heterogeneous, generally idiopathic disorders characterised by episodes of myofibre damage that occur in association with exercise. Episodes are intermittent and vary within and between affected horses and across breeds. The aetiopathogenesis is often unclear; there might be multiple causes. Poor phenotypic characterisation hinders genetic and other disease analyses. OBJECTIVES The aim of this study was to characterise phenotypic patterns across exercise-associated myopathies in horses. STUDY DESIGN Historical cross-sectional study, with subsequent masked case-control validation study. METHODS Historical clinical and histological features from muscle samples (n = 109) were used for k-means clustering and validated using principal components analysis and hierarchical clustering. For further validation, a blinded histological study (69 horses) was conducted comparing two phenotypic groups with selected controls and horses with histopathological features characterised by myofibrillar disruption. RESULTS We identified two distinct broad phenotypes: a non-classic exercise-associated myopathy syndrome (EAMS) subtype was associated with practitioner-described signs of apparent muscle pain (p < 0.001), reluctance to move (10.85, p = 0.001), abnormal gait (p < 0.001), ataxia (p = 0.001) and paresis (p = 0.001); while a non-specific classic RER subtype was not uniquely associated with any particular variables. No histological differences were identified between subtypes in the validation study, and no identifying histopathological features for other equine myopathies identified in either subtype. MAIN LIMITATIONS Lack of an independent validation population; small sample size of smaller identified subtypes; lack of positive control myofibrillar myopathy cases; case descriptions derived from multiple independent and unblinded practitioners. CONCLUSIONS This is the first study using computational clustering methods to identify phenotypic patterns in equine exercise-associated myopathies, and suggests that differences in patterns of presenting clinical signs support multiple disease subtypes, with EAMS a novel subtype not previously described. Routine muscle histopathology was not helpful in sub-categorising the phenotypes in our population.
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Affiliation(s)
| | - Claire Massey
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
| | - Ying Ting Li
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
| | - Emily L Clark
- The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Androniki Psifidi
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
- The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Richard J Piercy
- Department of Clinical Sciences and Services, Royal Veterinary College, London, UK
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Babaee M, Nilipour Y, Alijanpour S, Ghasemi A, Taghdiri MM, Sarraf P, Miryounesi M, Ramezani M. Phenotypic and genotyping spectrum of two Iranian cases with RBCK1-associated polyglucosan body myopathy. Neuropathology 2024. [PMID: 38922716 DOI: 10.1111/neup.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
Glycogen storage diseases (GSDs) are a group of metabolic disorders affecting glycogen metabolism, with polyglucosan body myopathy type 1 (PGBM1) being a rare variant linked to RBCK1 gene mutations. Understanding the clinical diversity of PGBM1 aids in better characterization of the disease. Two unrelated Iranian families with individuals exhibiting progressive muscle weakness underwent clinical evaluations, genetic analysis using whole exome sequencing (WES), and histopathological examinations of muscle biopsies. In one case, a novel homozygous RBCK1 variant was identified, presenting with isolated myopathy without cardiac or immune involvement. Conversely, the second case harbored a known homozygous RBCK1 variant, displaying a broader phenotype encompassing myopathy, cardiomyopathy, inflammation, and immunodeficiency. Histopathological analyses confirmed characteristic skeletal muscle abnormalities consistent with PGBM1. Our study contributes to the expanding understanding of RBCK1-related diseases, illustrating the spectrum of phenotypic variability associated with distinct RBCK1 variants. These findings underscore the importance of genotype-phenotype correlations in elucidating disease mechanisms and guiding clinical management. Furthermore, the utility of next-generation sequencing techniques in diagnosing complex neurogenetic disorders is emphasized, facilitating precise diagnosis and enabling tailored genetic counseling for affected individuals and their families.
