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Fernández-Eulate G, Alfieri G, Spinazzi M, Ackermann-Bonan I, Duval F, Solé G, Caillon F, Mercier S, Pereon Y, Magot A, Pegat A, Salort-Campana E, Chabrol B, Gorokhova S, Krahn M, Biancalana V, Evangelista T, Behin A, Metay C, Stojkovic T. Phenotype variability and natural history of X-linked myopathy with excessive autophagy. J Neurol 2024; 271:4008-4018. [PMID: 38517523 DOI: 10.1007/s00415-024-12298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE X-linked myopathy with excessive autophagy (XMEA) linked to the VMA21 gene leads to autophagy failure with progressive vacuolation and atrophy of skeletal muscles. Current knowledge of this rare disease is limited. Our objective was to define the clinical, radiological, and natural history of XMEA. METHODS We conducted a retrospective study collecting clinical, genetic, muscle imaging, and biopsy data of XMEA patients followed in France and reviewed the literature for additional cases. RESULTS Eighteen males had genetically confirmed XMEA in France, carrying four different VMA21 variants. Mean age at disease onset was 9.4 ± 9.9 (range 1-40) years. In 14/18 patients (77.8%), onset occurred during childhood (< 15 years); however in four patients, the disease started in adulthood. Patients had anterior and medial compartment thigh muscle weakness, distal contractures (56.3%), elevated CK levels (1287.9 ± 757.8 U/l) and autophagic vacuoles with sarcolemmal features on muscle histopathology. Muscle MRI (n = 10) showed a characteristic pattern of lower limb muscle involvement. In 11 patients, outcome measures were available for an average follow-up period of 10.6 ± 9.8 years and six of them show disease progression. Mean change of functional outcomes was 0.5 ± 1.2 points for Brooke and 2.2 ± 2.5 points for Vignos score, 7/16 patients (43.8%) needed a walking aid and 3/16 (18.8%) were wheelchair-bound (median age of 40 years old, range 39-48). The variant c.164-7 T > G was associated with a later onset of symptoms. Respiratory insufficiency was common (57.1%) but cardiac involvement rare (12.5%). INTERPRETATION XMEA has variable age of onset, but a characteristic clinical, histopathological, and muscle imaging presentation, guiding the diagnosis. Although slowly, motor disability progresses with time, and relevant genotype-phenotype correlations will help design future clinical trials.
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Affiliation(s)
- Gorka Fernández-Eulate
- Nord/Est/Ile-de-France Neuromuscular Diseases Reference Center, Institut de Myologie, Pitié-Salpêtrière Hospital, APHP, 47-83 Bd de L'Hôpital, 75013, Paris, France.
| | - Girolamo Alfieri
- Nord/Est/Ile-de-France Neuromuscular Diseases Reference Center, Institut de Myologie, Pitié-Salpêtrière Hospital, APHP, 47-83 Bd de L'Hôpital, 75013, Paris, France
- Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Marco Spinazzi
- Neuromuscular Diseases Reference Center, Neurology Department, CHU Angers, Angers, France
| | | | - Fanny Duval
- Neuromuscular Diseases Reference Center "AOC", Nerve-Muscle Unit, Pellegrin Hospital, CHU Bordeaux, Bordeaux, France
| | - Guilhem Solé
- Neuromuscular Diseases Reference Center "AOC", Nerve-Muscle Unit, Pellegrin Hospital, CHU Bordeaux, Bordeaux, France
| | | | - Sandra Mercier
- Medical Genetics Department, Neuromuscular Diseases Reference Center "AOC", CHU Nantes, Nantes, France
| | - Yann Pereon
- Neuromuscular Diseases Reference Center "AOC", Laboratoire d'Explorations Fonctionnelles, CHU de Nantes, FILNEMUS, Euro-NMD, Nantes, France
| | - Armelle Magot
- Neuromuscular Diseases Reference Center "AOC", Laboratoire d'Explorations Fonctionnelles, CHU de Nantes, FILNEMUS, Euro-NMD, Nantes, France
| | - Antoine Pegat
- Electroneuromyography and Neuromuscular Diseases Unit, PACA-Réunion-Rhône Alpes Neuromuscular Diseases Reference Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Brigitte Chabrol
- Neuromuscular Diseases and ALS Reference Center, FILNEMUS, CHU La Timone, APHM, Marseille, France
| | - Svetlana Gorokhova
- Medical Genetics Department, CHU La Timone Enfants, APHM, Aix-Marseille University, Inserm, U1251-MMG, Marseille, France
| | - Martin Krahn
- Medical Genetics Department, CHU La Timone Enfants, APHM, Aix-Marseille University, Inserm, U1251-MMG, Marseille, France
| | - Valerie Biancalana
- Diagnostic Genetics Laboratory, CRU Strasbourg, Strasbourg University, Strasbourg, France
| | - Teresinha Evangelista
- Muscle Pathology Unit, Institut de Myologie, Nord/Est/Ile-de-France Neuromuscular Diseases Reference Center, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Anthony Behin
- Nord/Est/Ile-de-France Neuromuscular Diseases Reference Center, Institut de Myologie, Pitié-Salpêtrière Hospital, APHP, 47-83 Bd de L'Hôpital, 75013, Paris, France
| | - Corinne Metay
- Cardiomyogenetics and Molecular and Cellular Myogenetics Unit, Institut de Myologie, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Tanya Stojkovic
- Nord/Est/Ile-de-France Neuromuscular Diseases Reference Center, Institut de Myologie, Pitié-Salpêtrière Hospital, APHP, 47-83 Bd de L'Hôpital, 75013, Paris, France
