1
|
Waisayarat J, Wongsuwan P, Tuntiseranee K, Waisayarat P, Dejthevaporn C, Khongkhatithum C, Soponkanaporn S. Sarcoplasmic Myxovirus Resistance Protein A: A Study of Expression in Idiopathic Inflammatory Myopathy. J Inflamm Res 2023; 16:5417-5426. [PMID: 38026261 PMCID: PMC10676103 DOI: 10.2147/jir.s433239] [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: 08/24/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases affecting primarily proximal muscles. Major subtypes include dermatomyositis, polymyositis, inclusion body myositis, immune-mediated necrotizing myopathy and antisynthetase syndrome. Overexpression of sarcoplasmic myxovirus-resistance protein A (MxA) has been observed in muscle biopsy specimens of dermatomyositis but is rarely seen in other subtypes of IIM and other myopathies. Objective We evaluate the expression of sarcoplasmic MxA and its diagnostic value in IIM and other myopathies. Methods One hundred and thirty-eight muscle biopsy specimens with the diagnosis of IIM and other myopathies from 2011 to 2020 were reviewed and stained for MxA by immunohistochemistry. The difference of the expression of MxA between IIM and other myopathies was analyzed by Fisher's exact test, and the sensitivity and specificity of MxA immunohistochemistry in the diagnosis of IIM were assessed. Results MxA protein was positive in 16/138 (11.6%) specimens. All 12 dermatomyositis specimens positive for MxA protein were positive in perifascicular area pattern. Only dermatomyositis specimens had a significantly higher percentage of positive sarcoplasmic MxA expression than specimens of other subtypes of IIM (p<0.001). Sarcoplasmic MxA expression for dermatomyositis diagnosis had a sensitivity of 46.15% (95% CI 26.59-66.63%) and a specificity of 94.44% (95% CI 81.34-99.32%) with the positive and negative likelihood ratio of 8.31 (95% CI 2.03-34.01) and 0.57 (95% CI 0.40-0.82), respectively. Conclusion The MxA immunohistochemistry is highly specific for dermatomyositis and should be added to a routine inflammatory panel of muscle biopsy. MxA expression should be cautiously interpreted to avoid pitfalls.
Collapse
Affiliation(s)
- Jariya Waisayarat
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phumin Wongsuwan
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Phu Waisayarat
- Faculty of Medicine, King Mongkut’s Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Charungthai Dejthevaporn
- Division of Neurology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiyos Khongkhatithum
- Division of Neurology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirisucha Soponkanaporn
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
2
|
Honda M, Shimizu F, Sato R, Mizukami Y, Watanabe K, Takeshita Y, Maeda T, Koga M, Kanda T. Jo-1 Antibodies From Myositis Induce Complement-Dependent Cytotoxicity and TREM-1 Upregulation in Muscle Endothelial Cells. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/4/e200116. [PMID: 37147138 PMCID: PMC10162704 DOI: 10.1212/nxi.0000000000200116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/21/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Muscle microangiopathy due to dysfunction of endothelial cells because of inflammation is a critical hallmark of dermatomyositis (DM); however, its pathomechanism remains unclear. The aim of this study was to evaluate the effect of immunogloblin G (IgG) from patients with idiopathic inflammatory myopathies (IIM) on muscle endothelial cells in vitro. METHODS Using a high-content imaging system, we analyzed whether IgG purified from sera from patients with IIM (n = 15), disease controls (DCs: n = 7), and healthy controls (HCs: n = 7) can bind to muscle endothelial cells and induce complement-dependent cellular cytotoxicity. RESULTS IgGs from Jo-1 antibody myositis could bind to muscle endothelial cells and caused complement-dependent cell cytotoxicity. RNA-seq demonstrated the upregulation of genes associated with tumor necrosis factor (TNF)-α, triggering receptor expressed on myeloid cells-1 (TREM-1), CD25, and mitochondria pathways after exposure to IgG from the Jo-1, signal recognition particle (SRP), and polymyositis (PM) groups. The high-content imaging system showed that TREM-1 expression in the Jo-1, SRP, and PM groups was increased in comparison with DCs and HCs and that the TNF-α expression in the Jo-1 group was higher in comparison with the SRP, PM, DC, and HC groups. The expression of TREM-1 was observed in biopsied capillaries and the muscle membrane from patients with Jo-1 and in biopsied muscle fiber and capillaries from patients with DM and SRP. The depletion of Jo-1 antibodies by IgG of patients with Jo-1 antibody myositis reduced the Jo-1 antibody-induced complement-dependent cellular cytotoxicity in muscle endothelial cells. DISCUSSION Jo-1 antibodies from Jo-1 antibody myositis show complement-dependent cellular cytotoxicity in muscle endothelial cells. IgGs from patients with Jo-1, SRP, and DM increase the TREM-1 expression in endothelial cells and muscles.
