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Zhang L, Fu L, Zhang G, Hou Y, Ma X, Zhao D, Li W, Dai T, Shu Q, Yan C, Zhao B. Clinico-sero-pathological profiles and risk prediction model of idiopathic inflammatory myopathy (IIM) patients with different perifascicular changes. CNS Neurosci Ther 2024; 30:e14882. [PMID: 39097917 PMCID: PMC11298199 DOI: 10.1111/cns.14882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 08/06/2024] Open
Abstract
AIMS To explore the clinico-sero-pathological characteristics and risk prediction model of idiopathic inflammatory myopathy (IIM) patients with different muscular perifascicular (PF) changes. METHODS IIM patients in our center were enrolled and the clinico-sero-pathological data were retrospectively analyzed. A decision tree model was established through machine learning. RESULTS There were 231 IIM patients enrolled, including 53 with perifascicular atrophy (PFA), 39 with perifascicular necrosis (PFN), and 26 with isolated perifascicular enhancement of MHC-I/MHC-II (PF-MHCn). Clinically, PFA patients exhibited skin rashes and dermatomyositis-specific antibodies (DM-MSAs, 74.5%) except for anti-Mi2. PFN patients showed the most severe muscle weakness, highest creatine kinase (CK), anti-Mi2 (56.8%), and anti-Jo-1 (24.3%) antibodies. PF-MHCn patients demonstrated negative MSAs (48.0%) and elevated CK. Histopathologically, MAC predominantly deposited on PF capillaries in PFA but on non-necrotic myofiber in PFN (43.4% and 36.8%, p < 0.001). MxA expression was least in PF-MHCn (36.0% vs. 83.0% vs. 63.2%, p < 0.001). The decision tree model could effectively predict different subgroups, especially PFA and PFN. CONCLUSIONS Three types of PF change of IIMs representing distinct clinico-serological characteristics and pathomechanism. Undiscovered MSAs should be explored especially in PF-MHCn patients. The three pathological features could be accurately predicted through the decision tree model.
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Affiliation(s)
- Lining Zhang
- Department of RheumatologyQilu Hospital of Shandong UniversityJinanShandongChina
- Department of NeurologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Lijun Fu
- School of FinanceSouthwestern University of Finance and EconomicsChengduChina
| | - Guoyong Zhang
- Department of NeurologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Ying Hou
- Department of NeurologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Xiaotian Ma
- Department of Medicine Experimental Center, Qilu Hospital (Qingdao), Cheeloo College of MedicineShandong UniversityQingdaoShandongChina
| | - Dandan Zhao
- Department of NeurologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Wei Li
- Department of NeurologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Tingjun Dai
- Department of NeurologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Qiang Shu
- Department of RheumatologyQilu Hospital of Shandong UniversityJinanShandongChina
- Shandong Key Laboratory of Medicine and Prevention Integration in Rheumatism and Immunity DiseaseQilu Hospital of Shandong UniversityJinanShandongChina
| | - Chuanzhu Yan
- Department of NeurologyQilu Hospital of Shandong UniversityJinanShandongChina
- Department of Neurology, Qilu Hospital (Qingdao), Cheeloo College of MedicineShandong UniversityQingdaoShandongChina
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu HospitalShandong UniversityJinanShandongChina
- Mitochondrial Medicine Laboratory, Qilu Hospital (Qingdao)Shandong UniversityQingdaoShandongChina
| | - Bing Zhao
- Department of Neurology, Qilu Hospital (Qingdao), Cheeloo College of MedicineShandong UniversityQingdaoShandongChina
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Iwami K, Kano T, Mizushima K, Yaguchi H, Nishino I, Houzen H. [Diagnosis of anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis led by sarcoplasmic myxovirus resistance protein A expression on muscle pathology]. Rinsho Shinkeigaku 2024; 64:480-485. [PMID: 38897972 DOI: 10.5692/clinicalneurol.cn-001963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
A 44-year-old woman with autism spectrum disorder developed bulbar symptoms and generalized muscle weakness 7 months before referral. Six months before, she was administered glucocorticoid for liver involvement. During the course, while she presented alopecia, skin ulcers, and poikiloderma, hyperCKemia was observed only twice. Due to complications including cardiac involvement and hearing loss as well, we suspected mitochondrial disease and performed a muscle biopsy. The muscle pathology showed sarcoplasmic myxovirus resistance A (MxA) expression with scattered pattern. Since anti-melanoma differentiation-associated gene 5 (MDA5) antibody was detected, we diagnosed the patient with anti-MDA5 antibody-positive dermatomyositis (DM). We reinforced immunosuppressive therapy, and her clinical symptoms and liver involvement were improved. When we diagnose a case of anti-MDA5 antibody-positive DM who is difficult to make clinical diagnosis, it may be valuable to evaluate sarcoplasmic MxA expression on muscle pathology.
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Affiliation(s)
- Kosuke Iwami
- Department of Neurology, Obihiro Kosei General Hospital
| | - Takahiro Kano
- Department of Neurology, Obihiro Kosei General Hospital
| | - Keiichi Mizushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Hiroaki Yaguchi
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP)
| | - Hideki Houzen
- Department of Neurology, Obihiro Kosei General Hospital
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Englert B, Dittmayer C, Goebel HH, Schneider U, Holzer MT, Uruha A, Stenzel W. "Amyopathic" MDA5-positive dermatomyositis with severe lung involvement presenting with net myositic morphological features - insights from an autopsy study. Neuromuscul Disord 2024; 36:42-47. [PMID: 38354588 DOI: 10.1016/j.nmd.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
Anti-MDA5-positive dermatomyositis (MDA5-DM) often presents with extramuscular, especially pulmonary and skin manifestations, and apparent clinical signs of frank myositis can be missing (so called amyopathic DM). We hereby present two male patients who died from respiratory failure during the course of MDA5-DM. While overt signs of myositis or any skin involvement were absent at admission to hospital we noticed conspicuous inflammatory alterations in various skeletal muscles morphologically, showing different degrees of affection. Furthermore, pathological changes of the lungs compatible with rapid progressive interstitial lung disease and characteristic cutaneous vasculoocclusive features were identified at autopsy. This observation shows that muscles and skin are subclinically affected in a widespread fashion, hence subtle signs of muscle involvement should be sought after in anti-MDA5-positive patients with predominant lung affection to ensure adequate treatment.
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Affiliation(s)
- Benjamin Englert
- Center for Neuropathology and Prion Research, Faculty of Medicine, LMU Munich, Feodor-Lynen-Strasse 23, 81377 Munich, Germany.
| | - Carsten Dittmayer
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; Department of Neuropathology, Universitätsmedizin Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Udo Schneider
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Marie-Therese Holzer
- Division of Rheumatology and Systemic Inflammatory Diseases, III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Akinori Uruha
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Nelke C, Schmid S, Kleefeld F, Schroeter CB, Goebel HH, Hoffmann S, Preuße C, Kölbel H, Meuth SG, Ruck T, Stenzel W. Complement and MHC patterns can provide the diagnostic framework for inflammatory neuromuscular diseases. Acta Neuropathol 2024; 147:15. [PMID: 38214778 PMCID: PMC10786976 DOI: 10.1007/s00401-023-02669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024]
Abstract
Histopathological analysis stands as the gold standard for the identification and differentiation of inflammatory neuromuscular diseases. These disorders continue to constitute a diagnostic challenge due to their clinical heterogeneity, rarity and overlapping features. To establish standardized protocols for the diagnosis of inflammatory neuromuscular diseases, the development of cost-effective and widely applicable tools is crucial, especially in settings constrained by limited resources. The focus of this review is to emphasize the diagnostic value of major histocompatibility complex (MHC) and complement patterns in the immunohistochemical analysis of these diseases. We explore the immunological background of MHC and complement signatures that characterize inflammatory features, with a specific focus on idiopathic inflammatory myopathies. With this approach, we aim to provide a diagnostic algorithm that may improve and simplify the diagnostic workup based on a limited panel of stainings. Our approach acknowledges the current limitations in the field of inflammatory neuromuscular diseases, particularly the scarcity of large-scale, prospective studies that validate the diagnostic potential of these markers. Further efforts are needed to establish a consensus on the diagnostic protocol to effectively distinguish these diseases.