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Bardhan M, Polavarapu K, Baskar D, Preethish-Kumar V, Vengalil S, Nashi S, Ganaraja VH, Sharma D, Kulanthaivelu K, Nandeesh B, Nalini A. Identification of a Novel Intronic Mutation in VMA21 Associated with a Classical Form of X-Linked Myopathy with Autophagy. Glob Med Genet 2024; 11:167-174. [PMID: 38736558 PMCID: PMC11087142 DOI: 10.1055/s-0044-1786815] [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] [Indexed: 05/14/2024] Open
Abstract
Introduction VMA21 -related myopathy is one of the rare forms of slowly progressive myopathy observed in males. Till now, there have been only a handful of reports, mainly from Europe and America, and two reports from India. Method Here, we describe a case of genetically confirmed VMA21 -associated myopathy with clinical, histopathological, and imaging features with a list of known VMA21 mutations. Results A 29-year-old man had the onset of symptoms at 18 years of age with features of proximal lower limb weakness. Muscle magnetic resonance imaging showed the preferential involvement of vasti and adductor magnus. A biopsy of the left quadriceps femoris showed features of autophagic vacuolar myopathy with vacuoles containing granular eosinophilic materials. In targeted next-generation sequencing, hemizygous mutation in the 3' splice site of intron 2 of the VMA21 gene (c.164-7 T > A) was identified and confirmed the diagnosis of X-linked myopathy with excessive autophagy. Conclusion This report expands the phenotypic and genotypic profile of VMA21 -related myopathy, with a yet unreported mutation in India.
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Affiliation(s)
- Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kiran Polavarapu
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 5B2, Ontario, Canada
| | - Dipti Baskar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Valakunja H. Ganaraja
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dinesh Sharma
- Deaprtment of Neuroradiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Karthik Kulanthaivelu
- Deaprtment of Neuroradiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - B.N. Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Rajeshwari M, Dhiman N, Chakrabarty B, Gulati S, Shamim U, Faruq M, Suri V, Sharma MC. X-linked Myopathy with Excessive Autophagy - A Rare Cause of Vacuolar Myopathy in Children. Neurol India 2022; 70:1643-1648. [PMID: 36076674 DOI: 10.4103/0028-3886.355110] [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: 11/04/2022]
Abstract
X-linked myopathy with excessive autophagy (XMEA) is a rare, recently characterized type of autophagic vacuolar myopathy caused by mutations in the VMA21 gene. It is characterized by slowly progressive weakness restricted to proximal limb muscles and generally has a favorable outcome. The characteristic histological and ultrastructural features distinguish this entity from other mimics, notably Danon disease. XMEA is an under recognized disease and should be considered in the differentials of slowly progressive myopathy in children. Awareness of this rare entity is also important for the pathologists in order to distinguish it from other causes of vacuolar myopathy in view of its favourable prognosis. We report the first genetically confirmed case of XMEA from India in an 8-year-old boy which was diagnosed based on the characteristic light microscopic and ultrastructural findings on muscle biopsy and subsequently confirmed by mutation analysis. The differential diagnostic considerations are also discussed.
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Affiliation(s)
- Madhu Rajeshwari
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Dhiman
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Biswaroop Chakrabarty
- Department of Pediatrics (Child Neurology Division), All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Department of Pediatrics (Child Neurology Division), All India Institute of Medical Sciences, New Delhi, India
| | - Uzma Shamim
- Department of Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Mohammed Faruq
- Department of Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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X-linked myopathy with excessive autophagy: First report of an Israeli family presenting with late onset lower limb girdle weakness. Neuromuscul Disord 2021; 31:854-858. [PMID: 34404574 DOI: 10.1016/j.nmd.2021.06.013] [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: 06/05/2020] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/20/2022]
Abstract
X-linked myopathy with excessive autophagy (XMEA) is a rare disorder characterized by slow progressive muscle weakness and distinctive pathology of excessive autophagic vacuoles on muscle biopsy. Here we report on five patients, in a single family, with proximal lower limb weakness. The proband, a 25-year-old man, presented with 5 years of progressive lower limbs proximal muscle weakness. His maternal grandfather and three of his maternal male cousins had similar clinical findings and were initially suspected to have Becker muscular dystrophy. Muscle biopsy in two affected family members demonstrated autophagic myopathy, and guided the genetic investigations to the identification of a pathogenic mutation, c.272G > C in the VMA21 gene, known to cause XMEA [1]. To the best of our knowledge this is the first identified Israeli Jewish family afflicted by XMEA.