Collapse
Affiliation(s)
- Masaya Honda
- From the Department of Neurology and Clinical Neuroscience (M.H., F.S., R.S., Y.T., M.K., T.K.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi; and Center for Gene Research (Y.M., K.W.), Yamaguchi University, Ube, Japan
| | - Fumitaka Shimizu
- From the Department of Neurology and Clinical Neuroscience (M.H., F.S., R.S., Y.T., M.K., T.K.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi; and Center for Gene Research (Y.M., K.W.), Yamaguchi University, Ube, Japan.
| | - Ryota Sato
- From the Department of Neurology and Clinical Neuroscience (M.H., F.S., R.S., Y.T., M.K., T.K.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi; and Center for Gene Research (Y.M., K.W.), Yamaguchi University, Ube, Japan
| | - Yoichi Mizukami
- From the Department of Neurology and Clinical Neuroscience (M.H., F.S., R.S., Y.T., M.K., T.K.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi; and Center for Gene Research (Y.M., K.W.), Yamaguchi University, Ube, Japan
| | - Kenji Watanabe
- From the Department of Neurology and Clinical Neuroscience (M.H., F.S., R.S., Y.T., M.K., T.K.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi; and Center for Gene Research (Y.M., K.W.), Yamaguchi University, Ube, Japan
| | - Yukio Takeshita
- From the Department of Neurology and Clinical Neuroscience (M.H., F.S., R.S., Y.T., M.K., T.K.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi; and Center for Gene Research (Y.M., K.W.), Yamaguchi University, Ube, Japan
| | - Toshihiko Maeda
- From the Department of Neurology and Clinical Neuroscience (M.H., F.S., R.S., Y.T., M.K., T.K.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi; and Center for Gene Research (Y.M., K.W.), Yamaguchi University, Ube, Japan
| | - Michiaki Koga
- From the Department of Neurology and Clinical Neuroscience (M.H., F.S., R.S., Y.T., M.K., T.K.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi; and Center for Gene Research (Y.M., K.W.), Yamaguchi University, Ube, Japan
| | - Takashi Kanda
- From the Department of Neurology and Clinical Neuroscience (M.H., F.S., R.S., Y.T., M.K., T.K.), Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi; and Center for Gene Research (Y.M., K.W.), Yamaguchi University, Ube, Japan
| |
Collapse
|
3
|
Meng S, Wang T, Zhao Q, Hu Q, Chen Y, Li H, Liu C, Liu D, Hong X. Proteomics Analysis of Plasma-Derived Exosomes Unveils the Aberrant Complement and Coagulation Cascades in Dermatomyositis/Polymyositis. J Proteome Res 2023; 22:123-137. [PMID: 36507906 PMCID: PMC9830643 DOI: 10.1021/acs.jproteome.2c00532] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dermatomyositis and polymyositis (DM/PM) are systemic autoimmune diseases characterized by proximal muscle weakness. The underlying pathogenetic mechanism of this disease remains under-researched. Here, using proteomics analysis, a great overlap of differentially expressed plasma exosomal proteins involved in the complement and coagulation cascade pathway, including FGA, FGB, FGG, C1QB, C1QC, and VWF, was identified in DM/PM patients versus healthy controls. Correlation analysis showed that the expression levels of complement-associated proteins (C1QB and C1QC) correlated positively with CRP, ESR, and platelet count. ROC curve analysis demonstrated that complement and coagulation cascade-associated proteins could be strong predictors for DM/PM. In addition, we also identified several other proteins that were differentially expressed in DM and PM. The selected candidate proteins were further validated by parallel reaction monitoring (PRM) and enzyme-linked immunosorbent assay (ELISA). Together, our findings indicate that these exosome-derived proteins might participate in microvascular damage in DM/PM through the activation of the complement and coagulation cascade pathway and function as biomarkers for the clinical diagnosis of DM/PM.
