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Nicolau S, Milone M. Sporadic Late-Onset Nemaline Myopathy: Current Landscape. Curr Neurol Neurosci Rep 2023; 23:777-784. [PMID: 37856049 DOI: 10.1007/s11910-023-01311-0] [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] [Accepted: 09/29/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE OF REVIEW Sporadic late-onset nemaline myopathy (SLONM) is a rare adult-onset, acquired, muscle disease that can be associated with monoclonal gammopathy or HIV infection. The pathological hallmark of SLONM is the accumulation of nemaline rods in muscle fibers. We review here current knowledge about its presentation, pathophysiology, and management. RECENT FINDINGS SLONM usually manifests with subacutely progressive proximal and axial weakness, but it can also present with chronic progressive weakness mimicking muscular dystrophy. The pathophysiology of the disease remains poorly understood, with evidence pointing to both autoimmune mechanisms and hematological neoplasia. Recent studies have identified histological, proteomic, and transcriptomic alterations that shed light on disease mechanisms and distinguish SLONM from inherited nemaline myopathies. A majority of SLONM patients respond to intravenous immunoglobulins, chemotherapy, or hematopoietic stem cell transplant. SLONM is a treatable myopathy, although its underlying etiology and pathomechanisms remain unclear. A high degree of suspicion should be maintained for this disease to reduce diagnostic delay and treatment in SLONM and facilitate its distinction from inherited nemaline myopathies.
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Affiliation(s)
- Stefan Nicolau
- Center for Gene Therapy, Nationwide Children's Hospital, Columbus, OH, USA
| | - Margherita Milone
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Matsuura E, Nozuma S, Shigehisa A, Dozono M, Nakamura T, Tanaka M, Kubota R, Hashiguchi A, Takashima H. HTLV-1-associated myelopathy/tropical spastic paraplegia with sporadic late-onset nemaline myopathy: a case report. BMC Musculoskelet Disord 2023; 24:355. [PMID: 37149561 PMCID: PMC10163739 DOI: 10.1186/s12891-023-06461-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/25/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Sporadic late onset nemaline myopathy (SLONM) is a muscle disorder characterized by the presence of nemaline rods in muscle fibers. SLONM has no known genetic cause but has been associated with monoclonal gammopathy of undetermined significance and with human immunodeficiency virus (HIV) infection. Human T-cell leukemia virus-1 (HTLV-1) is a known causative agent of adult T-cell leukemia/lymphoma and HTLV-1 associated myelopathy/tropical spastic paraplegia (HAM/TSP), a chronic inflammatory neurological disease. HTLV-1 has been reported to be implicated in inflammatory myopathies, as well as in HIV infection.; however, there have been no reports of an association between HTLV-1 infection and SLONM to date. CASE PRESENTATION A 70-year-old Japanese woman presented with gait disturbance, lumbar kyphosis, and respiratory dysfunction. The diagnosis of HAM/TSP with SLONM was made based on characteristic clinical symptoms of HAM/TSP, such as spasticity in the lower extremities, and cerebrospinal fluid test results; and of SLONM, such as generalized head drooping, respiratory failure, and muscle biopsy results. Steroid treatment was initiated and improvement in her stooped posture was observed after 3 days of treatment. CONCLUSION This is the first case report of SLONM combined with HTLV-1 infection. Further studies are needed to elucidate the relationship between retroviruses and muscle diseases.
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Affiliation(s)
- Eiji Matsuura
- Department of Neurology and Geriatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8544, Japan.