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Krag TO, Holm-Yildiz S, Witting N, Vissing J. Autophagy is affected in patients with hypokalemic periodic paralysis: an involvement in vacuolar myopathy? Acta Neuropathol Commun 2021; 9:109. [PMID: 34120654 PMCID: PMC8201813 DOI: 10.1186/s40478-021-01212-8] [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: 04/07/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022] Open
Abstract
Hypokalemic periodic paralysis is an autosomal dominant, rare disorder caused by variants in the genes for voltage-gated calcium channel CaV1.1 (CACNA1S) and NaV1.4 (SCN4A). Patients with hypokalemic periodic paralysis may suffer from periodic paralysis alone, periodic paralysis co-existing with permanent weakness or permanent weakness alone. Hypokalemic periodic paralysis has been known to be associated with vacuolar myopathy for decades, and that vacuoles are a universal feature regardless of phenotype. Hence, we wanted to investigate the nature and cause of the vacuoles. Fourteen patients with the p.R528H variation in the CACNA1S gene was included in the study. Histology, immunohistochemistry and transmission electron microscopy was used to assess general histopathology, ultrastructure and pattern of expression of proteins related to muscle fibres and autophagy. Western blotting and real-time PCR was used to determine the expression levels of proteins and mRNA of the proteins investigated in immunohistochemistry. Histology and transmission electron microscopy revealed heterogenous vacuoles containing glycogen, fibrils and autophagosomes. Immunohistochemistry demonstrated autophagosomes and endosomes arrested at the pre-lysosome fusion stage. Expression analysis showed a significant decrease in levels of proteins an mRNA involved in autophagy in patients, suggesting a systemic effect. However, activation level of the master regulator of autophagy gene transcription, TFEB, did not differ between patients and controls, suggesting competing control over autophagy gene transcription by nutritional status and calcium concentration, both controlling TFEB activity. The findings suggest that patients with hypokalemic periodic paralysis have disrupted autophagic processing that contribute to the vacuoles seen in these patients.
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Fernandes SA, Almeida CF, Souza LS, Lazar M, Onofre-Oliveira P, Yamamoto GL, Nogueira L, Tasaki LY, Cardoso RR, Pavanello RCM, Silva HCA, Ferrari MFR, Bigot A, Mouly V, Vainzof M. Altered in vitro muscle differentiation in X-linked myopathy with excessive autophagy. Dis Model Mech 2020; 13:dmm.041244. [PMID: 31826868 PMCID: PMC6994946 DOI: 10.1242/dmm.041244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/29/2019] [Indexed: 11/30/2022] Open
Abstract
X-linked myopathy with excessive autophagy (XMEA) is a genetic disease associated with weakness of the proximal muscles. It is caused by mutations in the VMA21 gene, coding for a chaperone that functions in the vacuolar ATPase (v-ATPase) assembly. Mutations associated with lower content of assembled v-ATPases lead to an increase in lysosomal pH, culminating in partial blockage of macroautophagy, with accumulation of vacuoles of undigested content. Here, we studied a 5-year-old boy affected by XMEA, caused by a small indel in the VMA21 gene. Detection of sarcoplasmic Lc3 (also known as MAP1LC3B)-positive vacuoles in his muscle biopsy confirmed an autophagy defect. To understand how autophagy is regulated in XMEA myogenesis, we used patient-derived muscle cells to evaluate autophagy during in vitro muscle differentiation. An increase in lysosomal pH was observed in the patient's cells, compatible with predicted functional defect of his mutation. Additionally, there was an increase in autophagic flux in XMEA myotubes. Interestingly, we observed that differentiation of XMEA myoblasts was altered, with increased myotube formation observed through a higher fusion index, which was not dependent on lysosomal acidification. Moreover, no variation in the expression of myogenic factors nor the presence of regenerating fibers in the patient's muscle were observed. Myoblast fusion is a tightly regulated process; therefore, the uncontrolled fusion of XMEA myoblasts might generate cells that are not as functional as normal muscle cells. Our data provide new evidence on the reason for predominant muscle involvement in the context of the XMEA phenotype. This article has an associated First Person interview with the first author of the paper. Summary: Here, we show that in X-linked myopathy with excessive autophagy there is increased fusion of myoblasts, which is not caused by the primary lysosomal acidification defect.