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Affiliation(s)
- Christopher Nelke
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Simone Schmid
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Kleefeld
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany
| | - Christina B Schroeter
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Hoffmann
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany
| | - Corinna Preuße
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany
- Department of Neuropediatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Augustenburger Platz 1, 13353, Berlin, Germany
| | - Heike Kölbel
- Department of Neuropaediatrics, Klinik für Kinderheilkunde I, Universitätsklinikum Essen, Essen, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany.
- Leibniz Science Campus Chronic Inflammation, Berlin, Germany.
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Mammen AL. Paraneoplastic myopathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:327-332. [PMID: 38494286 DOI: 10.1016/b978-0-12-823912-4.00022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This chapter reviews the association between cancer and the idiopathic inflammatory myopathies (IIM), which includes dermatomyositis (DM), antisynthetase syndrome (ASyS), immune-mediated necrotizing myopathy (IMNM), and inclusion body myositis (IBM). Accumulating evidence shows that the risk of a coexisting malignancy is high in patients with DM, especially among those with anti-Tif1γ autoantibodies. Patients with IMNM and no defined autoantibodies also have an increased risk of malignancy. Recent evidence demonstrates that many IBM patients have increased numbers of circulating CD57+ CD8+ T cells, consistent with a diagnosis of large granular lymphocytic leukemia. In contrast, IMNM patients with anti-SRP or anti-HMGCR autoantibodies as well as patients with ASyS syndrome do not have a definitively increased risk of cancer. Patients who have a cancer treated with one of the immune checkpoint inhibitors can develop myositis (ICI-myositis), sometimes along with myasthenia gravis and/or myocarditis.
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Affiliation(s)
- Andrew L Mammen
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States; Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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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.
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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
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Khoo T, Lilleker JB, Thong BYH, Leclair V, Lamb JA, Chinoy H. Epidemiology of the idiopathic inflammatory myopathies. Nat Rev Rheumatol 2023; 19:695-712. [PMID: 37803078 DOI: 10.1038/s41584-023-01033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/08/2023]
Abstract
The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of systemic autoimmune diseases that affect the skeletal muscles and can also involve the skin, joints, lungs and heart. The epidemiology of IIM is obscured by changing classification criteria and the inherent shortcomings of case identification using healthcare record diagnostic coding. The incidence of IIM is estimated to range from 0.2 to 2 per 100,000 person-years, with prevalence from 2 to 25 per 100,000 people. Although the effects of age and gender on incidence are known, there is only sparse understanding of ethnic differences, particularly in indigenous populations. The incidence of IIM has reportedly increased in the twenty-first century, but whether this is a genuine increase is not yet known. Understanding of the genetic risk factors for different IIM subtypes has advanced considerably. Infections, medications, malignancy and geography are also commonly identified risk factors. Potentially, the COVID-19 pandemic has altered IIM incidence, although evidence of this occurrence is limited to case reports and small case series. Consideration of the current understanding of the epidemiology of IIM can highlight important areas of interest for future research into these rare diseases.
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Affiliation(s)
- Thomas Khoo
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neuroscience, Manchester Academic Health Science Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Valérie Leclair
- Department of Medicine, Division of Rheumatology, McGill University, Montreal, Canada
| | - Janine A Lamb
- Epidemiology and Public Health Group, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
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Oyama M, Ohnuki Y, Uruha A, Saito Y, Nishimori Y, Suzuki S, Inoue M, Tanboon J, Okiyama N, Shiina T, Nishino I, Suzuki S. Association Between HLA Alleles and Autoantibodies in Dermatomyositis Defined by Sarcoplasmic Expression of Myxovirus Resistance Protein A. J Rheumatol 2023; 50:1159-1164. [PMID: 37321638 DOI: 10.3899/jrheum.2022-1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The diagnosis in the studies analyzing HLA of dermatomyositis (DM) was based on a combined clinical category of polymyositis/DM. This retrospective study investigated the associations of HLA with 5 DM-specific autoantibodies in Japanese patients diagnosed by muscle pathology. METHODS We diagnosed Japanese patients with DM based on sarcoplasmic expression of myxovirus resistance protein A. These patients underwent investigation for 5 DM-specific autoantibodies and HLA genotyping. RESULTS Of 175 patients (83 males and 92 females; range 1-86 yrs; mean 46 yrs), 173 (98.9%) had 1 of the 5 autoantibodies. Seven alleles-A*02:07, B*46:01, DRB1*04:07, DRB1*07:01, DRB1*08:03, DQB1*06:01, and DPB1*02:02-were more frequently detected in the patients with DM than healthy controls, but these associations were not significant after multiple testing correction. Stratifying by DM-specific autoantibodies, we found the associations of 6 already known and 7 new alleles-B*48:01, B*52:01, C*12:02, DRB1*04:05, DRB1*15:02, DPB1*05:01, and DPB1*09:01-with subsets of DM. Moreover, significant associations of 5 alleles with antinucleosome remodeling deacetylase complex (Mi-2) remained after multiple testing correction. In particular, the DRB1*04:07 (odds ratio [OR 28.9]; corrected P = 2.7 × 10-6) and DQB1*06:01 (OR 4.0; corrected P = 1.6 × 10-4) alleles were significantly more prevalent in patients with anti-Mi-2 antibody than in controls. CONCLUSION This study demonstrates DM-specific autoantibodies defined immunogenetic subsets of DM.
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Affiliation(s)
- Munenori Oyama
- M. Oyama, MD, PhD, Shigeaki Suzuki, MD, PhD, Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Ohnuki
- Y. Ohnuki, MD, PhD, Department of Medical Ethics, Tokai University School of Medicine, and Department of Clinical Genetics, Tokai University Hospital, Kanagawa, Japan
| | - Akinori Uruha
- A. Uruha, MD, PhD, Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Yoshihiko Saito
- Y. Saito, MD, M. Inoue, MD, PhD, I. Nishino, MD, PhD, Department of Neuromuscular Research, National Institute of Neuroscience, and Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Yukako Nishimori
- Y. Nishimori, MD, Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Shingo Suzuki
- Shingo. Suzuki, MD, PhD, T. Shiina, PhD, Department of Molecular Life Science, Tokai University School of Medicine, Kanagawa, Japan;
| | - Michio Inoue
- Y. Saito, MD, M. Inoue, MD, PhD, I. Nishino, MD, PhD, Department of Neuromuscular Research, National Institute of Neuroscience, and Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Jantima Tanboon
- J. Tanboon, MD, Department of Neuromuscular Research, National Institute of Neuroscience, and Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan, and Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Naoko Okiyama
- N. Okiyama, MD, PhD, Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takashi Shiina
- Shingo. Suzuki, MD, PhD, T. Shiina, PhD, Department of Molecular Life Science, Tokai University School of Medicine, Kanagawa, Japan
| | - Ichizo Nishino
- Y. Saito, MD, M. Inoue, MD, PhD, I. Nishino, MD, PhD, Department of Neuromuscular Research, National Institute of Neuroscience, and Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Shigeaki Suzuki
- M. Oyama, MD, PhD, Shigeaki Suzuki, MD, PhD, Department of Neurology, Keio University School of Medicine, Tokyo, Japan
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Chompoopong P, Skolka MP, Ernste FC, Milone M, Liewluck T. Symptomatic myopathies in sarcoidosis: disease spectrum and myxovirus resistance protein A expression. Rheumatology (Oxford) 2023; 62:2556-2562. [PMID: 36440911 DOI: 10.1093/rheumatology/keac668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/19/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES Symptomatic myopathy in sarcoidosis patients is not always due to sarcoid myopathy (ScM). We investigated the clinical and pathological spectrum including myxovirus resistance protein A (MxA) expression among sarcoidosis patients. METHODS We reviewed the Mayo Clinic database (May 1980-December 2020) to identify sarcoidosis patients with myopathic symptoms and pathological evidence of myopathy. RESULTS Among 5885 sarcoidosis patients, 21 had symptomatic myopathy. Eight carried a diagnosis of sarcoidosis 5.5 years (median) prior to myopathy onset. Eleven patients had ScM. The remaining had non-sarcoid myopathies (five IBM, one immune-mediated necrotizing myopathy, one non-specific myositis, two non-specific myopathy and one steroid myopathy). Estimated frequency of IBM is 85 per 100 000 sarcoidosis patients. The following features were associated with non-sarcoid myopathies (P < 0.05): (i) predominant finger flexor and quadriceps weakness, (ii) modified Rankin scale (mRS) >2 at time of diagnosis, (iii) creatine kinase >500 U/l, and (iv) absence of intramuscular granulomas. Sarcoplasmic MxA expression was observed in scattered myofibres in three patients, two of whom were tested for DM-specific autoantibodies and were negative. Immunosuppressive therapy led to improvement in mRS ≥1 in 5/10 ScM, none of the five IBM, and 3/3 remaining patients with non-sarcoid myopathies. DISCUSSION Symptomatic myopathy occurred in 0.36% of sarcoidosis. IBM was the second most common cause of myopathies after ScM. Frequency of IBM in sarcoidosis is higher than in the general population. Recognition of features suggestive of alternative aetiologies can guide proper treatment. Our findings of abnormal MxA expression warrant a larger study.