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Affiliation(s)
- Marzieh Babaee
- Physical Medicine, and Rehabilitation, Mofid Children's Hospital, Tehran, Iran
- Physical Medicine and Rehabilitation Research Center, SBMU, Tehran, Iran
| | - Yalda Nilipour
- Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Sahar Alijanpour
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aida Ghasemi
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Taghdiri
- Pediatric Neurology Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pediatric Neurology Department, Mofid Children Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Sarraf
- Department of Neuromuscular Diseases, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Miryounesi
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahtab Ramezani
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Ellis KL, Contino EK, Nout‐Lomas YS. Poor performance in the horse: Diagnosing the non‐orthopaedic causes. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Katherine L. Ellis
- Gail Holmes Equine Orthopedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins Colorado USA
| | - Erin K. Contino
- Gail Holmes Equine Orthopedic Research Center, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins Colorado USA
| | - Yvette S. Nout‐Lomas
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins Colorado USA
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Longué CM, Dagleish MP, McGovern G, Brownlow AC, Baily JL. Intrasarcoplasmic Polyglucosan Inclusions in Heart and Skeletal Muscles of Long-Finned Pilot Whales (Globicephala melas) may be Age-Related. J Comp Pathol 2020; 181:18-25. [PMID: 33288146 DOI: 10.1016/j.jcpa.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/04/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022]
Abstract
Polysaccharide storage myopathies have been described in several animal species and are characterized by periodic acid-Schiff (PAS)-positive, diastase-resistant intrasarcoplasmic inclusions in myocytes. Skeletal and cardiac muscle samples from a subset of a single pod of stranded long-finned pilot whales (Globicephala melas) were evaluated by light and transmission electron microscopy. Twelve individuals demonstrated sporadic basophilic packets of PAS-positive, diastase-resistant complex polysaccharide material, either centrally or peripherally, in skeletal and cardiac myocytes. Few microscopic myopathic changes were found but included focal inflammation and internalized nuclei. Ultrastructurally, the inclusions consisted of loosely arranged, tangled filaments and were not membrane-bound, which is consistent with polyglucosan inclusions. Within skeletal muscle, the number of inclusions had a marginal statistically significant (P = 0.0536) correlation with length, as a proxy for age, suggesting that such inclusions in skeletal muscles may be age-related, although the cause remains unclear.
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Affiliation(s)
- Camille M Longué
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Scotland, UK
| | - Mark P Dagleish
- Moredun Research Institute, Pentlands Science Park, Penicuik, Scotland, UK.
| | - Gillian McGovern
- Animal and Plant Health Agency, Pentlands Science Park, Penicuik, Scotland, UK
| | - Andrew C Brownlow
- Scottish Marine Animal Stranding Scheme, SRUC Northern Faculty, Inverness Campus, Inverness, Scotland, UK
| | - Johanna L Baily
- Moredun Research Institute, Pentlands Science Park, Penicuik, Scotland, UK; Institute of Aquaculture, University of Stirling, Stirling, Scotland, UK
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Cenacchi G, Papa V, Costa R, Pegoraro V, Marozzo R, Fanin M, Angelini C. Update on polyglucosan storage diseases. Virchows Arch 2019; 475:671-686. [DOI: 10.1007/s00428-019-02633-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 11/27/2022]
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Fanin M, Nascimbeni AC, Savarese M, Papa V, Cenacchi G, Nigro V, Angelini C. Familial polyglucosan body myopathy with unusual phenotype. Neuropathol Appl Neurobiol 2015; 41:385-90. [DOI: 10.1111/nan.12171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/06/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Marina Fanin
- Department of Neurosciences; University of Padova; Padova Italy
| | | | - Marco Savarese
- Department of Biochemistry, Biophysics and General Pathology; 2nd University of Naples; Naples Italy
- Telethon Institute of Genetics and Medicine; Naples Italy
| | - Valentina Papa
- Department of Radiology and Histopathological Sciences; ‘Alma Mater’ University of Bologna; Bologna Italy
| | - Giovanna Cenacchi
- Department of Radiology and Histopathological Sciences; ‘Alma Mater’ University of Bologna; Bologna Italy
| | - Vincenzo Nigro
- Department of Biochemistry, Biophysics and General Pathology; 2nd University of Naples; Naples Italy
- Telethon Institute of Genetics and Medicine; Naples Italy
| | - Corrado Angelini
- Department of Neurosciences; University of Padova; Padova Italy
- Fondazione IRCCS San Camillo Hospital; Venice Italy
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Vacuolar myopathy in an adult Warmblood horse. Neuromuscul Disord 2013; 23:473-7. [PMID: 23623568 DOI: 10.1016/j.nmd.2013.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 02/28/2013] [Accepted: 03/11/2013] [Indexed: 11/23/2022]
Abstract
Histopathological interpretation of semimembranosus muscle samples from an adult Warmblood mare with clinical signs suggestive of exertional rhabdomyolysis and intermittent mild elevations in muscle enzyme activities revealed abundant sarcoplasmic vacuoles in all fibre-types containing fine, apparently proteinaceous debris. Vacuolar contents stained lightly with PAS, but did not appear to contain amylopectate, lipid or acid phosphatase and their periphery was unstained with dystrophin immunohistochemistry. Electron microscopy revealed that vacuoles were not membrane bound. No vacuoles were detected in muscle samples evaluated at post mortem following 4 months of rest. To our knowledge, this is the first report of a presumed primary vacuolar myopathy in a horse.