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Affiliation(s)
- Stephanie A Fernandes
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Camila F Almeida
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Lucas S Souza
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Monize Lazar
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Paula Onofre-Oliveira
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Guilherme L Yamamoto
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Letícia Nogueira
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Letícia Y Tasaki
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Rafaela R Cardoso
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Rita C M Pavanello
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Helga C A Silva
- Department of Neurology and Neurosurgery, Division of Neuromuscular Disorders, Federal University of São Paulo, 04023-062 São Paulo, Brazil
| | - Merari F R Ferrari
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
| | - Anne Bigot
- Sorbonne Université, Inserm, Institut de Myologie, U974, Center for Research in Myology, 47 Boulevard de l'hôpital, 75013 Paris, France
| | - Vincent Mouly
- Sorbonne Université, Inserm, Institut de Myologie, U974, Center for Research in Myology, 47 Boulevard de l'hôpital, 75013 Paris, France
| | - Mariz Vainzof
- Human Genome and Stem-Cell Research Center, Biosciences Institute, University of São Paulo, 05508-900 São Paulo, Brazil
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Munteanu I, Kalimo H, Saraste A, Nishino I, Minassian BA. Cardiac autophagic vacuolation in severe X-linked myopathy with excessive autophagy. Neuromuscul Disord 2017; 27:185-187. [DOI: 10.1016/j.nmd.2016.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 08/19/2016] [Accepted: 10/17/2016] [Indexed: 12/24/2022]
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Ackerley CA, Cooper MA, Munoz DG, Minassian BA. Fatal hepatic failure and pontine and extrapontine myelinolysis in XMEA. Neurology 2016; 87:1417-9. [PMID: 27566744 DOI: 10.1212/wnl.0000000000003155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/09/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Cameron A Ackerley
- From the Division of Pathology (C.A.A.), Department of Pathology and Laboratory Medicine, The Hospital for Sick Children, Toronto; Division of Gastroenterology (M.A.C.), Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto; Division of Pathology (D.G.M.), Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto; and Division of Neurology (B.A.M.), Department of Paediatrics and Program in Genetics and Genome Biology, The Hospital for Sick Children, and the Institute of Medical Science, University of Toronto, Canada
| | - Mary Anne Cooper
- From the Division of Pathology (C.A.A.), Department of Pathology and Laboratory Medicine, The Hospital for Sick Children, Toronto; Division of Gastroenterology (M.A.C.), Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto; Division of Pathology (D.G.M.), Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto; and Division of Neurology (B.A.M.), Department of Paediatrics and Program in Genetics and Genome Biology, The Hospital for Sick Children, and the Institute of Medical Science, University of Toronto, Canada
| | - David G Munoz
- From the Division of Pathology (C.A.A.), Department of Pathology and Laboratory Medicine, The Hospital for Sick Children, Toronto; Division of Gastroenterology (M.A.C.), Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto; Division of Pathology (D.G.M.), Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto; and Division of Neurology (B.A.M.), Department of Paediatrics and Program in Genetics and Genome Biology, The Hospital for Sick Children, and the Institute of Medical Science, University of Toronto, Canada
| | - Berge A Minassian
- From the Division of Pathology (C.A.A.), Department of Pathology and Laboratory Medicine, The Hospital for Sick Children, Toronto; Division of Gastroenterology (M.A.C.), Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto; Division of Pathology (D.G.M.), Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto; and Division of Neurology (B.A.M.), Department of Paediatrics and Program in Genetics and Genome Biology, The Hospital for Sick Children, and the Institute of Medical Science, University of Toronto, Canada.
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Mercier S, Magot A, Caillon F, Isidor B, David A, Ferrer X, Vital A, Coquet M, Penttilä S, Udd B, Mussini JM, Pereon Y. Muscle magnetic resonance imaging abnormalities in X-linked myopathy with excessive autophagy. Muscle Nerve 2015; 52:673-80. [PMID: 25809233 DOI: 10.1002/mus.24664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 11/06/2022]
Abstract
INTRODUCTION X-linked myopathy with excessive autophagy (XMEA) is an X-linked recessive myopathy due to recently reported mutations in the VMA21 gene. METHODS Four men from 2 separate families were studied. The clinical presentation, genetic data, muscle biopsy, and muscle MRI were analyzed. RESULTS A known VMA21 mutation, c.163+4A>G, and a new mutation, c.163+3A>G, respectively, were found in the 2 families. The clinical course was characterized by onset in childhood and progressive muscle weakness with a limb-girdle pattern. Muscle biopsy revealed a mild myopathy with an increased number of giant autophagic vacuoles. Whole-body muscle MRI showed that pelvic girdle and proximal thighs were the most and earliest affected territories, with sparing of rectus femoris muscles. Muscle changes essentially consisted of degenerative fatty replacement. CONCLUSIONS This study highlights a distinctive MRI pattern of muscle involvement, which can be helpful for diagnosis of XMEA, even before muscle biopsy or genetic analysis.