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Affiliation(s)
- Pitcha Chompoopong
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Michael P Skolka
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Floranne C Ernste
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Margherita Milone
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Teerin Liewluck
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Gudipati A, Rifat S, Uppin M, Jabeen A, Mathukumalli NL, Yareeda S, Kayidhi S, Pyal A, Dhamne M, Reddy YM. Comparison of Muscle Biopsy Features with Myositis Autoantibodies in Inflammatory Myopathies: A Pilot Experience. Ann Indian Acad Neurol 2023; 26:408-418. [PMID: 37970294 PMCID: PMC10645206 DOI: 10.4103/aian.aian_142_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/13/2023] [Accepted: 05/23/2023] [Indexed: 11/17/2023] Open
Abstract
Background Idiopathic inflammatory myopathies (IIM), also called autoimmune myositis, are heterogeneous. These include dermatomyositis (DM), inclusion body myositis, immune mediated necrotizing myopathy (IMNM), anti-synthetase syndrome (ASS), and overlap polymyositis. Classification of IIM has evolved from clinical to clinico-pathologic to the recent clinico-sero-pathologic with the discovery of myositis-specific antibodies (MSA) and myositis-associated antibodies. The various antibodies have shown association with specific phenotypes. Objective To analyze muscle biopsy features with respect to each MSA and MAA to understand the frequency of findings in each entity. Materials and Methods Biopsy-proven cases of IIM where myositis profile was available were included in the study after obtaining Institutional Ethics Committee (IEC) approval. In addition to the stains and enzyme histochemistry, immunohistochemistry with MHC class I and II and MxA was performed. Features like perifascicular atrophy, perifascicular necrosis, scattered necrosis, inflammation, etc. were analyzed. Myositis profile was performed by line-blot technique using a 16-antigen panel. Cases were divided into different autoantibody subgroups. Various clinical, demographic, and muscle biopsy features were studied with respect to each MSA and MAA. Results There were a total of 64 cases. Mi2 (N = 18) was the most common autoantibody. Some of the salient observations included PFA with perivascular inflammation in Mi2; pediatric cases and microinfarcts in NXP2; no PFA or inflammation in MDA5; perifascicular necrosis in JO1; extensive necrosis with sparse inflammation in SRP; more inflammation in overlap myositis; MxA positivity in DM; and absent in ASS. Conclusion This is a pilot study documenting differences in biopsy phenotype with each MSA and MAA which is comparable to the literature. These findings can be used to characterize IIM in seronegative biopsies.
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Affiliation(s)
- Archana Gudipati
- Department of Pathology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shaikh Rifat
- Department of Pathology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha Uppin
- Department of Pathology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Afshan Jabeen
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Sireesha Yareeda
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sunitha Kayidhi
- Department of Consultant Rheumatologist, Continental Hospital, Hyderabad, Telangana, India
| | - Anjan Pyal
- Department of Consultant Neurologist, Citi Neuro Centre, Hyderabad, Telangana, India
| | - Megha Dhamne
- Department of Consultant, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - Y Muralidhar Reddy
- Department of Consultant Neurologist, Care Hospital, Banjara Hills, Hyderabad, Telangana, India
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11
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Wang Y, Zheng Y, Zhao Y, Liu Y, Zhang W, Yu M, Xie Z, Hao H, Gao F, Zhang W, Wang Z, Yuan Y. Comparison of cytokine/chemokine profiles between dermatomyositis and anti-synthetase syndrome. Front Neurol 2022; 13:1042580. [PMID: 36570445 PMCID: PMC9772994 DOI: 10.3389/fneur.2022.1042580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives Dermatomyositis (DM) and anti-synthetase syndrome (ASS) are autoimmune diseases with multisystem involvement. Despite sharing some clinical and myopathological features, these are two diseases with different pathogeneses and prognoses. We aimed to clarify and compare cytokine/chemokine profiles in both disorders, which may help in the differential diagnosis. Materials and methods We collected clinical data and serum samples of consecutive patients with DM and ASS. Quantibody® Human Inflammation Array 3 for cytokines/chemokines was performed in the serum of all participants. Receiver operating characteristic analysis with the area under the curve and Youden's index were performed. Results Eight newly diagnosed and treatment-naïve patients with DM, nine newly diagnosed and treatment-naïve patients with ASS, and 14 healthy controls were enrolled. Serum C-C motif chemokine ligand (CCL) 2, CCL4, C-X-C motif chemokine ligand (CXCL) 13, and tumor necrosis factor receptor 2 (TNFR2) were increased in patients with both DM and ASS. Serum interleukin (IL)-1 receptor type 1 (IL-1ra), IL-1b, CCL1, CXCL11, and CCL3 were modulated in patients with DM only, and IL-8, CXCL9, and tissue inhibitors of metalloproteinases-1 (TIMP-1) in patients with ASS only. Serum CCL2, CXCL13, and TNFR2 accurately distinguished patients with DM and ASS from healthy controls, as shown by the area under the curve >0.80. Moreover, receiver operating characteristic analysis showed that, as biomarkers for discrimination between DM and ASS, the combination of IL-1ra and TIMP-1, had an area under the curve of 0.944, a sensitivity of 87.5%, and a specificity of 88.9%. Conclusion Our study demonstrated that serum levels of cytokines/chemokines showed a different pattern in newly diagnosed patients with DM and ASS, in which serum IL-1ra and TIMP-1 could be used to distinguish between the two diseases.
