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Rathore G, Kang PB. Pediatric Neuromuscular Diseases. Pediatr Neurol 2023; 149:1-14. [PMID: 37757659 DOI: 10.1016/j.pediatrneurol.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/25/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
The diagnostic and referral workflow for children with neuromuscular disorders is evolving, particularly as newborn screening programs are expanding in tandem with novel therapeutic developments. However, for the children who present with symptoms and signs of potential neuromuscular disorders, anatomic localization, guided initially by careful history and physical examination, continues to be the cardinal initial step in the diagnostic evaluation. It is important to consider whether the localization is more likely to be in the lower motor neuron, peripheral nerve, neuromuscular junction, or muscle. After that, disease etiologies can be divided broadly into inherited versus acquired categories. Considerations of localization and etiologies will help generate a differential diagnosis, which in turn will guide diagnostic testing. Once a diagnosis is made, it is important to be aware of current treatment options, as a number of new therapies for some of these disorders have been approved in recent years. Families are also increasingly interested in clinical research, which may include natural history studies and interventional clinical trials. Such research has proliferated for rare neuromuscular diseases, leading to exciting advances in diagnostic and therapeutic technologies, promising dramatic changes in the landscape of these disorders in the years to come.
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Affiliation(s)
- Geetanjali Rathore
- Division of Neurology, Department of Pediatrics, University of Nebraska College of Medicine, Omaha, Nebraska
| | - Peter B Kang
- Paul and Sheila Wellstone Muscular Dystrophy Center and Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota; Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota.
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2
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Skeletal Muscles of Patients Infected with SARS-CoV-2 Develop Severe Myofiber Damage upon One Week of Admission on the Intensive Care Unit. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many critically ill patients infected with SARS-CoV-2 have been submitted to an intensive care unit (ICU). Patients with a SARS-CoV-2 infection that survive critical illness are confronted with months of physical impairments. To maximize recovery, it is important to understand the musculoskeletal involvement in critically ill patients infected with SARS-CoV-2. The aim of the present study was to assess the myocellular changes in SARS-CoV-2 patients that occur throughout the first week of ICU admission. In n = 22 critically ill patients infected with SARS-CoV-2, a biopsy sample from the vastus lateralis muscle was obtained at day 1–3 and day 5–8 following ICU admission. Fluorescence microscopy was used to assess type I and type II muscle fiber size and distribution, myonuclear content, and muscle tissue capillarization. Transmission electron microscopy was used to support quantitative data at an ultrastructural level. Changes in type I and type II muscle fiber size showed large inter-individual variation. The average change in type I fiber size was +309 ± 1834 µm2, ranging from −2129 µm2 (−31%) to +3375 µm2 (+73%). The average change in type II fiber size was −224 ± 1256 µm2, ranging from −1410 µm2 (−36%) to +2592 µm2 (+48%). Ultrastructural observations showed myofibrillar and hydropic degeneration, and fiber necrosis. This study shows that ICU patients admitted with SARS-CoV-2 suffer from substantial muscle fiber damage during ICU admission. These results are a call for action towards more specialized rehabilitation programs for patients admitted to the ICU with SARS-CoV-2 infection.
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3
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Papah MB, Brannick EM, Schmidt CJ, Abasht B. Evidence and role of phlebitis and lipid infiltration in the onset and pathogenesis of Wooden Breast Disease in modern broiler chickens. Avian Pathol 2017; 46:623-643. [DOI: 10.1080/03079457.2017.1339346] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Michael B. Papah
- Department of Animal and Food Sciences, University of Delaware, Newark, DE, USA
| | - Erin M. Brannick
- Department of Animal and Food Sciences, University of Delaware, Newark, DE, USA
| | - Carl J. Schmidt
- Department of Animal and Food Sciences, University of Delaware, Newark, DE, USA
| | - Behnam Abasht
- Department of Animal and Food Sciences, University of Delaware, Newark, DE, USA
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4
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Mahdy MA, Warita K, Hosaka YZ. Early ultrastructural events of skeletal muscle damage following cardiotoxin-induced injury and glycerol-induced injury. Micron 2016; 91:29-40. [DOI: 10.1016/j.micron.2016.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022]