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Affiliation(s)
- Sandra Mercier
- Service de Génétique Médicale, Hôpital Mre-Enfant, CHU de Nantes, Nantes, France.,Centre de Référence Maladies Neuromusculaires Nantes, Angers, Hôtel-Dieu, CHU de Nantes, 44093, Nantes cedex, France.,Atlantic Gene Therapy, Biotherapy Institute for Rare Diseases, Nantes, France
| | - Armelle Magot
- Centre de Référence Maladies Neuromusculaires Nantes, Angers, Hôtel-Dieu, CHU de Nantes, 44093, Nantes cedex, France.,Atlantic Gene Therapy, Biotherapy Institute for Rare Diseases, Nantes, France.,Laboratoire d'Explorations Fonctionnelles, Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - Florence Caillon
- Service de Radiologie Centrale, Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - Bertrand Isidor
- Service de Génétique Médicale, Hôpital Mre-Enfant, CHU de Nantes, Nantes, France.,Centre de Référence Maladies Neuromusculaires Nantes, Angers, Hôtel-Dieu, CHU de Nantes, 44093, Nantes cedex, France
| | - Albert David
- Service de Génétique Médicale, Hôpital Mre-Enfant, CHU de Nantes, Nantes, France.,Centre de Référence Maladies Neuromusculaires Nantes, Angers, Hôtel-Dieu, CHU de Nantes, 44093, Nantes cedex, France
| | - Xavier Ferrer
- Centre de Référence Maladies Neuromusculaires, CHU de Bordeaux, Bordeaux, France
| | - Anne Vital
- Centre de Référence Maladies Neuromusculaires, CHU de Bordeaux, Bordeaux, France
| | - Michelle Coquet
- Centre de Référence Maladies Neuromusculaires, CHU de Bordeaux, Bordeaux, France
| | - Sini Penttilä
- Neuromuscular Research Center, Tampere University and University Hospital Tampere, Finland
| | - Bjarne Udd
- Neuromuscular Research Center, Tampere University and University Hospital Tampere, Finland.,Folkhalsan Institute of Genetics, Helsinki, Finland.,Vasa Central Hospital, Vasa, Finland
| | - Jean-Marie Mussini
- Centre de Référence Maladies Neuromusculaires Nantes, Angers, Hôtel-Dieu, CHU de Nantes, 44093, Nantes cedex, France.,Laboratoire d'Anatomie Pathologique, Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - Yann Pereon
- Centre de Référence Maladies Neuromusculaires Nantes, Angers, Hôtel-Dieu, CHU de Nantes, 44093, Nantes cedex, France.,Atlantic Gene Therapy, Biotherapy Institute for Rare Diseases, Nantes, France.,Laboratoire d'Explorations Fonctionnelles, Hôtel-Dieu, CHU de Nantes, Nantes, France
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Dowling JJ, Moore SA, Kalimo H, Minassian BA. X-linked myopathy with excessive autophagy: a failure of self-eating. Acta Neuropathol 2015; 129:383-90. [PMID: 25644398 DOI: 10.1007/s00401-015-1393-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 12/15/2022]
Abstract
Autophagic vacuolar myopathies (AVMs) are a group of disorders united by shared histopathological features on muscle biopsy that include the aberrant accumulation of autophagic vacuoles. The classic conditions that compose the AVMs include Pompe Disease, Danon Disease and X-linked myopathy with excessive autophagy (XMEA). Other disorders, including acquired myopathies like chloroquine toxicity, also have features of an autophagic myopathy. This review is focused on XMEA, a myopathy with onset of slowly progressive proximal weakness and elevated serum creatine kinase (2× to 20× normal) typically in the first decade of life. However, both late-adult onset and severe, sometimes lethal, neonatal cases also occur. Skeletal muscle pathology is characterized by numerous cytoplasmic autophagic vacuoles, complex muscle fiber splitting with internalization of capillaries, and complement C5b-9 deposition within vacuoles and along the sarcolemma. The autophagic vacuoles have sarcolemmal features. Mutations in the VMA21 gene at Xq28 cause XMEA by reducing the activity of lysosomal hydrolases. The VMA21 protein regulates the assembly of the V-ATPase required to acidify the lysosome. Increased lysosomal pH and poor degradation of cellular debris may secondarily induce autophagy, the net effect being accumulation of autophagolysosomes. The relationship of XMEA to other lysosomal disorders of muscle and potential therapeutic interventions for XMEA are discussed.