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Affiliation(s)
- Yikang Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yiming Zheng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yawen Zhao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yilin Liu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wenhao Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhiying Xie
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Feng Gao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China,Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China,Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China,Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China,*Correspondence: Yun Yuan
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12
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Abstract
PURPOSE OF REVIEW This review summarizes and comments on current knowledge in dermatomyositis. RECENT FINDINGS The 2018 European Neuromuscular Centre classification of dermatomyositis has been challenging by the discovery of clinicopathological features associated with dermatomyositis-specific antibody (DMSA) that were not incorporated in the original criteria. These features include but may not be limited to the presence of perifascicular necrosis in anti-Mi-2 dermatomyositis; presence of diffuse nonperifascicular sarcoplasmic myxovirus resistance protein A expression in anti-MDA5 dermatomyositis; and dermatomyositis sine dermatitis in anti-NXP-2 dermatomyositis. Variations and subclassifications within the same DMSA subtypes are observed: anti-MDA5 dermatomyositis is clinically subcategorized into good, intermediate, and poor prognostic subgroups; concurrent anti-CCAR1 and anti-TIF1-γ positivity identify anti-TIF1-γ-positive patient with a lower risk for cancer-associated myositis. Owing to distinct IFN1-signaling pathway activation in dermatomyositis, JAK-STAT inhibitor - the pathway-targeted therapy, have been studied with promising results in refractory dermatomyositis and some new-onset dermatomyositis. In addition, the potential serum biomarkers for IFN1 pathway activation are being investigated for their performance in monitoring the disease activity and the efficacy of the treatment. SUMMARY DMSA, evidence of prominent IFN1 pathway activation, and risk/severity-associated biomarkers would likely play major roles in future dermatomyositis classification, disease monitoring, and treatment decision.
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Affiliation(s)
- Jantima Tanboon
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Neuromuscular Research, National Institute of Neuroscience (NIN), National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience (NIN), National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
- Department of Genome Medicine Development
- Department of Clinical Genome Analysis, Medical Genome Center (MGC), National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
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13
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Weng C, Liu Z. Pathogenesis of anti-melanoma differentiation-associated gene-5 (MDA5) dermatomyositis. Chin Med J (Engl) 2022; 135:2188-2190. [PMID: 35245925 PMCID: PMC9771161 DOI: 10.1097/cm9.0000000000002049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 01/26/2023] Open
Affiliation(s)
- Chenghua Weng
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Zhichun Liu
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
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14
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Abstract
PURPOSE OF REVIEW This review provides updates regarding biomarker studies that address key clinical unmet needs, which relate to the evaluation of the disease activity in patients with dermatomyositis. RECENT FINDINGS Increasing evidence supports that the serum levels of dermatomyositis-specific antibodies (DM-MSAs), which include anti-Mi-2, anti-NXP2, anti-MDA5, anti-TNF1-γ, and anti-SAE, are correlated with the disease activity. Moreover, serial measurements of DM-MSA levels may help to predict the disease status. Beyond the MSA, macrophage activation-related biomarker-soluble CD163, CD206, neopterin, and galectin-3/9 are the most currently talked biomarkers for disease activity in dermatomyositis; new circulating T-cell subsets CD4+CXCR5+CCR7loPD-1hi and TIGIT+CD226+ CD4 T cells can potentially harbor biomarkers of disease activity in dermatomyositis. In addition, LDGs and NETs were also shown to be correlated with the disease activities of dermatomyositis. SUMMARY Promising candidate biomarkers are now available for evaluating disease activity in dermatomyositis. These biomarkers need external validation in other large cohort studies.
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15
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Zhou M, Cheng X, Zhu W, Jiang J, Zhu S, Wu X, Liu M, Fang Q. Activation of
cGAS‐STING
pathway – A possible cause of myofiber atrophy/necrosis in dermatomyositis and immune‐mediated necrotizing myopathy. J Clin Lab Anal 2022; 36:e24631. [PMID: 36030554 PMCID: PMC9550984 DOI: 10.1002/jcla.24631] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/08/2019] [Accepted: 06/22/2022] [Indexed: 11/09/2022] Open
Abstract
Objective The objective was to investigate the expression of the cGAS‐STING pathway‐associated protein in idiopathic inflammatory myopathy (IIM) and to investigate whether it is related to myofiber atrophy/necrosis in patients with dermatomyositis and immune‐mediated necrotizing myopathy. Material and Methods Muscle specimens obtained by open biopsy from 26 IIM patients (14 with dermatomyositis (DM), 8 with immune‐mediated necrotizing myopathy (IMNM), and 4 with other types of IIM), 4 dystrophinopathy, and 9 control patients were assessed for expression of cGAS‐STING pathway members via Western blot, quantitative real‐time PCR analysis (qRT‐PCR), and immunochemistry. Meanwhile, analysis its location distribution througn immunochemistry. Results Compared to the control group, the expression of cGAS, STING, and related molecules was obviously increased in muscle samples of IIM patients. Upregulated cGAS and STING were mainly located in the vascular structure, inflammatory infiltrates, and atrophic and necrotic fibers. While comparing to the Dys patients, the mRNA level of cGAS, STING, and TNF‐a was upregulated, meanwhile, the protein of the TBK1, P‐TBK1, and P‐IRF3 associated with interferon upregulation was overexpressed through Western blot in IMNM and DM. Considering that cGAS and STING are located in necrotic and Mx1‐positive atrophic fibers, it is really possible that the cGAS‐STING pathway may lead to fibers atrophy/necrosis by producing IFNs. Conclusion The cGAS‐STING pathway was activated in the muscle samples of IIM patients and its activation may be the reason of myofiber atrophy and necrosis in DM and IMNM patients.
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Affiliation(s)
- Meichen Zhou
- Department of Neurology First Affiliated Hospital of Soochow University Suzhou China
| | - Xiaoxiao Cheng
- Department of Neurology First Affiliated Hospital of Soochow University Suzhou China
| | - Wenhua Zhu
- Department of Neurology Huashan hospital Shanghai China
| | - Jianhua Jiang
- Department of Neurology First Affiliated Hospital of Soochow University Suzhou China
| | - Sijia Zhu
- Department of Neurology First Affiliated Hospital of Soochow University Suzhou China
| | - Xuan Wu
- Department of Neurology Affiliated Hospital of Yangzhou University Yangzhou China
| | - Meirong Liu
- Department of Neurology First Affiliated Hospital of Soochow University Suzhou China
| | - Qi Fang
- Department of Neurology First Affiliated Hospital of Soochow University Suzhou China
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16
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Abstract
A 72-year-old woman presented with gradually-worsening myalgia and muscle weakness of the proximal lower limbs as well as elevated serum creatine kinase level. Based on a clinicoseropathological examination including a muscle biopsy, she was diagnosed with anti-signal recognition particle (SRP) myopathy. Although the myopathy relapsed two times in two years under oral prednisolone and intravenous immunoglobulin therapy, the myopathy remained in remission for more than three years after resection of gastric cancer. Although the anti-SRP myopathy is not considered to be cancer-associated in general, we should note that some cases of anti-SRP myopathy may be ameliorated with appropriate cancer treatment.
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Affiliation(s)
- Yoshihide Sehara
- Department of Neurology, Haga Red Cross Hospital, Japan
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical University, Japan
| | - Kyoichiro Tsuchiya
- Department of Diabetes and Endocrinology, University of Yamanashi Hospital, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Japan
- Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry (NCNP), Japan
| | - Hirotake Sato
- Department of Surgery, Haga Red Cross Hospital, Japan
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17
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Merve A, Schneider U, Kara E, Papadopoulou C, Stenzel W. Muscle biopsy in myositis: What the rheumatologist needs to know. Best Pract Res Clin Rheumatol 2022; 36:101763. [PMID: 35773136 DOI: 10.1016/j.berh.2022.101763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The appropriate analysis of skeletal muscle tissues is a key element in many diagnostic procedures and can deliver valuable information about the organ that is affected. Although arguably the frequency of muscle biopsy may be declining in certain domains where genetic analysis is now the first line of diagnostic evaluation, it still has an important role in assessment of patients with neuromuscular disorders such as congenital myopathies, muscular dystrophies, metabolic and inflammatory diseases. Here, we have comprehensively discussed the aspects of a modern and fruitful approach to muscle biopsy histopathological studies in rheumatological disorders. We have focussed on the neuromuscular involvement in myositis and its differential diagnoses in both adult and paediatric settings. We have also covered the clinical indications for the biopsy, technical aspects and practical points relevant for the rheumatologists. Finally, we have critically discussed the current and future opportunities that a muscle biopsy may offer and its limitations.