Collapse
Affiliation(s)
- Shuhui Meng
- Department
of Rheumatology and Immunology, The Second Clinical Medical College
of Jinan University, The First Affiliated Hospital of Southern University
of Science and Technology, Shenzhen People’s
Hospital, Shenzhen 518020, Guangdong, China
| | - Tingting Wang
- Department
of Rheumatology and Immunology, The Second Clinical Medical College
of Jinan University, The First Affiliated Hospital of Southern University
of Science and Technology, Shenzhen People’s
Hospital, Shenzhen 518020, Guangdong, China,Integrated
Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou 510632, China
| | - Qianqian Zhao
- Department
of Rheumatology and Immunology, The Second Clinical Medical College
of Jinan University, The First Affiliated Hospital of Southern University
of Science and Technology, Shenzhen People’s
Hospital, Shenzhen 518020, Guangdong, China,Integrated
Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou 510632, China
| | - Qiu Hu
- Department
of Rheumatology and Immunology, The Second Clinical Medical College
of Jinan University, The First Affiliated Hospital of Southern University
of Science and Technology, Shenzhen People’s
Hospital, Shenzhen 518020, Guangdong, China
| | - Yulan Chen
- Department
of Rheumatology and Immunology, The Second Clinical Medical College
of Jinan University, The First Affiliated Hospital of Southern University
of Science and Technology, Shenzhen People’s
Hospital, Shenzhen 518020, Guangdong, China
| | - Heng Li
- Department
of Rheumatology and Immunology, The Second Clinical Medical College
of Jinan University, The First Affiliated Hospital of Southern University
of Science and Technology, Shenzhen People’s
Hospital, Shenzhen 518020, Guangdong, China,Integrated
Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou 510632, China
| | - Cuilian Liu
- Department
of Rheumatology and Immunology, The Second Clinical Medical College
of Jinan University, The First Affiliated Hospital of Southern University
of Science and Technology, Shenzhen People’s
Hospital, Shenzhen 518020, Guangdong, China
| | - Dongzhou Liu
- Department
of Rheumatology and Immunology, The Second Clinical Medical College
of Jinan University, The First Affiliated Hospital of Southern University
of Science and Technology, Shenzhen People’s
Hospital, Shenzhen 518020, Guangdong, China,
| | - Xiaoping Hong
- Department
of Rheumatology and Immunology, The Second Clinical Medical College
of Jinan University, The First Affiliated Hospital of Southern University
of Science and Technology, Shenzhen People’s
Hospital, Shenzhen 518020, Guangdong, China,
| |
Collapse
|
4
|
Pathophysiological Mechanisms and Treatment of Dermatomyositis and Immune Mediated Necrotizing Myopathies: A Focused Review. Int J Mol Sci 2022; 23:ijms23084301. [PMID: 35457124 PMCID: PMC9030619 DOI: 10.3390/ijms23084301] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 12/15/2022] Open
Abstract
Idiopathic inflammatory myopathies (IIM), collectively known as myositis, are a composite group of rare autoimmune diseases affecting mostly skeletal muscle, although other organs or tissues may also be involved. The main clinical feature of myositis is subacute, progressive, symmetrical muscle weakness in the proximal arms and legs, whereas subtypes of myositis may also present with extramuscular features, such as skin involvement, arthritis or interstitial lung disease (ILD). Established subgroups of IIM include dermatomyositis (DM), immune-mediated necrotizing myopathy (IMNM), anti-synthetase syndrome (ASyS), overlap myositis (OM) and inclusion body myositis (IBM). Although these subgroups have overlapping clinical features, the widespread variation in the clinical manifestations of IIM suggests different pathophysiological mechanisms. Various components of the immune system are known to be important immunopathogenic pathways in IIM, although the exact pathophysiological mechanisms causing the muscle damage remain unknown. Current treatment, which consists of glucocorticoids and other immunosuppressive or immunomodulating agents, often fails to achieve a sustained beneficial response and is associated with various adverse effects. New therapeutic targets have been identified that may improve outcomes in patients with IIM. A better understanding of the overlapping and diverging pathophysiological mechanisms of the major subgroups of myositis is needed to optimize treatment. The aim of this review is to report on recent advancements regarding DM and IMNM.
Collapse
|
5
|
Cavalli S, Lonati PA, Gerosa M, Caporali R, Cimaz R, Chighizola CB. Beyond Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome: The Relevance of Complement From Pathogenesis to Pregnancy Outcome in Other Systemic Rheumatologic Diseases. Front Pharmacol 2022; 13:841785. [PMID: 35242041 PMCID: PMC8886148 DOI: 10.3389/fphar.2022.841785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/27/2022] [Indexed: 12/17/2022] Open
Abstract
Evidence about the relevance of the complement system, a highly conserved constituent of the innate immunity response that orchestrates the elimination of pathogens and the inflammatory processes, has been recently accumulated in many different rheumatologic conditions. In rheumatoid arthritis, complement, mainly the classical pathway, contributes to tissue damage especially in seropositive subjects, with complement activation occurring in the joint. Data about complement pathways in psoriatic arthritis are dated and poorly consistent; among patients with Sjögren syndrome, hypocomplementemia exerts a prognostic role, identifying patients at risk of extra-glandular manifestations. Hints about complement involvement in systemic sclerosis have been recently raised, following the evidence of complement deposition in affected skin and in renal samples from patients with scleroderma renal crisis. In vasculitides, complement plays a dual role: on one hand, stimulation of neutrophils with anti-neutrophil cytoplasmic antibodies (ANCA) results in the activation of the alternative pathway, on the other, C5a induces translocation of ANCA antigens, favouring the detrimental role of antibodies. Complement deposition in the kidneys identifies patients with more aggressive renal disease; patients with active disease display low serum levels of C3 and C4. Even though in dermatomyositis sC5b-9 deposits are invariably present in affected muscles, data on C3 and C4 fluctuation during disease course are scarce. C3 and C1q serum levels have been explored as potential markers of disease activity in Takayasu arteritis, whereas data in Behçet disease are limited to in vitro observations. Pregnancies in women with rheumatologic conditions are still burdened by a higher rate of pregnancy complications, thus the early identification of women at risk would be invaluable. A fine-tuning of complement activation is required from a physiological progression of pregnancy, from pre-implantation stages, through placentation to labour. Complement deregulation has been implicated in several pregnancy complications, such as recurrent abortion, eclampsia and premature birth; low complement levels have been shown to reliably identify women at risk of complications. Given its physiologic role in orchestrating pregnancy progression and its involvement as pathogenic effector in several rheumatologic conditions, complement system is an attractive candidate biomarker to stratify the obstetric risk among women with rheumatologic conditions.