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Myopathy in a rhesus monkey with biopsy findings similar to human sporadic inclusion body myositis. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2012.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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6
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The muscular dystrophies. Neurogenetics 2012. [DOI: 10.1017/cbo9781139087711.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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7
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Wang Y, Melkani GC, Suggs JA, Melkani A, Kronert WA, Cammarato A, Bernstein SI. Expression of the inclusion body myopathy 3 mutation in Drosophila depresses myosin function and stability and recapitulates muscle inclusions and weakness. Mol Biol Cell 2012; 23:2057-65. [PMID: 22496423 PMCID: PMC3364171 DOI: 10.1091/mbc.e12-02-0120] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A Drosophila model of myosin-based inclusion body myopathy type 3 is presented. Muscle function, ATPase activity, and actin sliding velocity were dramatically reduced. The mutant myosin is prone to aggregate, likely accounting for the observed cytoplasmic inclusions and disorganized muscle filaments reminiscent of the human disease. Hereditary myosin myopathies are characterized by variable clinical features. Inclusion body myopathy 3 (IBM-3) is an autosomal dominant disease associated with a missense mutation (E706K) in the myosin heavy chain IIa gene. Adult patients experience progressive muscle weakness. Biopsies reveal dystrophic changes, rimmed vacuoles with cytoplasmic inclusions, and focal disorganization of myofilaments. We constructed a transgene encoding E706K myosin and expressed it in Drosophila (E701K) indirect flight and jump muscles to establish a novel homozygous organism with homogeneous populations of fast IBM-3 myosin and muscle fibers. Flight and jump abilities were severely reduced in homozygotes. ATPase and actin sliding velocity of the mutant myosin were depressed >80% compared with wild-type myosin. Light scattering experiments and electron microscopy revealed that mutant myosin heads bear a dramatic propensity to collapse and aggregate. Thus E706K (E701K) myosin appears far more labile than wild-type myosin. Furthermore, mutant fly fibers exhibit ultrastructural hallmarks seen in patients, including cytoplasmic inclusions containing aberrant proteinaceous structures and disorganized muscle filaments. Our Drosophila model reveals the unambiguous consequences of the IBM-3 lesion on fast muscle myosin and fibers. The abnormalities observed in myosin function and muscle ultrastructure likely contribute to muscle weakness observed in our flies and patients.
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Affiliation(s)
- Yang Wang
- Department of Biology and Molecular Biology Institute, San Diego State University, San Diego, CA 92182, USA
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Meola G, Bugiardini E, Cardani R. Muscle biopsy. J Neurol 2011; 259:601-10. [PMID: 21805256 DOI: 10.1007/s00415-011-6193-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 07/12/2011] [Accepted: 07/14/2011] [Indexed: 01/31/2023]
Affiliation(s)
- G Meola
- Department of Neurology, IRCCS Policlinico San Donato, University of Milan, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.
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Mari M, Hofman V, Butori C, Ilie M, Lassalle S, Grier P, Sadoulet D, Scoazec JY, Hofman P. [What is new in 2010 for electron microscopy in surgical pathology?]. Ann Pathol 2010; 30:263-72. [PMID: 20837234 PMCID: PMC7115376 DOI: 10.1016/j.annpat.2010.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/21/2010] [Accepted: 05/09/2010] [Indexed: 11/24/2022]
Abstract
Différentes méthodes complémentaires permettant d’optimiser le diagnostic et le pronostic des lésions observées dans un laboratoire d’anatomopathologie ont permis, ces dernières années, d’améliorer considérablement l’offre de soins aux patients. Ces méthodes correspondent essentiellement aux techniques d’immuno-histochimie et de biologie moléculaire. La place d’une autre technique autrefois largement utilisée en anatomopathologie, la microscopie électronique (ME), est à l’inverse de plus en plus restreinte. La ME est une méthode longue, difficile, onéreuse, nécessitant un personnel hautement qualifié. Elle est de moins en moins implantée dans un laboratoire de pathologie et devient surtout réservée à des centres universitaires et de recherche. Toutefois, la ME reste un outil indispensable pour le pathologiste. En effet, elle permet parfois de confirmer, et plus exceptionnellement de poser, le diagnostic de certaines lésions tissulaires et cellulaires observées en pathologie humaine. La ME est aussi d’un apport très important pour la compréhension de la physiopathologie de certaines maladies humaines émergentes, notamment d’origine infectieuse. Nous abordons dans cette revue les principales indications actuelles de la ME, en insistant sur certains domaines de la pathologie humaine, comme les maladies infectieuses et certaines tumeurs.