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Affiliation(s)
- Ashirwad Merve
- Department of Neuropathology, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Udo Schneider
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology, Charitéplatz 1, 10117 Berlin, Germany
| | - Eleanna Kara
- Department of Neuropathology, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK
| | | | - Werner Stenzel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany.
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18
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Is it really myositis? Mimics and pitfalls. Best Pract Res Clin Rheumatol 2022; 36:101764. [PMID: 35752578 DOI: 10.1016/j.berh.2022.101764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Idiopathic inflammatory myopathies are a heterogeneous set of systemic inflammatory disorders primarily affecting muscle. Signs and symptoms vary greatly between and within subtypes, requiring supportive laboratory and pathologic evidence to confirm the diagnosis. Several studies are typical assessments for patients with suspected inflammatory myopathy, including muscle enzymes, autoimmune markers, imaging, and muscle biopsy. Misdiagnoses of myositis are not only related to the overlap of clinical phenotype with non-inflammatory myopathies, but also due to the limitations of diagnostic tests employed. Since many of the investigative tests are non-specific, they share features with other disorders, including muscular dystrophies, endocrine, toxic, and metabolic myopathies, and other neuromuscular or rheumatologic conditions. Recognizing the limitations of tests and understanding the shared features between inflammatory and non-inflammatory myopathies can help prevent misdiagnosing myositis with one of its several mimics.
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19
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Shiota T, Eura N, Hasegawa A, Kiriyama T, Sugie K. Pathological features of inflammatory myopathy as a manifestation of chronic graft-versus-host disease after allogeneic bone marrow transplantation. Neuropathology 2022; 42:309-314. [PMID: 35508303 DOI: 10.1111/neup.12816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/26/2022] [Accepted: 04/02/2022] [Indexed: 11/28/2022]
Abstract
Chronic graft-versus-host disease (cGVHD) is the most important complication resulting in the death of bone marrow transplantation (BMT) survivors. It is also a relatively rare cause of inflammatory myopathy (IM). We report the case of a 46-year-old woman who developed severe cGVHD-related IM after BMT for myelodysplastic syndrome. She presented with severe muscle pain and weakness with cGVHD-related symptoms in other organs. Myopathological analysis showed moderate cell infiltration with remarkable necrotic and regenerative fibers. Sarcoplasm and capillaries expressed C5b9 and myxovirus resistance protein 1. Non-necrotic fibers in perifascicular regions expressed MHC-II. Steroid therapy did not sufficiently control cGVHD-related IM, and the patient was concurrently treated with an immunosuppressant. Our findings show that IM is a key manifestation of cGVHD and that the expression of interferon-inducible proteins in muscle pathology is useful for identifying cGVHD-related IM.
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Affiliation(s)
- Tomo Shiota
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Nobuyuki Eura
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Atsushi Hasegawa
- Department of Hematology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Takao Kiriyama
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Japan
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20
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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.
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21
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Gallay L, Fermon C, Lessard L, Weiss-Gayet M, Viel S, Streichenberger N, Corpet A, Mounier R, Gitiaux C, Mouchiroud G, Chazaud B. Involvement of Type-I Interferon Signaling in Muscle Stem Cell Proliferation During Dermatomyositis. Neurology 2022; 98:e2108-e2119. [DOI: 10.1212/wnl.0000000000200271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background and objective:The idiopathic inflammatory myopathy Dermatomyositis (DM) is an acquired disease that combines muscle, lung and skin impairments. DM patients show a wide range of severity of proximal skeletal muscle weakness, associated with inflammatory infiltrates, vasculitis, and capillary dropout, perifascicular myofiber atrophy. Moreover, DM muscles show signs of muscle regeneration. Since muscle stem cells (MuSCs) are responsible for myofiber repair, we asked wether the proliferative properties of muscle stem cells (MuSCs) are altered in DM muscle. We investigated the role of type-I interferon (IFN-I) in this process since DM is associated with sustained inflammation with high IFN-I levels.Methods:MuSCs isolated from normal, adult and juvenile DM muscles were grown in culture and were analyzed in vitro for their proliferating properties, their myogenic capacities and their senescence. Gain and loss of function experiments were performed to assess the role of IFN-I signaling in the prolfierative capacities of MuSCs.Results:MuSCs derived from 8 DM adult patients (DM-MuSCs) (5 severe form and 3 mild form, established from histological evaluation), from 3 juvenile DM patients and from normal muscle were used to analyze their myogenesis in vitro. DM-MuSCs exhibited strongly reduced proliferating capacities as compared with healthy MuSCs (-31 to -43% for severe and mild DM, respectively), leading to poor myotube formation (-36 to -71%). DM-MuSCs were enriched in senescent, beta-galactosidase positive cells, explaining partly the proliferation defect. Gain and loss of function experiments were performed to assess the role of IFN-I on the proliferative capacity of MuSCs. High concentrations of IFN-I decreased the proliferation of healthy MuSCs. Similarly, conditioned-medium from DM-MuSCs decreased the proliferation of healthy MuSC (-15 to -22%), suggesting the delivery of an autocrine effector. Then, pharmacological blockade of the IFN signaling (using ruxolitinib or anti-IFN-receptor antibodies) in DM-MuSCs rescued their proliferation up to the control values.Discussion:These results show that autocrine IFN-I signaling prevents MuSC expansion, leading to muscle repair deficit. This process may explain the persistent muscle weakness observed in severe DM patients.
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22
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Graf M, von Stuckrad SL, Uruha A, Klotsche J, Zorn-Pauly L, Unterwalder N, Buttgereit T, Krusche M, Meisel C, Burmester GR, Hiepe F, Biesen R, Kallinich T, Stenzel W, Schneider U, Rose T. SIGLEC1 enables straightforward assessment of type I interferon activity in idiopathic inflammatory myopathies. RMD Open 2022; 8:rmdopen-2021-001934. [PMID: 35177553 PMCID: PMC8860073 DOI: 10.1136/rmdopen-2021-001934] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/23/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate sialic acid binding Ig-like lectin 1 (SIGLEC1) expression on monocytes by flow cytometry as a type I interferon biomarker in idiopathic inflammatory myopathies (IIM). Methods We performed a retrospective analysis of adult and paediatric patients with the diagnosis of IIM. SIGLEC1 expression was assessed by flow cytometry and was compared with Physician Global Assessment or Childhood Myositis Assessment Scale disease activity scores. Mann Whitney U test and receiver operating characteristic curves were used for cross-sectional data analysis (n=96), two-level mixed-effects linear regression model for longitudinal analyses (n=26, 110 visits). Response to treatment was analysed in 14 patients within 12 months, using Wilcoxon test. SIGLEC1 was compared with interferon-stimulated gene 15/MxA status by immunohistochemical staining of muscle biopsies (n=17). Results 96 patients with adult (a) and juvenile (j) dermatomyositis (DM, n=38), antisynthetase syndrome (AS, n=19), immune-mediated necrotising myopathy (IMNM, n=8), inclusion body myositis (IBM, n=9) and overlap myositis (n=22) were included. SIGLEC1 distinguished significantly between active and inactive disease with an area under the curve of 0.92 (95% CI 0.83 to 1) in DM and correlated with disease activity longitudinally (aDM: standardised beta=0.54, p<0.001; jDM: standardised beta=−0.70, p<0.001). Response to treatment in DM was associated with a decreasing SIGLEC1 (p<0.01, Wilcoxon test). SIGLEC1 was found upregulated in 8 of 19 patients with AS, 2 of 9 patients with IBM but not in IMNM. Conclusion SIGLEC1 is a candidate biomarker to assess type I interferon activity in IIM and proved useful for monitoring disease activity and response to treatment in juvenile and adult DM.