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Hechtman JF, Gordon RE, Harpaz N. Intramuscular corpora amylacea adjacent to ileal low-grade neuroendocrine tumours (typical carcinoids): a light microscopic, immunohistochemical and ultrastructural study. J Clin Pathol 2013; 66:569-72. [PMID: 23443895 DOI: 10.1136/jclinpath-2012-201415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS The purposes of this study are to (1) document the prevalence of intracytoplasmic inclusions adjacent to ileal well-differentiated neuroendocrine tumours (WNETs), (2) examine whether and how tumour and patient characteristics are associated with inclusions and (3) investigate their properties on special stains and electron microscopy in comparison with corpora amylacea (CA). METHODS We examined the resection slides from 26 ileal, 5 gastric and 5 rectal cases of WNET. Inclusions were readily identified with H&E staining. Histochemical, immunohistochemical and ultrastructural evaluations were performed on the block with the highest number of inclusions. RESULTS Intracytoplasmic inclusions occurred adjacent (<1 mm) to 15 of 26 (57.7%) ileal WNETs. Patients with and without inclusions were of similar mean ages (59.5 vs 57.4 years; p=0.88), but NETs with inclusions were larger than those without inclusions (3.3 vs 1.7 cm, p=0.03). Inclusions were neither associated with gastric (mean age=65 years, mean diameter=1.5 cm) or rectal WNETs (mean age=47.8 years, mean diameter=0.5 cm) (p=0.01), nor were they present >1 mm from ileal NETs. CA stained strongly for ubiquitin, DPAS and Alcian blue; faintly and peripherally for desmin and smooth muscle actin and negatively for calcium. Ultrastructurally, their appearance was consistent with filaments, some with cores of particle matter. CONCLUSIONS Our results suggest that these inclusions are virtually identical to CA and present adjacent to the majority of ileal WNET. They may be the result of a degenerative process, possibly due to chronic myocyte stress from an infiltrating slow growing tumour mass or local hormonal effects.
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Naylor RJ, Livesey L, Schumacher J, Henke N, Massey C, Brock KV, Fernandez-Fuente M, Piercy RJ. Allele copy number and underlying pathology are associated with subclinical severity in equine type 1 polysaccharide storage myopathy (PSSM1). PLoS One 2012; 7:e42317. [PMID: 22860112 PMCID: PMC3409190 DOI: 10.1371/journal.pone.0042317] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 07/02/2012] [Indexed: 11/28/2022] Open
Abstract
Equine type 1 polysaccharide storage myopathy (PSSM1), a common glycogenosis associated with an R309H founder mutation in the glycogen synthase 1 gene (GYS1), shares pathological features with several human myopathies. In common with related human disorders, the pathogenesis remains unclear in particular, the marked phenotypic variability between affected animals. Given that affected animals accumulate glycogen and alpha-crystalline polysaccharide within their muscles, it is possible that physical disruption associated with the presence of this material could exacerbate the phenotype. The aim of this study was to compare the histopathological changes in horses with PSSM1, and specifically, to investigate the hypothesis that the severity of underlying pathology, (e.g. vacuolation and inclusion formation) would (1) be higher in homozygotes than heterozygotes and (2) correlate with clinical severity. Resting and post-exercise plasma creatine kinase (CK) and aspartate aminotransferase (AST) enzyme activity measurements and muscle pathology were assessed in matched cohorts of PSSM1 homozygotes, heterozygotes or control horses. Median (interquartile range (IR)) resting CK activities were 364 (332–764) U/L for homozygotes, 301 (222–377) U/L for heterozygotes and 260 (216–320) U/L for controls, and mean (+/− SD) AST activity for homozygotes were 502 (+/116) U/L, for heterozygotes, 357 (+/−92) U/L and for controls, 311 (+/−64) U/L and were significantly different between groups (P = 0.04 and P = 0.01 respectively). Resting plasma AST activity was significantly associated with the severity of subsarcolemmal vacuolation (rho = 0.816; P = 0.01) and cytoplasmic inclusions (rho = 0.766; P = 0.01). There were fewer type 2× and more type 2a muscle fibres in PSSM1-affected horses. Our results indicate that PSSM1 has incomplete dominance. Furthermore, the association between plasma muscle enzyme activity and severity of underlying pathology suggests that physical disruption of myofibres may contribute to the myopathic phenotype. This work provides insight into PSSM1 pathogenesis and has implications for related human glycogenoses.