Collapse
Affiliation(s)
- Silvia Cavalli
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Paola Adele Lonati
- Experimental Laboratory of Immunorheumatological Researches, IRCCS Istituto Auxologico Italiano, Cusano Milanino, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Pediatric Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Pediatric Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| |
Collapse
|
6
|
Proteome study of cutaneous lupus erythematosus (CLE) and dermatomyositis skin lesions reveals IL-16 is differentially upregulated in CLE. Arthritis Res Ther 2021; 23:132. [PMID: 33931094 PMCID: PMC8086067 DOI: 10.1186/s13075-021-02511-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background The objective of the study was to explore the disease pathways activated in the inflammatory foci of skin lesions in cutaneous lupus erythematosus (CLE) and dermatomyositis (DM). Methods Skin biopsies acquired from active CLE and DM lesions, patient (PC), and also healthy controls (HC) were investigated. Biopsy sections were examined by a pathologist, inflammatory foci were laser micro-dissected and captured, and proteins within captured tissue were detected in an unbiased manner by mass spectrometry. Protein pathway analysis was performed by the string-db.org platform. Findings of interest were confirmed by immunohistochemistry (IHC). Results Proteome investigation identified abundant expression of interferon-regulated proteins (IRP) as a common feature of CLE and DM. Interleukin (IL)-16 was the only abundant cytokine differentially expressed in CLE compared to DM. Caspase-3, an enzyme that cleaves IL-16 into its active form, was detected in low levels. Significantly higher proportion of IL-16- and caspase-3-positive cells was identified in CLE lesions in comparison with DM, PC, and HC. Proteomic results indicate more abundant complement deposition in CLE skin lesions. Conclusions Using unbiased mass spectrometry investigation of CLE and DM inflammatory infiltrates, we confirmed that high IRP expression is a common feature of both CLE and DM, while IL-16 is the only differentially expressed cytokine in CLE. IHC confirmed high expression of IL-16 and caspase-3 in CLE. Our novel molecular findings indicate that IL-16 detection could be useful in differential diagnostics between the two conditions that can display similar histopathological appearance. IL-16 could be of interest as a future therapeutic target for CLE.
Collapse
|
7
|
Woelfinger P, Hauptrock B, Kriege O, Wagner W, Heider J, Schwarting A, Birklein F, Theobald M, Wagner-Drouet EM. Alloimmune Myositis as Paraneoplastic Complication of an Oral Squamous Cell Carcinoma After Severe Chronic Graft vs Host Disease or a Manifestation of Chronic Graft vs Host Disease? A Case Report and Literature Discussion. Transplant Proc 2021; 53:1365-1368. [PMID: 33478746 DOI: 10.1016/j.transproceed.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
A 53-year-old female patient with acute myeloid leukemia developed severe chronic graft vs host disease (cGVHD) of the oral mucosa after allogeneic hematopoietic stem cell transplantation with leukoplakia and relapsing oral squamous cell carcinoma (SCC) of the tongue. cGVHD needed long-lasting immunosuppressive therapy; SCC was treated with radiation and surgery. Acute myeloid leukemia remained in complete remission. The patient developed a myositis with pain of all muscles as well as paraparesis with elevated creatine kinase and C-reactive protein and detection of antiskeletal muscle autoantibodies 3500 days after hematopoietic stem cell transplantation. No other clinical features of chronic GVHD were apparent at this time. Symptoms disappeared after treatment with corticosteroids but relapsed while tapering. Weekly therapy with the B-cell-depleting antibody rituximab was started and administered for 6 weeks. Symptoms disappeared again but partly returned after some weeks, so therapy with azathioprine was started. During therapy with azathioprine slow tapering of corticosteroids was possible and clinical symptoms remained absent. Here we present a case report and review of the literature on alloimmune myositis as paraneoplastic complication of an oral SCC of the tongue after severe chronic GVHD or as late manifestation of chronic GVHD itself.