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Affiliation(s)
- James J Dowling
- Division of Neurology and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada,
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Ruggieri A, Ramachandran N, Wang P, Haan E, Kneebone C, Manavis J, Morandi L, Moroni I, Blumbergs P, Mora M, Minassian B. Non-coding VMA21 deletions cause X-linked Myopathy with Excessive Autophagy. Neuromuscul Disord 2015; 25:207-11. [DOI: 10.1016/j.nmd.2014.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/11/2014] [Accepted: 11/20/2014] [Indexed: 02/07/2023]
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Crockett CD, Ruggieri A, Gujrati M, Zallek CM, Ramachandran N, Minassian BA, Moore SA. Late adult-onset of X-linked myopathy with excessive autophagy. Muscle Nerve 2014; 50:138-44. [PMID: 24488655 PMCID: PMC4589296 DOI: 10.1002/mus.24197] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2014] [Indexed: 11/05/2022]
Abstract
INTRODUCTION X-linked myopathy with excessive autophagy (XMEA) is characterized by autophagic vacuoles with sarcolemmal features. Mutations in VMA21 result in insufficient lysosome acidification, causing progressive proximal weakness with onset before age 20 years and loss of ambulation by middle age. METHODS We describe a patient with onset of slowly progressive proximal weakness of the lower limbs after age 50, who maintains ambulation with the assistance of a cane at age 71. RESULTS Muscle biopsy at age 66 showed complex muscle fiber splitting, internalized capillaries, and vacuolar changes characteristic of autophagic vacuolar myopathy. Vacuoles stained positive for sarcolemmal proteins, LAMP2, and complement C5b-9. Ultrastructural evaluation further revealed basal lamina reduplication and extensive autophagosome extrusion. Sanger sequencing identified a known pathologic splice site mutation in VMA21 (c.164-7T>G). CONCLUSIONS This case expands the clinical phenotype of XMEA and suggests VMA21 sequencing be considered in evaluating men with LAMP2-positive autophagic vacuolar myopathy.
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Affiliation(s)
| | - Alessandra Ruggieri
- Program in Genetics and Genome Biology, and Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meena Gujrati
- University of Illinois College of Medicine, Peoria, IL, USA
| | | | - Nivetha Ramachandran
- Program in Genetics and Genome Biology, and Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Berge A. Minassian
- Program in Genetics and Genome Biology, and Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven A. Moore
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Duguez S, Duddy W, Johnston H, Lainé J, Le Bihan MC, Brown KJ, Bigot A, Hathout Y, Butler-Browne G, Partridge T. Dystrophin deficiency leads to disturbance of LAMP1-vesicle-associated protein secretion. Cell Mol Life Sci 2013; 70:2159-74. [PMID: 23344255 PMCID: PMC11113779 DOI: 10.1007/s00018-012-1248-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 01/06/2023]
Abstract
Duchenne muscular dystrophy results from loss of the protein dystrophin, which links the intracellular cytoskeletal network with the extracellular matrix, but deficiency in this function does not fully explain the onset or progression of the disease. While some intracellular events involved in the degeneration of dystrophin-deficient muscle fibers have been well characterized, changes in their secretory profile are undescribed. To analyze the secretome profile of mdx myotubes independently of myonecrosis, we labeled the proteins of mdx and wild-type myotubes with stable isotope-labeled amino acids (SILAC), finding marked enrichment of vesicular markers in the mdx secretome. These included the lysosomal-associated membrane protein, LAMP1, that co-localized in vesicles with an over-secreted cytoskeletal protein, myosin light chain 1. These LAMP1/MLC1-3-positive vesicles accumulated in the cytosol of mdx myotubes and were secreted into the culture medium in a range of abnormal densities. Restitution of dystrophin expression, by exon skipping, to some 30 % of the control value, partially normalized the secretome profile and the excess LAMP1 accumulation. Together, our results suggest that a lack of dystrophin leads to a general dysregulation of vesicle trafficking. We hypothesize that disturbance of the export of proteins through vesicles occurs before, and then concurrently with, the myonecrotic cascade and contributes chronically to the pathophysiology of DMD, thereby presenting us with a range of new potential therapeutic targets.
