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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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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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