| | - Satoshi Nozuma
- Department of Neurology and Geriatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8544, Japan
| | - Ayano Shigehisa
- Department of Neurology and Geriatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8544, Japan
| | - Mika Dozono
- Department of Neurology and Geriatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8544, Japan
| | - Tomonori Nakamura
- Department of Neurology and Geriatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8544, Japan
| | - Masakazu Tanaka
- Division of Neuroimmunology, Joint Research Center for Human Retrovirus Infection, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8544, Japan
| | - Ryuji Kubota
- Division of Neuroimmunology, Joint Research Center for Human Retrovirus Infection, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8544, Japan
| | - Akihiro Hashiguchi
- Department of Neurology and Geriatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8544, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8544, Japan
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Zhao B, Dai T, Zhao D, Ma X, Zhao C, Li L, Sun Y, Zhang Y, Yan Y, Lu JQ, Liu F, Yan C. Clinicopathologic Profiles of Sporadic Late-Onset Nemaline Myopathy: Practical Importance of Anti-α-Actinin Immunostaining. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/4/e1184. [PMID: 35581006 PMCID: PMC9128036 DOI: 10.1212/nxi.0000000000001184] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/05/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Sporadic late-onset nemaline myopathy (SLONM) is a treatable or otherwise fatal myopathy. Diagnosis of SLONM is still challenging, and no therapeutic consensus has been achieved. Here, we reported the clinicopathologic features and long-term follow-up data of SLONM in a Chinese cohort. METHODS We performed a retrospective evaluation of clinical, pathologic, and treatment outcomes of 17 patients with SLONM diagnosed between March 1986 and April 2021 at our neuromuscular center. Immunohistochemistry (IHC) with antibodies against 5 Z-disc-associated proteins was performed in the muscle biopsies of SLONM to identify a potential pathologic marker in aid of diagnosis. In comparison, we also performed muscle IHC in patients with selective type II fiber atrophy (n = 22), neurogenic atrophy (n = 22), mitochondrial myopathy (n = 5), immune-mediated necrotizing myopathy (n = 5), and normal controls (n = 5). RESULTS Most of the patients exhibited asymmetric limb muscles weakness (71%, 12/17) and neck extensor weakness (53%, 9/17). Immunofixation electrophoresis was performed in 11 patients, and 4 of them were identified with monoclonal gammopathy of undetermined significance (MGUS). EMG from 16 patients demonstrated a myopathic pattern with spontaneous activities in 69% (11/16) of them. Muscle MRI showed preferential involvement of paraspinal, gluteus minimus and medius, semimembranosus, and soleus muscles. Suspected nemaline bodies on modified Gomori trichrome were confirmed by IHC using anti-α-actinin antibody (100%, 17/17), anti-myotilin antibody (94%, 16/17), anti-desmin antibody (94%, 16/17), anti-α-B crystallin antibody (65%, 11/17), and anti-telethonin antibody (18%, 3/17) with various positive rates. Notably, anti-α-actinin IHC showed the highest percentage of strongly positive staining (77%, 13/17), being the only one without negative results. Moderate improvement following autologous stem cell transplantation (ASCT) was noted in 3/4 patients with MGUS; favorable outcomes were also achieved in 6/7 patients without MGUS, including 3 patients with complete recovery who were given a combined treatment of prednisone and another immunosuppressant. DISCUSSION SLONM is a treatable myopathy with ASCT or traditional immunotherapy, especially when combined with steroids and immunosuppressants. Anti-α-actinin immunostaining is the most reliable pathologic marker to identify rod-bearing fibers, and it should be performed routinely in adult patients with undiagnosed nonnecrotic myopathies.
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Affiliation(s)
- Bing Zhao
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China
| | - Tingjun Dai
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China
| | - Dandan Zhao
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China
| | - Xiaotian Ma
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China
| | - Cuiping Zhao
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China
| | - Ling Li
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China
| | - Yuan Sun
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China
| | - Yongqing Zhang
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China
| | - Yaping Yan
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China.
| | - Jian-Qiang Lu
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China
| | - Fuchen Liu
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China
| | - Chuanzhu Yan
- From the Department of Neurology (B.Z., C.Z., L.L., Y.S., Y.Z., C.Y.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology (T.D., D.Z., F.L., C.Y.), Qilu Hospital, Shandong University; Department of Medicine Experimental Center (X.M.), Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University; Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (Y.Y.), College of Life Sciences, Shanxi Normal University, Xi'an, China; Division of Neuropathology (J.-Q.L.), Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Mitochondrial Medicine Laboratory (C.Y.), Qilu Hospital (Qingdao); and Brain Science Research Institute (C.Y.), Shandong University, Jinan, China.
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Gonçalves Júnior J, Shinjo SK. Rituximab as a treatment for human immunodeficiency virus-associated nemaline myopathy: What does the literature have to tell us? World J Clin Cases 2022; 10:1454-1456. [PMID: 35211583 PMCID: PMC8855173 DOI: 10.12998/wjcc.v10.i4.1454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/13/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
We presented a letter about a case of a 37-year-old Black female with a history of human immunodeficiency virus and an undetectable viral load. She was evaluated with weakness in the scapular (grade III) and pelvic girdles (grade II), elevation of creatine phosphokinase levels and muscle biopsy compatible with nemaline myopathy. She was treated with rituximab showing improvement of the condition.