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Affiliation(s)
- Rosie J. Naylor
- Comparative Neuromuscular Diseases Laboratory, The Royal Veterinary College, London, United Kingdom
| | - Leanda Livesey
- Auburn University, Auburn, Alabama, United States of America
| | - John Schumacher
- Auburn University, Auburn, Alabama, United States of America
| | - Nicole Henke
- Auburn University, Auburn, Alabama, United States of America
| | - Claire Massey
- Comparative Neuromuscular Diseases Laboratory, The Royal Veterinary College, London, United Kingdom
| | - Kenny V. Brock
- Auburn University, Auburn, Alabama, United States of America
| | - Marta Fernandez-Fuente
- Comparative Neuromuscular Diseases Laboratory, The Royal Veterinary College, London, United Kingdom
| | - Richard J. Piercy
- Comparative Neuromuscular Diseases Laboratory, The Royal Veterinary College, London, United Kingdom
- * E-mail:
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McCue ME, Armién AG, Lucio M, Mickelson JR, Valberg SJ. Comparative Skeletal Muscle Histopathologic and Ultrastructural Features in Two Forms of Polysaccharide Storage Myopathy in Horses. Vet Pathol 2009; 46:1281-91. [DOI: 10.1354/vp.08-vp-0177-m-fl] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Polysaccharide storage myopathy (PSSM) has been found in more than 35 different horse breeds through identification of abnormal storage of polysaccharide in muscle biopsies. A dominant mutation in the glycogen synthase 1 gene ( GYS1) accounts for a substantial proportion of PSSM cases in at least 17 breeds, including Quarter Horses, but some horses diagnosed with PSSM by muscle histopathologic analysis are negative for the mutation. We hypothesized that a second distinct form of glycogen storage disease exists in GYS1 -negative horses with PSSM. The objectives of this study were to compare the histopathologic features, ultrastructure of polysaccharide, signalment, history, and presenting complaints of GYS1 -negative Quarter Horses and related breeds with PSSM to those of GYS1 -positive horses with PSSM. The total histopathologic score in frozen sections of skeletal muscle stained with hematoxylin and eosin, periodic acid Schiff (PAS) and amylase-PAS stains from 53 GYS1-negative horses did not differ from that of 52 GYS1 -positive horses. Abnormal polysaccharide was fine granular or homogenous in appearance (49/53; 92%), often amylase-sensitive (28/53; 53%), more commonly located under the sarcolemma, and consisting of β glycogen particles in GYS1 -negative horses. However, in GYS1 -positive horses, abnormal polysaccharide was usually coarse granular (50/52; 96%), amylase-resistant (51/52; 98%), more commonly cytoplasmic, and consisting of β glycogen particles or, in some myofibers, filamentous material surrounded by β glycogen particles. Retrospective analysis found that GYS1 -negative horses ( n = 43) were younger at presentation (4.9 ± 0.6 years vs. 6.7 ± 0.3 years for GYS1 -positive horses) and were more likely to be intact males than GYS1 -positive horses ( n = 160). We concluded that 2 forms of PSSM exist and often have distinctive abnormal polysaccharide. However, because evaluation of the histologic appearance of polysaccharide can be subjective and affected by age, the gold standard for diagnosis of PSSM at present would appear to be testing for the GYS1 mutation followed by evaluating muscle biopsy for characteristic abnormal polysaccharide in those horses that are negative for the mutation.
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Affiliation(s)
- M. E. McCue
- Department of Veterinary Population Medicine, University of Minnesota College of Veterinary Medicine
| | - A. G. Armién
- Department of Veterinary Population Medicine, University of Minnesota College of Veterinary Medicine
| | - M. Lucio
- Department of Veterinary Population Medicine, University of Minnesota College of Veterinary Medicine
| | - J. R. Mickelson
- Department of Veterinary Biosciences, University of Minnesota College of Veterinary Medicine
| | - S. J. Valberg
- Department of Veterinary Population Medicine, University of Minnesota College of Veterinary Medicine
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