Collapse
Affiliation(s)
- Pascal Woelfinger
- Hematology, Oncology and Pneumology, UCT, University Medical Center Mainz, Mainz, Germany.
| | - Beate Hauptrock
- Hematology, Oncology and Pneumology, UCT, University Medical Center Mainz, Mainz, Germany
| | - Oliver Kriege
- Hematology, Oncology and Pneumology, UCT, University Medical Center Mainz, Mainz, Germany
| | - Wilfried Wagner
- Maxillofacial Surgery, UCT, University Medical Center Mainz, Mainz, Germany
| | - Julia Heider
- Maxillofacial Surgery, UCT, University Medical Center Mainz, Mainz, Germany
| | | | - Frank Birklein
- Neurology, University Medical Center Mainz, Mainz, Germany
| | - Matthias Theobald
- Hematology, Oncology and Pneumology, UCT, University Medical Center Mainz, Mainz, Germany
| | | |
Collapse
|
8
|
Meng L, Ji S, Wang Q, Bu B. Polymyositis as a manifestation of chronic graft-versus-host disease after allo-HSCT. Clin Case Rep 2018; 6:1723-1726. [PMID: 30214750 PMCID: PMC6132093 DOI: 10.1002/ccr3.1709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 06/03/2018] [Accepted: 06/21/2018] [Indexed: 01/08/2023] Open
Abstract
Patients who received allogeneic haematopoietic stem cell transplantation (allo-HSCT) may develop T cell-mediated immunologic injury to muscles, recapitulating the characteristics of polymyositis clinically and pahtologically. Polymyositis is a rarely reported complication of graft-versus-host disease (GVHD), which often responds well to corticosteroids and immunosuppressive treatment.
Collapse
Affiliation(s)
- Lijuan Meng
- Department of NeurologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Suqiong Ji
- Department of NeurologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Qiong Wang
- Department of NeurologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Bitao Bu
- Department of NeurologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| |
Collapse
|
9
|
Shahnoor N, Siebers EM, Brown KJ, Lawlor MW. Pathological Issues in Dystrophinopathy in the Age of Genetic Therapies. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2018; 14:105-126. [PMID: 30148687 DOI: 10.1146/annurev-pathmechdis-012418-012945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dystrophinopathy is a class of genetic skeletal muscle disease characterized by myofiber degeneration and regeneration due to insufficient levels or functioning of dystrophin. Pathological evaluation for dystrophinopathy includes the identification of dystrophic skeletal muscle pathology and the immunohistochemical evaluation of dystrophin epitopes, but biopsies have become rare in recent years. However, the evaluation of dystrophin expression in the research setting has become critically important due to recent advances in genetic therapies, including exon skipping and gene therapy. Given the number of these therapies under evaluation in patients, it is likely that the traditional methods of evaluating dystrophinopathy will need to evolve in the near future. This review discusses current muscle biopsy diagnostic practices in dystrophinopathy and further focuses on how these practices have evolved in the context of therapeutic interventions for dystrophinopathy.
Collapse
Affiliation(s)
- Nazima Shahnoor
- Department of Pathology and Laboratory Medicine, and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA; , ,
| | - Emily M Siebers
- Department of Pathology and Laboratory Medicine, and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA; , ,
| | - Kristy J Brown
- Solid Biosciences, Inc., Cambridge, Massachusetts 02139, USA;
| | - Michael W Lawlor
- Department of Pathology and Laboratory Medicine, and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA; , ,
| |
Collapse
|
10
|
Gallay L, Hot A, Petiot P, Thivolet-Bejui F, Maucort-Boulch D, Streichenberger N. Focal myositis: New insights on diagnosis and pathology. Neurology 2018; 90:e1013-e1020. [PMID: 29467303 DOI: 10.1212/wnl.0000000000005160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/20/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To better define in a cohort study the clinical and pathologic features of focal myositis (FM). METHODS With the use of the usual clinicopathologic definition, each confirmed case of FM in the Lyon University Hospital's myopathologic database between 2000 and 2016 was retrieved. Clinical, pathologic, imaging, serologic, and therapeutic data were collected. When data were missing but feasible, appropriate pathologic analyses were performed. RESULTS Of the 924 patients included in the database, 37 (4%) had confirmed FM (14 female, 23 male patients). The main symptoms were pain (n = 30, 81%), muscular mass (n = 16, 43%), erythema at the site of FM (n = 12, 32%), and fever (n = 9, 24%). Serum creatine kinase was normal in most patients (81%); serum immune abnormalities were frequent (inflammatory syndrome in sera [39%], dysglobulinemia [52%], and anti-nuclear antibody positivity [29%]). In addition to confirming previously reported findings, pathologic analyses found significant rates of vasculitis (68%) and fasciitis (73%). Here, FM appeared frequently to be associated with other diseases such as immune-mediated inflammatory disease (IMID; 32%), neoplasia (24%), and radiculopathy (11%). Regarding outcomes, 64% of the cases had received immunosuppressive drugs, and the relapse rate was 41%. CONCLUSION The present study suggests that FM is not as innocuous as previously believed, particularly considering the associated disorders. Notably, patients with FM should receive careful IMID and neoplasia screening.