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Affiliation(s)
- Stephanie Duguez
- Center for Genetic Medicine, Children’s Research Institute, Children’s National Medical Center, 111 Michigan Avenue, Washington, DC USA
- Institut de Myologie, UM76, Inserm U974, CNRS, UMR7215, Université Pierre et Marie Curie-Paris 6, Paris, 75013 France
| | - William Duddy
- Center for Genetic Medicine, Children’s Research Institute, Children’s National Medical Center, 111 Michigan Avenue, Washington, DC USA
- Institut de Myologie, UM76, Inserm U974, CNRS, UMR7215, Université Pierre et Marie Curie-Paris 6, Paris, 75013 France
| | - Helen Johnston
- Center for Genetic Medicine, Children’s Research Institute, Children’s National Medical Center, 111 Michigan Avenue, Washington, DC USA
| | - Jeanne Lainé
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
- Département de Physiologie, Université Pierre Et Marie Curie-Paris 06, Site Pitié-Salpêtrière, Paris, 75013 France
| | - Marie Catherine Le Bihan
- Institut de Myologie, UM76, Inserm U974, CNRS, UMR7215, Université Pierre et Marie Curie-Paris 6, Paris, 75013 France
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Kristy J. Brown
- Center for Genetic Medicine, Children’s Research Institute, Children’s National Medical Center, 111 Michigan Avenue, Washington, DC USA
| | - Anne Bigot
- Institut de Myologie, UM76, Inserm U974, CNRS, UMR7215, Université Pierre et Marie Curie-Paris 6, Paris, 75013 France
| | - Yetrib Hathout
- Center for Genetic Medicine, Children’s Research Institute, Children’s National Medical Center, 111 Michigan Avenue, Washington, DC USA
| | - Gillian Butler-Browne
- Institut de Myologie, UM76, Inserm U974, CNRS, UMR7215, Université Pierre et Marie Curie-Paris 6, Paris, 75013 France
| | - Terence Partridge
- Center for Genetic Medicine, Children’s Research Institute, Children’s National Medical Center, 111 Michigan Avenue, Washington, DC USA
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14
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Affiliation(s)
- G Mazarei
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
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15
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Holton JL, Beesley C, Jackson M, Venner K, Bhardwaj N, Winchester B, Al-Memar A. Autophagic vacuolar myopathy in twin girls. Neuropathol Appl Neurobiol 2006; 32:253-9. [PMID: 16640643 DOI: 10.1111/j.1365-2990.2006.00691.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hereditary autophagic vacuolar myopathy (AVM) may occur in several diseases including the rimmed vacuolar myopathies, acid maltase deficiency, Danon disease, infantile autophagic vacuolar myopathy and X-linked myopathy with excessive autophagy (XMEA). In the latter three conditions the vacuoles are lined by membranes with sarcolemmal features. We present two unusual cases of autophagic vacuolar myopathy in twin girls born at term with no family history of neurological disease. After initial normal developmental milestones they developed progressive leg weakness and wasting with contractures from the age of 12 years. Investigations showed raised CK, normal female karyotype, normal acid maltase activity, normal nerve conduction and myopathic EMG features. Frozen sections of skeletal muscle were stained using routine tinctorial and histochemical methods. Immunohistochemical staining for spectrin, merosin, dystrophin, complement membrane attack complex and sarcoglycans was performed and ultrastructural examination undertaken. Direct sequence analysis of the lamp-2 gene using genomic DNA extracted from lymphocytes was performed. Histological analysis of the muscle biopsies demonstrated myofibres with vacuoles lacking glycogen and lipid many of which were delineated using immunohistochemistry for merosin, dystrophin and sarcoglycans. Ultrastructural examination showed duplication of the myofibre basal lamina with associated autophagic material. Vacuoles within myofibres were either membrane bound containing autophagic material or lined by plasma membrane and basal lamina. Intermyofibrillar glycogen was increased. Sequence analysis of the coding region and intron/exon boundaries of the lamp-2 gene was normal. This is the first report of female cases of AVM with sarcolemmal features. We suggest that these patients may represent manifesting carriers of XMEA, or alternatively, a new form of disease with a similar phenotype having autosomal recessive inheritance.
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Affiliation(s)
- J L Holton
- Department of Molecular Neuroscience and Division of Neuropathology, Institute of Neurology, University College London, London, UK.
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16
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Fernandez C, Figarella-Branger D, Meyronet D, Cassote E, Tong S, Pellissier JF. Electron microscopy in neuromuscular disorders. Ultrastruct Pathol 2006; 29:437-50. [PMID: 16316944 DOI: 10.1080/01913120500323175] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Electron microscopy has a strategic position in the diagnosis of neuromuscular disorders. In muscular fibers, the main abnormalities include vacuoles, inclusion bodies, and myofibrillar disorganization with or without abnormal inclusion material. Vacuolar changes include lipidic and glycogenic storage vacuoles, rimmed vacuoles, and lysosomal and autophagic vacuoles. Accumulation of abnormal inclusion material is found in nemaline myopathy, actinopathies, and hyaline body myopathy. Myofibrillar disorganization involves cores, multiminicores, and myosin chain depletion. Myofibrillar myopathies associate a pathologic pattern of myofibrillar dissolution and ectopic protein expression. They can be divided into two groups: myofibrillar myopathies with multiple expression proteins and myofibrillar myopathies with desmin and alphaB-crystallin expression only. In these two conditions, electron microscopy shows accumulation of a granulofilamentous material immunoreactive for desmin. At least three genes are implicated: desmin, alphaB-crystallin, and myotilin. Lastly, electron microscopy serves to identify changes, pathogenic or not, which are not shown up by light microscopy. Moreover, electron microscopy gives insight on pathophysiological mechanisms and can guide molecular genetics analysis.