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Affiliation(s)
- Manuel Graf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sae Lim von Stuckrad
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine and SPZ (Center for Chronically Sick Children), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Akinori Uruha
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Jens Klotsche
- German Rheumatism Research Center Berlin - a Leibniz Institute (DRFZ), Berlin, Germany
| | - Lydia Zorn-Pauly
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nadine Unterwalder
- Department of Immunology, Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Thomas Buttgereit
- Department of Dermatology and Allergy, Dermatological Allergology, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christian Meisel
- Department of Immunology, Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Hiepe
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Biesen
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tilmann Kallinich
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine and SPZ (Center for Chronically Sick Children), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Rheumatism Research Center Berlin - a Leibniz Institute (DRFZ), Berlin, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Udo Schneider
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Rose
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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23
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Morphological Characteristics of Idiopathic Inflammatory Myopathies in Juvenile Patients. Cells 2021; 11:cells11010109. [PMID: 35011672 PMCID: PMC8750180 DOI: 10.3390/cells11010109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 12/16/2022] Open
Abstract
Background: In juvenile idiopathic inflammatory myopathies (IIMs), morphological characteristic features of distinct subgroups are not well defined. New treatment strategies require a precise diagnosis of the subgroups in IIM, and, therefore, knowledge about the pathomorphology of juvenile IIMs is warranted. Methods: Muscle biopsies from 15 patients (median age 8 (range 3–17) years, 73% female) with IIM and seven controls were analyzed by standard methods, immunohistochemistry, and transmission electron microscopy (TEM). Detailed clinical and laboratory data were accessed retrospectively. Results: Proximal muscle weakness and skin symptoms were the main clinical symptoms. Dermatomyositis (DM) was diagnosed in 9/15, antisynthetase syndrome (ASyS) in 4/15, and overlap myositis (OM) in 2/15. Analysis of skeletal muscle tissues showed inflammatory cells and diffuse upregulation of MHC class I in all subtypes. Morphological key findings were COX-deficient fibers as a striking pathology in DM and perimysial alkaline phosphatase positivity in anti-Jo-1-ASyS. Vascular staining of the type 1 IFN-surrogate marker, MxA, correlated with endothelial tubuloreticular inclusions in both groups. None of these specific morphological findings were present in anti-PL7-ASyS or OM patients. Conclusions: Morphological characteristics discriminate IIM subtypes in juvenile patients, emphasizing differences in aetiopathogenesis and supporting the notion of individual and targeted therapeutic strategies.
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Patel J, Ravishankar A, Maddukuri S, Vazquez T, Grinnell M, Werth VP. Highly multiplexed imaging mass cytometry identifies similarities between antisynthetase syndrome and dermatomyositis skin lesions. Arthritis Rheumatol 2021; 74:882-891. [PMID: 34905301 PMCID: PMC9194682 DOI: 10.1002/art.42050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/31/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Antisynthetase syndrome (AS) and Dermatomyositis (DM) are autoimmune disorders that overlap clinically. Given the presence of DM skin lesions in AS patients, there is debate about whether AS is distinct or a subclassification of DM. Recently studies identified differences in type I interferon (IFN) between AS and DM muscle and finger eruptions. The aim of this study is to elucidate cutaneous disease pathogenic similarities and differences on a single cell level. METHODS Five AS and seven DM patients were recruited from a prospectively collected database of well-characterized DM patients. AS patients were clinically confirmed with anti-synthetase syndrome by the Connors and Solomon et al. criteria and aminoacyl-transfer ribonucleic acid synthetase antibodies. Immunophenotyping conducted using immunofluorescence (IF) and imaging mass cytometry (IMC). RESULTS IF revealed type I IFN upregulation in AS and DM compared to HC using MxA and IFNβ expression (p<0.05). IMC showed similar macrophages, T cells, B cells, and dendritic cells in AS and DM with no differences in counts (p>0.05), but an increase in myeloid dendritic cell percentage in DM (p<0.05). Key type I IFN, cytokine, and JAK-STAT pathways were similarly expressed in AS and DM (p>0.05). At a single cell level, pSTING+ macrophages in AS expressed increased TNFα, IL17, and IFNβ (p<0.001). CONCLUSION IMC is a powerful tool that identifies a role for the type I IFN system in DM-like skin lesions of AS and DM with some differences at a cellular level, but overall significant overlap exists supporting similar therapeutic decision making.
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Affiliation(s)
- Jay Patel
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, PA.,Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104
| | - Adarsh Ravishankar
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, PA.,Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104
| | - Spandana Maddukuri
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, PA.,Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104
| | - Thomas Vazquez
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, PA.,Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104
| | - Madison Grinnell
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, PA.,Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, PA.,Department of Dermatology, School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104
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25
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Tanboon J, Inoue M, Saito Y, Tachimori H, Hayashi S, Noguchi S, Okiyama N, Fujimoto M, Nishino I. Dermatomyositis: Muscle Pathology According to Antibody Subtypes. Neurology 2021; 98:e739-e749. [PMID: 34873015 PMCID: PMC8865893 DOI: 10.1212/wnl.0000000000013176] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/24/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Discoveries of dermatomyositis specific antibodies (DMSAs) in dermatomyositis patients raised awareness of various myopathological features among antibody subtypes. However, only perifascicular atrophy and perifascicular myxovirus resistant protein A (MxA) overexpression were officially included as the definitive pathological criteria for dermatomyositis classification. We aimed to demonstrate myopathological features in MxA-positive dermatomyositis to determine characteristic myopathological features in different DMSA subtypes. METHOD We performed a retrospective pathology review of muscle biopsies of dermatomyositis patients diagnosed between January 2009 and December 2020 in a tertiary laboratory for muscle diseases. We included all muscle biopsies with sarcoplasmic expression for MxA and seropositivity for DMSAs. MxA-positive muscle biopsies which tested negative for all DMSAs were included as seronegative dermatomyositis. We evaluated histological features stratified according to four pathology domains (muscle fiber, inflammatory, vascular, and connective tissue) and histological features of interest by histochemistry, enzyme histochemistry, and immunohistochemical study commonly used in the diagnosis of inflammatory myopathy. We performed ultrastructural studies of 54 available specimens. RESULT A total of 256 patients were included. Of these, 249 patients were positive for one of the five DMSAs (seropositive patients: 87 anti-TIF1-γ; 40 anti-Mi-2; 29 anti-MDA5; 83 anti-NXP-2; and 10 anti-SAE DM) and 7 patients were negative for all five DMSAs (seronegative patients). Characteristic myopathological features in each DMSA subtype were as follows: anti-TIF1-γ with vacuolated/punched out fibers (64.7%, P<.001) and perifascicular enhancement in HLA-ABC stain (75.9%, P<.001); anti-Mi-2 with prominent muscle fiber damage (score 4.8±2.1, P<.001), inflammatory cell infiltration (score 8.0±3.0, P=.002), perifascicular atrophy (67.5%, P=.02), perifascicular necrosis (52.5%, P<.001), increased perimysial alkaline phosphatase activity (70.0%, P<.001), central necrotic peripheral regenerating fibers (45.0%, P<.001), and sarcolemmal membrane attack complex deposition (67.5%, P<.001); anti-MDA5 with scattered/diffuse staining pattern of MxA (65.5%, P<.001) with less muscle pathology and inflammatory features; anti-NXP2 with microinfarction (26.5%, P<.001); and anti-SAE and seronegative DM with HLA-DR expression (50.0%, P=.02 and 57.1%, P=.02, respectively). DISCUSSION We described a comprehensive serological-pathological correlation of DM primarily using MxA expression as an inclusion criterion. In our study, DMSAs were associated with distinctive myopathological features suggesting different underlying pathobiological mechanisms in each subtype.