Collapse
Affiliation(s)
- Laure Gallay
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France.
| | - Arnaud Hot
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Philippe Petiot
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Françoise Thivolet-Bejui
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Delphine Maucort-Boulch
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Nathalie Streichenberger
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| |
Collapse
|
11
|
Uruha A, Suzuki S, Nishino I. Diagnosis of dermatomyositis: Autoantibody profile and muscle pathology. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/cen3.12419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Akinori Uruha
- Pierre and Marie Curie University - Paris VI; National Institute of Health and Medical Research (INSERM); Mixed Research Unit 974; Center of Research in Myology; Institute of Myology; Pitié-Salpêtrière University Hospital; Paris France
| | - Shigeaki Suzuki
- Department of Neurology; Keio University School of Medicine; Tokyo Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research; National Institute of Neuroscience; Tokyo Japan
- Department of Genome Medicine Development; Medical Genome Center; National Center of Neurology and Psychiatry; Tokyo Japan
| |
Collapse
|
12
|
Uruha A, Nishikawa A, Tsuburaya RS, Hamanaka K, Kuwana M, Watanabe Y, Suzuki S, Suzuki N, Nishino I. Sarcoplasmic MxA expression. Neurology 2016; 88:493-500. [DOI: 10.1212/wnl.0000000000003568] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/27/2016] [Indexed: 01/11/2023] Open
Abstract
Objective:To evaluate the diagnostic value of myxovirus resistance A (MxA) expression in the cytoplasm of myofibers in the diagnosis of dermatomyositis (DM).Methods:We assessed the sensitivity and specificity of the sarcoplasmic expression of MxA in muscles with DM by immunohistochemistry in consecutive cases of DM (n = 34) and other idiopathic inflammatory myopathies (n = 120: 8 with polymyositis, 16 with anti–tRNA-synthetase antibody–associated myositis, 46 with immune-mediated necrotizing myopathy, and 50 with inclusion body myositis) and compared them with conventional pathologic hallmarks of DM, including perifascicular atrophy (PFA) and membrane attack complex (MAC) deposition on endomysial capillaries.Results:The sensitivity and specificity of sarcoplasmic MxA expression were 71% and 98%, respectively. While the specificity was almost comparable to that of PFA and capillary MAC deposition, the sensitivity was higher, with PFA showing 47% sensitivity and 98% specificity and capillary MAC deposition showing 35% sensitivity and 93% specificity. Of note, in patients with DM with typical skin rash but no PFA, 44% of the samples showed sarcoplasmic MxA expression, which was higher than the 17% sensitivity of capillary MAC deposition in the population.Conclusions:Sarcoplasmic MxA expression detected by immunohistochemistry is a more sensitive marker of DM than the conventional hallmarks, indicating its practical utility in the diagnosis of DM. It may well be included in the routine immunohistochemistry panel for myositis.Classification of evidence:This study provides Class II evidence that immunohistochemistry-detected sarcoplasmic MxA expression accurately identifies patients with dermatomyositis.
Collapse
|
13
|
Abstract
Dermatomyositis is a chronic systemic autoimmune disease characterized by inflammatory infiltrates in the skin and muscle. The wide variability in clinical and serologic presentation poses a diagnostic challenge for the internist. Appreciation of the clinical variants of dermatomyositis allows for expedient diagnosis and avoidance of diagnostic error. We illustrate these challenges with the case of a 51-year-old Vietnamese-American man who initially presented with fever of unknown origin in the absence of overt skin and muscle manifestations. The diagnosis of dermatomyositis was not evident on several clinical encounters due to the absence of these hallmark symptoms. We review the variable clinical manifestations of a subtype of dermatomyositis associated with an autoantibody against melanoma differentiation-associated protein 5 (anti-MDA5) and suggest consideration of dermatomyositis as a diagnosis in patients presenting with systemic illness and markedly elevated ferritin, even in the absence of elevated muscle enzymes and classic autoantibodies.