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Maia T, Bergantim R, Costa H, Pinheiro J, Trigo F. Impact of hematologic complete response in the treatment of sporadic late-onset nemaline myopathy associated with monoclonal gammopathy. Clin Case Rep 2021; 9:e04471. [PMID: 34295490 PMCID: PMC8283848 DOI: 10.1002/ccr3.4471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/19/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022] Open
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) may be associated with pathologies with severe neuromuscular manifestations such as sporadic late-onset nemaline myopathy (SLONM). We describe a difficult to diagnose case of SLNOM with marked clinical improvement after achieving gammopathy complete hematologic response.
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Affiliation(s)
- Tânia Maia
- Hematology DepartmentCentro Hospitalar e Universitário São JoãoPortoPortugal
| | - Rui Bergantim
- Hematology DepartmentCentro Hospitalar e Universitário São JoãoPortoPortugal
- i3S ‐ Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- Cancer Drug Resistance GroupIPATIMUP ‐ Institute of Molecular Pathology and Immunology of the University of PortoPortoPortugal
- Hematology & Oncology UnitDepartment of Medicine ‐ Faculty of Medicine of University of PortoPortoPortugal
| | - Henrique Costa
- Neurology DepartmentCentro Hospitalar e de Vila Nova de Gaia e EspinhoGaiaPortugal
| | - Jorge Pinheiro
- Pathology DepartmentCentro Hospitalar e Universitário São JoãoPortoPortugal
| | - Fernanda Trigo
- Hematology DepartmentCentro Hospitalar e Universitário São JoãoPortoPortugal
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Kotchetkov R, Susman D, Bhutani D, Broch K, Dispenzieri A, Buadi FK. Chemotherapy-based approach is the preferred treatment for sporadic late-onset nemaline myopathy with a monoclonal protein. Int J Cancer 2021; 148:2807-2814. [PMID: 33529362 DOI: 10.1002/ijc.33483] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/29/2020] [Accepted: 01/15/2021] [Indexed: 01/24/2023]
Abstract
Sporadic late-onset nemaline myopathy (SLONM) associated with monoclonal protein (MP) is a rare disease with an aggressive, and often fatal course. Whether SLONM + MP represents a malignancy or dysimmune disease remains unclear. Currently, two main approaches are used to treat SLONM + MP: nonchemotherapy-based treatment (immunosuppression, intravenous immunoglobulins, plasmapheresis and plasma exchange) or chemotherapy with or without autologous stem cell transplantation. Due to the rare occurrence of the disease, the best treatment modality is unknown. We analyzed treatment and outcomes in a large cohort of 53 patients with SLONM + MP: four our own patients and 49 cases from published literature. Neurological improvement in the nonchemotherapy group (N = 25) was observed in 52% of patients: 8% reached marked improvement, 8% moderate response, 36% mild response; none reached complete remission (CR). In the chemotherapy group (N = 28), neurological improvement was seen in 86% of patients: 46% reached CR, 25% marked response, 11% moderate response and 4% mild response. The best neurological improvement correlated with deep hematological remission. Mean time to best response in the chemotherapy group was 8 months versus 21 months in the nonchemotherapy group (P < .001). Overall survival was higher in patients in the chemotherapy group. A chemotherapy approach should be the preferred treatment for patients with SLOMN + MP with the goal to reach complete hematologic remission. Based on the clinical, morphological peculiarities, aggressive disease course and superior clinical benefits of chemotherapy over nonchemotherapy, SLONM + MP should be considered as a hematological malignancy with the presence of MP of clinical rather than undetermined significance.