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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
| | - Michio Inoue
- 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
| | - Yoshihiko Saito
- 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
| | - Hisateru Tachimori
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.,Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Hayashi
- 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
| | - Satoru Noguchi
- 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
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - 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
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26
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Abstract
Idiopathic inflammatory myopathies (IIM), also known as myositis, are a heterogeneous group of autoimmune disorders with varying clinical manifestations, treatment responses and prognoses. Muscle weakness is usually the classical clinical manifestation but other organs can be affected, including the skin, joints, lungs, heart and gastrointestinal tract, and they can even result in the predominant manifestations, supporting that IIM are systemic inflammatory disorders. Different myositis-specific auto-antibodies have been identified and, on the basis of clinical, histopathological and serological features, IIM can be classified into several subgroups - dermatomyositis (including amyopathic dermatomyositis), antisynthetase syndrome, immune-mediated necrotizing myopathy, inclusion body myositis, polymyositis and overlap myositis. The prognoses, treatment responses and organ manifestations vary among these groups, implicating different pathophysiological mechanisms in each subtype. A deeper understanding of the molecular pathways underlying the pathogenesis and identifying the auto-antigens of the immune reactions in these subgroups is crucial to improving outcomes. New, more homogeneous subgroups defined by auto-antibodies may help define disease mechanisms and will also be important in future clinical trials for the development of targeted therapies and in identifying biomarkers to guide treatment decisions for the individual patient.
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27
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Merlonghi G, Antonini G, Garibaldi M. Immune-mediated necrotizing myopathy (IMNM): A myopathological challenge. Autoimmun Rev 2021; 21:102993. [PMID: 34798316 DOI: 10.1016/j.autrev.2021.102993] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/14/2021] [Indexed: 02/07/2023]
Abstract
This review is focused on the myopathological spectrum of immune mediated necrotizing myopathies (IMNMs) and its differentiation with other, potentially mimicking, inflammatory and non-inflammatory myopathies. IMNMs are a subgroup of idiopathic inflammatory myopathies (IIMs) characterized by severe clinical presentation with rapidly progressive muscular weakness and creatine kinase elevation, often requiring early aggressive immunotherapy, associated to the presence of muscle specific autoantibodies (MSA) against signal recognition particle (SRP) or 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Muscle biopsy usually shows unspecific features consisting in prominent necrosis and regeneration of muscle fibres with mild or absent inflammatory infiltrates, inconstant and faint expression of major histocompatibility complex (MHC) class I and variable deposition of C5b-9 on sarcolemma. Several conditions could present similar histopathological findings leading to possible misdiagnosis of IMNM with other IIMs or non-inflammatory myopathies (nIMs) and viceversa. This review analyses the muscle biopsy data in IMNMs through a systematic revision of the literature from the last five decades. Several histopathological variables have been considered in both SRP- and HMGCR-IMNM, and compared to other IIMs - as dermatomyositis (DM) and anti-synthethase syndrome (ASS) - or other nIMs -as toxic myopathies (TM), critical illness myopathy (CIM) and muscular dystrophy (MD) - to elucidate similarities and differences among these potentially mimicking conditions. The major histopathological findings of IMNMs were: very frequent necrosis and regeneration of muscle fibres (93%), mild inflammatory component mainly constituted by scattered isolated (65%) CD68-prevalent (68%) cells, without CD8 invading/surrounding non-necrotic fibres, variable expression of MHC-I in non-necrotic fibres (56%) and constant expression of sarcoplasmic p62, confirming those that are widely considered the major histological characteristics of IMNMs. Conversely, only 42% of biopsies showed a sarcolemmal deposition of C5b-9 component. Few differences between SRP and HMGCR IMNMs consisted in more severe necrosis and regeneration in SRP than in HMGCR (p = 0.01); more frequent inflammatory infiltrates (p = 0.007) with perivascular localization (p = 0.01) and clustered expression of MHC-I (p = 0.007) in HMGCR; very low expression of sarcolemmal C5b-9 in SRP (18%) compared to HMGCR (56%) (p = 0.0001). Milder necrosis and regeneration, detection of perifascicular pathology, presence of lymphocytic inflammatory infiltrates and myofibre expression of MxA help to distinguish DM or ASS from IMNM. nIMs can present signs of inflammation at muscle biopsy. Low fibre size variability with overexpression of both MHC-I and II, associated with C5b-9 deposition, could could be observed in CIM, while increased connective tissue should lead to consider MD, or TM in absence of C5b-9 deposition. Nevertheless, these features are not constantly detected and muscle biopsy could not be diriment. For this reason, muscle biopsy should always be critically considered in light of the clinical context before concluding for a definite diagnosis of IMNM, only based on histopathological findings. More rigorous collection and analysis of muscle biopsy is warranted to obtain a higher quality and more homogeneous histopathological data in inflammatory myopathies.
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Affiliation(s)
- Gioia Merlonghi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Giovanni Antonini
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Matteo Garibaldi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy.
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28
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Stenzel W, Goebel HH, Bader-Meunier B, Gitiaux C. Inflammatory myopathies in childhood. Neuromuscul Disord 2021; 31:1051-1061. [PMID: 34736626 DOI: 10.1016/j.nmd.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022]
Abstract
Myositis in childhood can occur under different conditions and with various aetiologies, juvenile dermatomyositis (jDM) being by far the most frequent entity. The exact diagnostic workup and precise assessment of muscular as well as extramuscular involvement of organs in these systemic autoimmune diseases are relevant for specific and adjunct treatment of complications. Many new insights have become available with respect to the pathophysiological concepts as well as modern diagnostic measures and therapeutic approaches. Autoantibody detection in the serum of children with myositis is one of the major novelties that has become widely used and that is indeed helpful for diagnostic and prognostic measures. The pathophysiological relevance of type I interferons in jDM has been studied intensively in the past years. jDM is now seen as an acquired interferonopathy and first therapeutic consequences have been drawn from this pathogenic finding with the use of Janus-kinase inhibitors for severe and not otherwise treatable children.
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Affiliation(s)
- Werner Stenzel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany.
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Brigitte Bader-Meunier
- Department of Pediatric Immunolgy, Hematology, Rheumatology and Reference Center for Rare Autoimmune Systemic Diseases (RAISE), Necker Enfants Malades Hospital, AP-HP Centre, Paris, France
| | - Cyril Gitiaux
- Department of Pediatric Clinical Neurophysiology and reference Centre for Neuromuscular Diseases "Nord-Est-Ile de France", Necker Enfants Malades Hospital, AP-HP Centre, Paris University, Paris, France
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29
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Uruha A, Goebel HH, Stenzel W. Updates on the Immunopathology in Idiopathic Inflammatory Myopathies. Curr Rheumatol Rep 2021; 23:56. [PMID: 34212266 DOI: 10.1007/s11926-021-01017-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW To review recent advances in immunopathology for idiopathic inflammatory myopathies, focusing on widely available immunohistochemical analyses. RECENT FINDINGS Sarcoplasmic expression of myxovirus resistance protein A (MxA) is specifically observed in all types of dermatomyositis and informs that type I interferons are crucially involved in its pathogenesis. It is a more sensitive diagnostic marker than perifascicular atrophy. Diffuse tiny dots in the sarcoplasm highlighted by p62 immunostaining are characteristically seen in immune-mediated necrotizing myopathy. This feature is linked to a chaperone-assisted selective autophagy pathway. Myofiber invasion by highly differentiated T cells, a marker of which is KLRG1, is specific to inclusion body myositis and has a crucial role in its pathogenesis. The recent advances in immunopathology contribute to increased diagnostic accuracy and a better understanding of the underlying pathophysiology in different types of idiopathic inflammatory myopathies.
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Affiliation(s)
- Akinori Uruha
- Department of Neuropathology, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany. .,Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo, 183-0042, Japan.