Collapse
|
14
|
Lahoria R, Selcen D, Engel AG. Microvascular alterations and the role of complement in dermatomyositis. Brain 2016; 139:1891-903. [DOI: 10.1093/brain/aww122] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/07/2016] [Indexed: 12/21/2022] Open
|
15
|
Braczynski AK, Harter PN, Zeiner PS, Drott U, Tews DS, Preusse C, Penski C, Dunst M, Weis J, Stenzel W, Mittelbronn M. C5b-9 deposits on endomysial capillaries in non-dermatomyositis cases. Neuromuscul Disord 2016; 26:283-91. [PMID: 27020463 DOI: 10.1016/j.nmd.2016.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 11/28/2022]
Abstract
Deposits of the terminal-membrane-attack-complex (MAC) C5b-9 on perfascicular endomysial capillaries are generally regarded as diagnostic hallmark of dermatomyositis (DM). Although the pathophysiology is not clear, C5b-9 deposits on capillaries seem to be associated with microinfarctions and vascular damage. Here, we report on a series of 19 patients presenting with C5b-9 accumulation on endomysial capillaries in the absence of features for DM. To decipher differences in the capillary C5b-9 accumulation pattern between DM and non-DM cases, we assessed the extent of endomysial capillary C5b-9 deposits related to capillary density and extent of myofiber necrosis by immunohistochemistry in 12 DM and 8 control patients. We found similar numbers of C5b-9-positive myofibers in both DM and non-DM C5b-9(+) cases. The distribution pattern differed as DM cases showed significantly more perifascicular capillary C5b-9 deposits as compared to non-DM cases, which presented stronger endomysial capillary C5b-9 deposits in a diffuse pattern. While total capillary density was not differing, DM patients displayed significantly more C5b-9(+) necrotic fibers as compared to non-DM C5b-9(+). In summary, endomysial capillary C5b-9 deposits are present in a variety of non-DM cases, however with differing distribution pattern. In conclusion, capillary C5b-9(+) deposits should be assessed critically, taking into consideration the distribution pattern.
Collapse
Affiliation(s)
- Anne K Braczynski
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Germany
| | - Patrick N Harter
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Germany
| | - Pia S Zeiner
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Germany
| | - Ulrich Drott
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Germany
| | | | | | - Cornelia Penski
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Germany
| | - Maika Dunst
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Germany
| | - Joachim Weis
- Institute of Neuropathology, RWTH, Aachen, Germany
| | | | - Michel Mittelbronn
- Edinger Institute, Institute of Neurology, University of Frankfurt am Main, Germany.
| |
Collapse
|
16
|
Tieu J, Lundberg IE, Limaye V. Idiopathic inflammatory myositis. Best Pract Res Clin Rheumatol 2016; 30:149-68. [DOI: 10.1016/j.berh.2016.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022]
|
17
|
Arshanapalli A, Shah M, Veerula V, Somani AK. The role of type I interferons and other cytokines in dermatomyositis. Cytokine 2014; 73:319-25. [PMID: 25541432 DOI: 10.1016/j.cyto.2014.11.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 12/24/2022]
Abstract
Much work has been done to unveil the mechanisms behind the pathogenesis of dermatomyositis (DM) - mainly those involving certain pathogenic cytokines, termed "pathokines" as the principal cytokines involved. Recently, it has become clear that a group of cytokines known as type I interferons (IFN-Is) play a significant role in the development of DM. We review the literature published between 1946 and 2014 using an Ovid Medline database search to provide an update on the role of IFN-Is and other cytokines in the pathogenesis of DM. We provide information about the genes and proteins induced by IFN-Is and potential mechanisms by which these downstream products relate to clinical disease activity. We also explore findings of other autoimmune phenomena that may contribute to disease onset and activity including T-helper 17 (Th17) cells and associated interleukins, as well as autoantibodies. Finally, we provide a brief update on current treatment options for DM as well as some new immunomodulatory treatment modalities in development.
Collapse
Affiliation(s)
- Ashish Arshanapalli
- Department of Dermatology, Indiana University School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA
| | - Mihir Shah
- Northeast Ohio Medical University, 4209 SR 44, Rootstown, OH 44272, USA
| | - Vindhya Veerula
- Department of Dermatology, Indiana University School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA
| | - Ally-Khan Somani
- Department of Dermatology, Indiana University School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA.
| |
Collapse
|
18
|
C4d Staining as Immunohistochemical Marker in Inflammatory Myopathies. Appl Immunohistochem Mol Morphol 2014; 22:696-704. [DOI: 10.1097/pai.0000000000000002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Bhansing KJ, Lammens M, Knaapen HKA, van Riel PLCM, van Engelen BGM, Vonk MC. Scleroderma-polymyositis overlap syndrome versus idiopathic polymyositis and systemic sclerosis: a descriptive study on clinical features and myopathology. Arthritis Res Ther 2014; 16:R111. [PMID: 24886750 PMCID: PMC4060195 DOI: 10.1186/ar4562] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 04/24/2014] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The objective was to characterize the clinical and myopathologic features of patients with scleroderma-polymyositis (SSc-PM) overlap compared with a population of patients with systemic sclerosis (SSc) and polymyositis (PM). METHODS A three-way comparison of patients with SSc-PM overlap (n = 25) with patients with SSc (n = 397) and PM (n = 40) on clinical and myopathologic features and causes of death. One neuropathologist blinded for the diagnosis evaluated all recent available muscle biopsies. Biopsies were scored for presence of inflammation, necrotic muscle fibers, rimmed vacuoles, fibrosis, and immunohistochemical staining. Clinical or myopathologic characteristics were compared by using the χ(2) test or one-way analysis of variance (ANOVA). RESULTS The prevalence of SSc-PM overlap in the Nijmegen Systemic Sclerosis cohort was 5.9%. The mortality was 32% (eight of 25) in SSc-PM, of which half was related to cardiac diseases. The prevalence of pulmonary fibrosis was significantly increased in SSc-PM (83%) (P = 0.04) compared with SSc (49%) and PM (53%). SSc or myositis-specific antibodies were nearly absent in the SSc-PM group. In almost all biopsies (96%) of SSc-PM patients, necrotic muscle fibers were present, which was significantly increased compared with PM patients (P = 0.02). CONCLUSIONS Patients with SSc-PM have increased prevalence of pulmonary fibrosis and cardiac disease as the cause of death compared with patients with SSc and PM . In addition, we found that necrotizing muscle fibers with inflammation characterize SSc-PM overlap in muscle biopsies. Further research should focus on underlying mechanisms causing necrosis, inflammation, and fibrosis and their relation to pulmonary involvement and mortality in patients with SSc-PM overlap.