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Affiliation(s)
- Carla Fernandez
- Department of Pathology and Neuropathology, Hôpital de la Timone, Marseille, France
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17
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Paradas C, Márquez C, Gallardo E, De Luna N, Chinchón I, Recan D, Jiménez MD, Illa I. X-linked Emery-Dreifuss muscular dystrophy and vacuoles: An immunohistochemical characterization. Muscle Nerve 2005; 32:61-5. [PMID: 15880484 DOI: 10.1002/mus.20311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a striking abundance of rimmed vacuoles in two brothers with X-linked Emery-Dreifuss muscular dystrophy (X-EDMD) confirmed by the absence of emerin at the muscular nuclear envelope and by genetic analysis showing a new 2-bp deletion in exon 6 of the STA gene at the Xq28 region. Immunohistochemical analysis of the vacuoles revealed expression of dystrophin but not of merosin in the sarcolemma of rimmed vacuoles and absence of amyloid and membrane attack complex (MAC) deposition either in vacuoles or muscle fibers. The presence of rimmed vacuoles can be a histopathological finding in X-EDMD, and the diagnosis should not be excluded in clinically well-defined EDMD patients because of this finding.
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Affiliation(s)
- Carmen Paradas
- Servicio de Neurología, Hospital Universitario de Valme, Sevilla, Spain
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18
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Ogier-Denis E, Codogno P. Autophagy: a barrier or an adaptive response to cancer. BIOCHIMICA ET BIOPHYSICA ACTA 2003; 1603:113-28. [PMID: 12618311 DOI: 10.1016/s0304-419x(03)00004-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Macroautophagy or autophagy is a degradative pathway terminating in the lysosomal compartment after the formation of a cytoplasmic vacuole that engulfs macromolecules and organelles. The recent discovery of the molecular controls of autophagy that are common to eukaryotic cells from yeast to human suggests that the role of autophagy in cell functioning is far beyond its nonselective degradative capacity. The involvement of proteins with properties of tumor suppressor and oncogenic properties at different steps of the pathway implies that autophagy must be considered in tumor progression. Autophagy as a stress response mechanism protects cancer cells from low nutrient supply or therapeutic insults. Autophagy is also involved in the elimination of cancer cells by triggering a non-apoptotic cell death program, suggesting a negative role in tumor development. These two aspects of autophagy will be discussed in this review.
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Affiliation(s)
- Eric Ogier-Denis
- INSERM U504 Glycobiologie et Signalisation cellulaire, Institut André Lwoff, 16 avenue Paul-Vaillant-Couturier, 94807 Villejuif Cedex, France
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Petiot A, Pattingre S, Arico S, Meley D, Codogno P. Diversity of signaling controls of macroautophagy in mammalian cells. Cell Struct Funct 2002; 27:431-41. [PMID: 12576636 DOI: 10.1247/csf.27.431] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Macroautophagy is a major lysosomal catabolic process conserved from yeast to human. The formation of autophagic vacuoles is stimulated by a variety of intracellular and extracellular stress situations including amino acid starvation, aggregation of misfolded proteins, and accumulation of damaged organelles. Several signaling pathways control the formation of autophagic vacuoles. As some of them are engaged in the control of protein synthesis or cell survival this suggests that macroautophagy is intimately associated with the execution of cell proliferation and cell death programs. Whether or not these different signaling pathways converge to a unique point to trigger the formation of autophagic vacuole remains an open question.
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Affiliation(s)
- Anne Petiot
- Department of Biochemistry, University of Geneva, Science II, 30 quai Ernest Ansermet, 1211 Geneva, Switzerland
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20
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Abstract
Bacteria have evolved a variety of mechanisms to invade eukaryotic cells and survive intracellularly. Once inside, bacterial pathogens often modulate their phagosome to establish an intracellular niche for survival and replication. A subset of intracellular pathogens, including Brucella abortus, Legionella pneumophila and Porphyromonas gingivalis, are diverted from the endosomal pathway to the auto-phagic pathway. Once within the autophagosome, each in some way presumably modifies this compartment to establish an environment necessary for its survival. Transit into autophagosomes represents an avenue by which to escape host defences. In this review, we examine the biochemical and morphological evidence for the survival of some bacterial pathogens by replicating within an autophagosome-like compartment.
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Affiliation(s)
- Brian R Dorn
- Center for Molecular Microbiology, Department of Oral Biology, College of Dentistry, University of Florida, Gainesville 32610, USA
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