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Affiliation(s)
- Mireille Mari
- Laboratoire de pathologie clinique et expérimentale, hôpital pasteur, CHU de Nice, 30, avenue de La-Voie-Romaine, BP 69, 06002 Nice, France
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Papa V, Tarantino L, Preda P, Badiali De Giorgi L, Fanin M, Pegoraro E, Angelini C, Cenacchi G. The Role of Ultrastructural Examination in Storage Diseases. Ultrastruct Pathol 2010; 34:243-51. [DOI: 10.3109/01913121003780593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Ju JS, Fuentealba RA, Miller SE, Jackson E, Piwnica-Worms D, Baloh RH, Weihl CC. Valosin-containing protein (VCP) is required for autophagy and is disrupted in VCP disease. ACTA ACUST UNITED AC 2010; 187:875-88. [PMID: 20008565 PMCID: PMC2806317 DOI: 10.1083/jcb.200908115] [Citation(s) in RCA: 408] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Accumulation of autophagosomes because of impaired autophagy during valosin-containing protein (VCP)–linked dementia is explained by the absence or reduced activity of VCP. Mutations in valosin-containing protein (VCP) cause inclusion body myopathy (IBM), Paget's disease of the bone, and frontotemporal dementia (IBMPFD). Patient muscle has degenerating fibers, rimmed vacuoles (RVs), and sarcoplasmic inclusions containing ubiquitin and TDP-43 (TARDNA-binding protein 43). In this study, we find that IBMPFD muscle also accumulates autophagosome-associated proteins, Map1-LC3 (LC3), and p62/sequestosome, which localize to RVs. To test whether VCP participates in autophagy, we silenced VCP or expressed adenosine triphosphatase–inactive VCP. Under basal conditions, loss of VCP activity results in autophagosome accumulation. After autophagic induction, these autophagosomes fail to mature into autolysosomes and degrade LC3. Similarly, IBMPFD mutant VCP expression in cells and animals leads to the accumulation of nondegradative autophagosomes that coalesce at RVs and fail to degrade aggregated proteins. Interestingly, TDP-43 accumulates in the cytosol upon autophagic inhibition, similar to that seen after IBMPFD mutant expression. These data implicate VCP in autophagy and suggest that impaired autophagy explains the pathology seen in IBMPFD muscle, including TDP-43 accumulation.
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Affiliation(s)
- Jeong-Sun Ju
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Skram MK, Gulati S, Larsson E, Lindal S, Torp SH. Muscle biopsies in children--an evaluation of histopathology and clinical value during a 5-year period. Ups J Med Sci 2009; 114:41-5. [PMID: 19242871 PMCID: PMC2852747 DOI: 10.1080/03009730802604949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Muscle biopsy is an important diagnostic tool in the investigation of children with neuromuscular disorders. This report presents the experience with paediatric muscle biopsies during a 5-year period at a routine pathology laboratory. A total number of 58 cases were included, and indications, microscopical findings, and final histopathological diagnoses were recorded. A total of 21 biopsies were from females (36%) and 37 biopsies from males (64%); 53% of the cases were from children under 2 years of age. Major pathological findings were found in 30% comprising muscular dystrophy, neurogenic atrophy, and congenital and metabolic disorders, even in cases with vague clinical manifestations. These findings confirm the high diagnostic yield of muscle biopsies, especially as new techniques have been introduced such as immunohistochemistry. Muscle pathology is difficult and emphasizes the importance of this service being undertaken by specialized laboratories with an experienced staff. Microscopical examination of muscle biopsies should be based on adequate clinical information, demonstrating the necessity of close contact between pathologists and referring physicians.
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Affiliation(s)
- Marius Kurås Skram
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim University Hospital, Trondheim, Norway
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Kepron C, Blumenthal A, Chitayat D, Cutz E, Superti-Furga A, Keating S. An autophagic vacuolar myopathy-like disorder presenting as nonimmune hydrops in a female fetus. Pediatr Dev Pathol 2009; 12:53-8. [PMID: 19243213 DOI: 10.2350/07-11-03670.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Accepted: 02/14/2008] [Indexed: 11/20/2022]
Abstract
A 37-year-old woman presented for routine obstetrical care at 15 weeks' gestational age and the fetus was found to have hydrops fetalis. Following elective termination of the pregnancy at 18 weeks' gestational age, pathologic examination of the female conceptus revealed findings suggestive of a lysosomal storage disease within the liver and cardiac muscle. Enzyme assays for beta-galactosidase, neuraminidase, alpha-l-iduronidase, beta-glucuronidase, beta-glucosidase, Morquio disease type A enzyme, beta-fucosidase, alpha-mannosidase, and beta-mannosidase were all normal, ruling out many of the common storage diseases. Electron microscopy identified vacuoles within hepatocytes, Kupffer cells, and cardiac myocytes resembling the autophagic vacuoles characteristic of a group of diseases known as the autophagic vacuolar myopathies (AVMs). Because these diseases are exceptionally rare in females, and because such autophagic vacuoles have never before been described in liver, we propose a novel entity of "AVM-like lysosomal storage disease" presenting as nonimmune hydrops in a female fetus.