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Affiliation(s)
- Rouslan Kotchetkov
- Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada
| | | | - Divaya Bhutani
- Columbia University Medical Center, Multiple Myeloma and Amyloidosis Program, Division of Hematology and Oncology, New York, New York, USA
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | | | - Francis K Buadi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Tanboon J, Uruha A, Arahata Y, Dittmayer C, Schweizer L, Goebel HH, Nishino I, Stenzel W. Inflammatory features in sporadic late-onset nemaline myopathy are independent from monoclonal gammopathy. Brain Pathol 2021; 31:e12962. [PMID: 34043258 PMCID: PMC8412091 DOI: 10.1111/bpa.12962] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022] Open
Abstract
Sporadic late-onset nemaline myopathy (SLONM) is a rare adult-onset non-hereditary disease with subacute proximal muscle and often axial muscle weakness, characterized by the presence of nemaline bodies in skeletal muscle biopsies. Considering its association with concurrent monoclonal gammopathy of undetermined significance (MGUS), the disease is classified into two major subtypes (1) SLONM without MGUS (SLONM-noMGUS) and (2) with MGUS (SLONM-MGUS) association. SLONM associated with HIV infection (SLONM-HIV) is also reported. SLONM-MGUS has been shown to be associated with poorer prognosis and required aggressive treatment including high-dose melphalan and autologous stem cell transplantation. The approach is currently debatable as recent reports suggested effectiveness of intravenous immunoglobulin as initial treatment with indifference of overall survival despite the presence of MGUS. Our study aimed to find an underlying basis by review of pathological features in 49 muscle biopsy proven-SLONM from two large tertiary centers in Japan and Germany (n = 49: SLONM-noMGUS = 34, SLONM-MGUS = 13, SLONM-HIV = 2). We compared pathological findings in SLONM-noMGUS and SLONM-MGUS and focused on the presence of any detectable inflammatory features by immunohistochemistry. The clinical and histological features in SLONM-noMGUS and SLONM-MGUS were not distinctively different except for more common regenerating fibers (>5% of myofibers) present in SLONM-MGUS (p < 0.01). HLA-ABC expression and fine granular p62 were observed in 66.7% and 78.3% of SLONM, respectively. The predominant inflammatory cells were CD68+ cells. The inflammatory cells showed positive correlations with the percentage of nemaline-containing fibers (p < 0.001). In conclusion, inflammatory features are present although rather mild in SLONM. This finding contributes to the hypothesis of an acquired inflammatory disease pathogenesis and opens the possibility to offer immunotherapy in SLONM with inflammatory features regardless of the monoclonal gammopathy status.
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Affiliation(s)
- Jantima Tanboon
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.,Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Akinori Uruha
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Yukie Arahata
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.,Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Carsten Dittmayer
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Leonille Schweizer
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neuropathology, Universitätsmedizin Mainz, Mainz, Germany
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.,Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Werner Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Leibniz ScienceCampus Chronic Inflammation, Berlin, Germany
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Ono E, Ishii A, Higashi Y, Koita N, Ayaki T, Tanigaki K, Takayanagi S, Kondo N, Sakai K, Endo S, Yokoi H, Matsubara T, Minamiguchi S, Nishino I, Takahashi R, Yanagita M. Monoclonal gammopathy of renal significance (MGRS)-related AL amyloidosis complicated by amyloid myopathy: a case report. BMC Nephrol 2021; 22:74. [PMID: 33639890 PMCID: PMC7916314 DOI: 10.1186/s12882-021-02272-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 02/18/2021] [Indexed: 12/05/2022] Open
Abstract
Background Lately, monoclonal gammopathy of renal significance (MGRS) has been defined as a group of renal disorders that are strongly associated with monoclonal protein, including amyloid immunoglobulin light chain (AL) amyloidosis. Amyloid myopathy is rare (1.5% of all patients with amyloidosis) and the prognosis is poor. Furthermore, only approximately 20% of patients with amyloid myopathy are reported to have renal involvement, indicating a lack of data in the literature. Case presentation Here, we report a rare case of MGRS-related AL amyloidosis complicated by amyloid myopathy that presented with muscle weakness in the upper and lower limbs, neck and fingers, and nephrotic syndrome. Blood, urine, and bone marrow examination revealed monoclonal gammopathy of undetermined significance (MGUS) (Bence Jones protein-lambda). Muscle biopsy of the vastus lateralis muscle demonstrated amyloid proteins in the sarcolemma and in the blood vessel walls on Congo red staining, suggesting amyloid myopathy, and tiny inclusions in fibers on modified Gomori trichrome stain. Although we thought they were reminiscent of nemaline bodies, we could not confirm the nature of this structure. Renal biopsy demonstrated amyloid proteins in the mesangial region, part of the capillary walls, and the blood vessel walls on direct fast scarlet staining. As these amyloid proteins were positive for p-component staining and negative for amyloid A staining, β2-microglobulin, and pre-albumin, and as lambda light chains were positive in the mesangial region, we diagnosed the patient with MGRS-related AL amyloidosis. Although he was treated with melphalan and dexamethasone, his symptoms did not improve. Conclusions AL amyloidosis involving the kidneys and muscles has a poor prognosis, and a delayed diagnosis of amyloid myopathy is common because of its rarity and frequent misdiagnosis, which increases organ function deterioration. Therefore, early detection, therapeutic intervention, and careful follow-up are crucial.