Collapse
|
20
|
Skeletal muscle microvasculature in the diagnosis of neuromuscular disease. J Neuropathol Exp Neurol 2013; 72:906-18. [PMID: 24042201 DOI: 10.1097/nen.0b013e3182a7f0b8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Blood vessels are often overlooked in analyses of skeletal muscle biopsies. However, there are many vascular features in skeletal muscle biopsies that, when interpreted in the context of other histologic patterns and clinical history, provide useful information that allows muscle pathologists to narrow their differential diagnoses and provide more accurate guidance to treating physicians. Here, we provide a review of normal skeletal muscle vasculature with details of the ultrastructure of vessel walls. We discuss the vascular effects of factors common to many patients undergoing muscle biopsy, for example, diabetes mellitus, hypertension, and aging. We then discuss vascular findings relevant to diagnostic muscle biopsy evaluation, with current theories of pathogenesis and detailed descriptions of the important features.
Collapse
|
21
|
Syriga M, Mavroidis M. Complement system activation in cardiac and skeletal muscle pathology: friend or foe? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 735:207-18. [PMID: 23402029 DOI: 10.1007/978-1-4614-4118-2_14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A major goal in current cardiology practice is to determine optimal strategies for minimizing myocardial necrosis and optimizing cardiac repair following an acute myocardial infarction. Temporally regulated activation and suppression of innate immunity may be critical for achieving this goal. Extensive experimental data in various animal models have indicated that inhibiting complement activation offers protection to cardiac tissue after ischemia/reperfusion. However, the results of clinical studies using complement inhibitors (mainly at the C5 level) in patients with acute myocardial infarction have largely been disappointing. In cases in which complement activation participates in the initial events of muscle cell destruction, as in autoimmune myocarditis or autoimmune muscle disorders, inhibition of complement activation is expected to prove a successful treatment. In other pathologic conditions in which complement is recruited by degenerating or dying muscle cells, as in ischemia, the ideal approach is probably to modulate rather than abruptly blunt complement activation. Beneficial effects of complement action with regard to waste disposal, recruitment of stem cells, regeneration, angiogenesis, and better utilization of energy sources under hypoxic conditions may also prove important for successful disease treatment. Patient outcome after myocardial infarction almost certainly depend upon the combined activation of several distinct but potentially interrelated signaling pathways, suggesting that a combination of treatments targeted to different pathways should be the therapy of choice, and modulation of complement could be one of them.
Collapse
Affiliation(s)
- Msaro Syriga
- Center of Basic Research, Biomedical Research Foundation, Academy of Athens, Athens 11527, Greece
| | | |
Collapse
|
22
|
Robinson AB, Reed AM. Clinical features, pathogenesis and treatment of juvenile and adult dermatomyositis. Nat Rev Rheumatol 2011; 7:664-75. [PMID: 21947177 DOI: 10.1038/nrrheum.2011.139] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Juvenile and adult dermatomyositis (DM) have multiple commonalities, yet display differing prevalence of features, outcomes and comorbidities. In general, compared with the disease in adults, children with DM have more vasculopathy and a greater likelihood of calcinosis, periungual and gingival telangiectasias, and ulceration, but have a better long-term prognosis with improved survival. Adults with DM are more likely to have myositis-specific antibodies, develop interstitial lung disease, have amyopathic disease, and have a marked association with malignancy and other comorbidities. Both diseases have similar features on muscle biopsy and interferon gene signature, although subtle differences can exist in pathogenesis and pathology, such as more capillary loss and a greater degree of C5b-9 complement deposition in affected muscle of juvenile patients. Initiatives are underway to improve classification, markers of disease activity and ability to predict outcome of juvenile and adult DM. The purpose of this Review is to compare and contrast the unique features between juvenile and adult disease and to outline new initiatives in the field.
Collapse
Affiliation(s)
- Angela B Robinson
- Department of Pediatrics, Case Western Reserve University Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | | |
Collapse
|