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Affiliation(s)
- Charis Kepron
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Haas KF, Woodruff E, Broadie K. Proteasome function is required to maintain muscle cellular architecture. Biol Cell 2008; 99:615-26. [PMID: 17523916 PMCID: PMC2712885 DOI: 10.1042/bc20070019] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND INFORMATION Protein degradation via the UPS (ubiquitin-proteasome system) plays critical roles in muscle metabolism and signalling pathways. The present study investigates temporal requirements of the UPS in muscle using conditional expression of mutant proteasome beta subunits to cause targeted inhibition of proteasome function. RESULTS AND CONCLUSIONS The Drosophila GeneSwitch system was used, with analyses of the well-characterized larval somatic body wall muscles. This method acutely disrupts proteasome function and causes rapid accumulation of polyubiquitinated proteins, specifically within the muscle. Within 12 h of transgenic proteasome inhibition, there was a gross disorganization of muscle architecture and prominent muscle atrophy, progressing to the arrest of all co-ordinated movement by 24 h. Progressive muscle architecture changes include rapid loss of sarcomere organization, loss of nuclei spacing/patterning, vacuole formation and the accumulation of nuclear and cytoplasmic aggregates at the ultrastructural level. At the neuromuscular junction, the highly specialized muscle membrane folds of the subsynaptic reticulum were rapidly lost. Within 24 h after transgenic proteasome inhibition, muscles contained numerous autophagosomes and displayed highly elevated expression of the endoplasmic reticulum chaperone GRP78 (glucose-regulated protein of 78 kDa), indicating that the loss of muscle maintenance correlates with induction of the unfolded protein response. Taken together, these results demonstrate that the UPS is acutely required for maintenance of muscle and neuromuscular junction architecture, and provides a Drosophila genetic model to mechanistically evaluate this requirement.
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Affiliation(s)
- Kevin F. Haas
- Department of Neurology, Vanderbilt University, Nashville, TN 37235-1634, U.S.A
| | - Elvin Woodruff
- Department of Biological Sciences, Vanderbilt University, Nashville, TN 37235-1634, U.S.A
| | - Kendal Broadie
- Department of Biological Sciences, Vanderbilt University, Nashville, TN 37235-1634, U.S.A
- Vanderbilt Kennedy Center for Research on Human Development, Vanderbilt University, Nashville, TN 37235-1634, U.S.A
- To whom correspondence should be addressed (email )
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Fielitz J, Kim MS, Shelton JM, Latif S, Spencer JA, Glass DJ, Richardson JA, Bassel-Duby R, Olson EN. Myosin accumulation and striated muscle myopathy result from the loss of muscle RING finger 1 and 3. J Clin Invest 2007; 117:2486-95. [PMID: 17786241 PMCID: PMC1957544 DOI: 10.1172/jci32827] [Citation(s) in RCA: 195] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 07/18/2007] [Indexed: 11/17/2022] Open
Abstract
Maintenance of skeletal and cardiac muscle structure and function requires precise control of the synthesis, assembly, and turnover of contractile proteins of the sarcomere. Abnormalities in accumulation of sarcomere proteins are responsible for a variety of myopathies. However, the mechanisms that mediate turnover of these long-lived proteins remain poorly defined. We show that muscle RING finger 1 (MuRF1) and MuRF3 act as E3 ubiquitin ligases that cooperate with the E2 ubiquitin-conjugating enzymes UbcH5a, -b, and -c to mediate the degradation of beta/slow myosin heavy chain (beta/slow MHC) and MHCIIa via the ubiquitin proteasome system (UPS) in vivo and in vitro. Accordingly, mice deficient for MuRF1 and MuRF3 develop a skeletal muscle myopathy and hypertrophic cardiomyopathy characterized by subsarcolemmal MHC accumulation, myofiber fragmentation, and diminished muscle performance. These findings identify MuRF1 and MuRF3 as key E3 ubiquitin ligases for the UPS-dependent turnover of sarcomeric proteins and reveal a potential basis for myosin storage myopathies.
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Affiliation(s)
- Jens Fielitz
- Department of Molecular Biology and
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA.
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Mi-Sung Kim
- Department of Molecular Biology and
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA.
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - John M. Shelton
- Department of Molecular Biology and
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA.
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Shuaib Latif
- Department of Molecular Biology and
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA.
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Jeffrey A. Spencer
- Department of Molecular Biology and
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA.
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - David J. Glass
- Department of Molecular Biology and
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA.
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - James A. Richardson
- Department of Molecular Biology and
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA.
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Rhonda Bassel-Duby
- Department of Molecular Biology and
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA.
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Eric N. Olson
- Department of Molecular Biology and
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
Novartis Institutes for Biomedical Research, Cambridge, Massachusetts, USA.
Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
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