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Affiliation(s)
- Erina Ono
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akira Ishii
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yoshiaki Higashi
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Natsuko Koita
- Department of Neurology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Ayaki
- Department of Neurology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Katsuya Tanigaki
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shunsuke Takayanagi
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Naoya Kondo
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kaoru Sakai
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichiro Endo
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hideki Yokoi
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Sporadic late-onset nemaline myopathy with monoclonal gammopathy of undetermined significance: Report of four patients. Neuromuscul Disord 2020; 31:29-34. [PMID: 33308940 DOI: 10.1016/j.nmd.2020.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
Sporadic late-onset nemaline myopathy (SLONM) is a rare, acquired muscle disease presenting with subacute progression in adulthood. It can be accompanied by a monoclonal gammopathy of undetermined significance (MGUS). We describe clinical and histopathological findings of four SLONM patients with MGUS. In all patients, nemaline rod, inter-myofibrillary network disruption, atrophic changes, peripheral basophilic discoloration, vacuole without rim, and cytoplasmic body without inflammation were seen. Three out of four patients were treated with prednisolone in combination with IVIG monthly and had an appropriate response to the treatment. The optimal first-line treatment remains unclear in SLONM-MGUS, although corticosteroids plus IVIg is associated with favorable clinical response. These treatment modalities might be used as an optional treatment before autologous stem cell transplantation; however, further studies with a higher number of patients are required.
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Sporadic late-onset nemaline myopathy in a patient with silicone breast implants. Clin Neurol Neurosurg 2020; 196:105999. [PMID: 32590250 DOI: 10.1016/j.clineuro.2020.105999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/30/2022]
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Yao X, Tsang T, Sun Q, Quinney S, Zhang P, Ning X, Li L, Shen L. Mining and visualizing high-order directional drug interaction effects using the FAERS database. BMC Med Inform Decis Mak 2020; 20:50. [PMID: 32183790 PMCID: PMC7079342 DOI: 10.1186/s12911-020-1053-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Adverse drug events (ADEs) often occur as a result of drug-drug interactions (DDIs). The use of data mining for detecting effects of drug combinations on ADE has attracted growing attention and interest, however, most studies focused on analyzing pairwise DDIs. Recent efforts have been made to explore the directional relationships among high-dimensional drug combinations and have shown effectiveness on prediction of ADE risk. However, the existing approaches become inefficient from both computational and illustrative perspectives when considering more than three drugs. Methods We proposed an efficient approach to estimate the directional effects of high-order DDIs through frequent itemset mining, and further developed a novel visualization method to organize and present the high-order directional DDI effects involving more than three drugs in an interactive, concise and comprehensive manner. We demonstrated its performance by mining the directional DDIs associated with myopathy using a publicly available FAERS dataset. Results Directional effects of DDIs involving up to seven drugs were reported. Our analysis confirmed previously reported myopathy associated DDIs including interactions between fusidic acid with simvastatin and atorvastatin. Furthermore, we uncovered a number of novel DDIs leading to increased risk for myopathy, such as the co-administration of zoledronate with different types of drugs including antibiotics (ciprofloxacin, levofloxacin) and analgesics (acetaminophen, fentanyl, gabapentin, oxycodone). Finally, we visualized directional DDI findings via the proposed tool, which allows one to interactively select any drug combination as the baseline and zoom in/out to obtain both detailed and overall picture of interested drugs. Conclusions We developed a more efficient data mining strategy to identify high-order directional DDIs, and designed a scalable tool to visualize high-order DDI findings. The proposed method and tool have the potential to contribute to the drug interaction research and ultimately impact patient health care. Availability and implementation http://lishenlab.com/d3i/explorer.html
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Affiliation(s)
- Xiaohui Yao
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Tiffany Tsang
- Department of Computer and Information Science, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Qing Sun
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sara Quinney
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN, 46202, USA
| | - Pengyue Zhang
- Department of Biomedical Informatics, College of Medicine, Ohio State University, Columbus, OH, 43210, USA
| | - Xia Ning
- Department of Biomedical Informatics, College of Medicine, Ohio State University, Columbus, OH, 43210, USA
| | - Lang Li
- Department of Biomedical Informatics, College of Medicine, Ohio State University, Columbus, OH, 43210, USA
| | - Li Shen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Naddaf E, Milone M, Kansagra A, Buadi F, Kourelis T. Sporadic late-onset nemaline myopathy: Clinical spectrum, survival, and treatment outcomes. Neurology 2019; 93:e298-e305. [PMID: 31167932 DOI: 10.1212/wnl.0000000000007777] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/05/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe the clinical phenotype, long-term treatment outcome, and overall survival of sporadic late-onset nemaline myopathy (SLONM) with or without a monoclonal protein (MP). METHODS We conducted a retrospective chart review of patients seen between September 2000 and June 2017 and collected clinical, laboratory, and survival data. Treatment response was classified as mild, moderate, or marked as adjudged by predefined criteria. RESULTS We identified 28 patients with SLONM; 17 (61%) had an associated MP. Median age at symptom onset was 62 years. Diagnosis was often delayed by a median of 35 months from symptom onset. There was no difference in clinical or laboratory features between patients with or without MP. Although the majority of patients had proximal or axial weakness at onset, about 18% of patients had atypical presentations. A total of 7/9 (78%) patients receiving IV immunoglobulin (IVIg), 6/8 (75%) receiving hematologic therapy as either autologous stem cell transplant (ASCT) or chemotherapy, and 1/8 (13%) receiving immunosuppressive therapies responded to treatment (p = 0.001). All 3 patients with marked response were treated with IVIg; 2 of them had an MP. The 5-year and 10-year overall survival from symptom onset was 92% and 68%, respectively, with no difference between patients with or without MP. CONCLUSION SLONM has a wide spectrum of clinical presentations. In this contemporary case series, overall survival of patients did not seem to be affected by the presence of an MP. Initial treatment with IVIg is reasonable in all patients, followed by ASCT or chemotherapy as second-line therapy in patients with an associated MP.
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Affiliation(s)
- Elie Naddaf
- From the Department of Neurology, Division of Neuromuscular Medicine (E.N., M.M.), and Department of Internal Medicine, Division of Hematology (F.B., T.K.), Mayo Clinic, Rochester, MN; and Department of Internal Medicine, Division of Hematology (A.K.), University of Texas-Southwestern, Dallas.
| | - Margherita Milone
- From the Department of Neurology, Division of Neuromuscular Medicine (E.N., M.M.), and Department of Internal Medicine, Division of Hematology (F.B., T.K.), Mayo Clinic, Rochester, MN; and Department of Internal Medicine, Division of Hematology (A.K.), University of Texas-Southwestern, Dallas
| | - Ankit Kansagra
- From the Department of Neurology, Division of Neuromuscular Medicine (E.N., M.M.), and Department of Internal Medicine, Division of Hematology (F.B., T.K.), Mayo Clinic, Rochester, MN; and Department of Internal Medicine, Division of Hematology (A.K.), University of Texas-Southwestern, Dallas
| | - Francis Buadi
- From the Department of Neurology, Division of Neuromuscular Medicine (E.N., M.M.), and Department of Internal Medicine, Division of Hematology (F.B., T.K.), Mayo Clinic, Rochester, MN; and Department of Internal Medicine, Division of Hematology (A.K.), University of Texas-Southwestern, Dallas
| | - Taxiarchis Kourelis
- From the Department of Neurology, Division of Neuromuscular Medicine (E.N., M.M.), and Department of Internal Medicine, Division of Hematology (F.B., T.K.), Mayo Clinic, Rochester, MN; and Department of Internal Medicine, Division of Hematology (A.K.), University of Texas-Southwestern, Dallas
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