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Department of Neuropathology, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Leibniz Science Campus Chronic Inflammation, Charitéplatz 1, 10117, Berlin, Germany
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30
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Siegert E, Uruha A, Goebel HH, Preuße C, Casteleyn V, Kleefeld F, Alten R, Burmester GR, Schneider U, Höppner J, Hahn K, Dittmayer C, Stenzel W. Systemic sclerosis-associated myositis features minimal inflammation and characteristic capillary pathology. Acta Neuropathol 2021; 141:917-927. [PMID: 33864496 PMCID: PMC8113184 DOI: 10.1007/s00401-021-02305-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 12/11/2022]
Abstract
Systemic sclerosis represents a chronic connective tissue disease featuring fibrosis, vasculopathy and autoimmunity, affecting skin, multiple internal organs, and skeletal muscles. The vasculopathy is considered obliterative, but its pathogenesis is still poorly understood. This may partially be due to limitations of conventional transmission electron microscopy previously being conducted only in single patients. The aim of our study was therefore to precisely characterize immune inflammatory features and capillary morphology of systemic sclerosis patients suffering from muscle weakness. In this study, we identified 18 individuals who underwent muscle biopsy because of muscle weakness and myalgia in a cohort of 367 systemic sclerosis patients. We performed detailed conventional and immunohistochemical analysis and large-scale electron microscopy by digitizing entire sections for in-depth ultrastructural analysis. Muscle biopsies of 12 of these 18 patients (67%) presented minimal features of myositis but clear capillary alteration, which we termed minimal myositis with capillary pathology (MMCP). Our study provides novel findings in systemic sclerosis-associated myositis. First, we identified a characteristic and specific morphological pattern termed MMCP in 67% of the cases, while the other 33% feature alterations characteristic of other overlap syndromes. This is also reflected by a relatively homogeneous clinical picture among MMCP patients. They have milder disease with little muscle weakness and a low prevalence of interstitial lung disease (20%) and diffuse skin involvement (10%) and no cases of either pulmonary arterial hypertension or renal crisis. Second, large-scale electron microscopy, introducing a new level of precision in ultrastructural analysis, revealed a characteristic capillary morphology with basement membrane thickening and reduplications, endothelial activation and pericyte proliferation. We provide open-access pan-and-zoom analysis to our datasets, enabling critical discussion and data mining. We clearly highlight characteristic capillary pathology in skeletal muscles of systemic sclerosis patients.
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Affiliation(s)
- Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health, Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Akinori Uruha
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany
| | - Corinna Preuße
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany
| | - Vincent Casteleyn
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Kleefeld
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Rieke Alten
- Schlosspark-Klinik, Heubnerweg 2, 14059, Berlin, Germany
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Udo Schneider
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jakob Höppner
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kathrin Hahn
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Dittmayer
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Charitéplatz 1, 10117, Berlin, Germany.
- Leibniz ScienceCampus Chronic Inflammation, 10117, Berlin, Germany.
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31
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Bolko L, Jiang W, Tawara N, Landon‐Cardinal O, Anquetil C, Benveniste O, Allenbach Y. The role of interferons type I, II and III in myositis: A review. Brain Pathol 2021; 31:e12955. [PMID: 34043262 PMCID: PMC8412069 DOI: 10.1111/bpa.12955] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/19/2021] [Indexed: 12/27/2022] Open
Abstract
The classification of idiopathic inflammatory myopathies (IIM) is based on clinical, serological and histological criteria. The identification of myositis-specific antibodies has helped to define more homogeneous groups of myositis into four dominant subsets: dermatomyositis (DM), antisynthetase syndrome (ASyS), sporadic inclusion body myositis (sIBM) and immune-mediated necrotising myopathy (IMNM). sIBM and IMNM patients present predominantly with muscle involvement, whereas DM and ASyS patients present additionally with other extramuscular features, such as skin, lung and joints manifestations. Moreover, the pathophysiological mechanisms are distinct between each myositis subsets. Recently, interferon (IFN) pathways have been identified as key players implicated in the pathophysiology of myositis. In DM, the key role of IFN, especially type I IFN, has been supported by the identification of an IFN signature in muscle, blood and skin of DM patients. In addition, DM-specific antibodies are targeting antigens involved in the IFN signalling pathways. The pathogenicity of type I IFN has been demonstrated by the identification of mutations in the IFN pathways leading to genetic diseases, the monogenic interferonopathies. This constitutive activation of IFN signalling pathways induces systemic manifestations such as interstitial lung disease, myositis and skin rashes. Since DM patients share similar features in the context of an acquired activation of the IFN signalling pathways, we may extend underlying concepts of monogenic diseases to acquired interferonopathy such as DM. Conversely, in ASyS, available data suggest a role of type II IFN in blood, muscle and lung. Indeed, transcriptomic analyses highlighted a type II IFN gene expression in ASyS muscle tissue. In sIBM, type II IFN appears to be an important cytokine involved in muscle inflammation mechanisms and potentially linked to myodegenerative features. For IMNM, currently published data are scarce, suggesting a minor implication of type II IFN. This review highlights the involvement of different IFN subtypes and their specific molecular mechanisms in each myositis subset.
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Affiliation(s)
- Loïs Bolko
- Division of RheumatologyHopital Maison BlancheReimsFrance
| | - Wei Jiang
- Department of Internal Medicine and Clinical ImmunlogySorbonne UniversitéPitié‐Salpêtrière University HospitalParisFrance
- Centre de Recherche en MyologieUMRS974Institut National de la Santé et de la Recherche MédicaleAssociation Institut de MyologieSorbonne UniversitéParisFrance
| | - Nozomu Tawara
- Department of Internal Medicine and Clinical ImmunlogySorbonne UniversitéPitié‐Salpêtrière University HospitalParisFrance
- Centre de Recherche en MyologieUMRS974Institut National de la Santé et de la Recherche MédicaleAssociation Institut de MyologieSorbonne UniversitéParisFrance
| | - Océane Landon‐Cardinal
- Division of RheumatologyCentre hospitalier de l'Université de Montréal (CHUM)CHUM Research CenterMontréalQCCanada
- Department of MedicineUniversité de MontréalMontréalQCCanada
| | - Céline Anquetil
- Department of Internal Medicine and Clinical ImmunlogySorbonne UniversitéPitié‐Salpêtrière University HospitalParisFrance
- Centre de Recherche en MyologieUMRS974Institut National de la Santé et de la Recherche MédicaleAssociation Institut de MyologieSorbonne UniversitéParisFrance
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical ImmunlogySorbonne UniversitéPitié‐Salpêtrière University HospitalParisFrance
- Centre de Recherche en MyologieUMRS974Institut National de la Santé et de la Recherche MédicaleAssociation Institut de MyologieSorbonne UniversitéParisFrance
| | - Yves Allenbach
- Department of Internal Medicine and Clinical ImmunlogySorbonne UniversitéPitié‐Salpêtrière University HospitalParisFrance
- Centre de Recherche en MyologieUMRS974Institut National de la Santé et de la Recherche MédicaleAssociation Institut de MyologieSorbonne UniversitéParisFrance
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Tanboon J, Inoue M, Hirakawa S, Tachimori H, Hayashi S, Noguchi S, Suzuki S, Okiyama N, Fujimoto M, Nishino I. Pathologic Features of Anti-Mi-2 Dermatomyositis. Neurology 2021; 96:e448-e459. [PMID: 33277422 DOI: 10.1212/wnl.0000000000011269] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/04/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To identify the characteristic pathologic features of dermatomyositis (DM) associated with anti-Mi-2 autoantibodies (anti-Mi-2 DM). METHODS We reviewed 188 muscle biopsies from patients (1) pathologically diagnosed with DM through the sarcoplasmic expression for the myxovirus-resistant protein A and (2) serologically positive for 1 of 5 DM-specific autoantibodies (DMSAs) (anti-Mi-2, n = 30; other DMSAs, n = 152) or negative for all 5 DMSAs (n = 6). We then compared the histopathologic and immunohistochemical features of patients with anti-Mi-2 DM to those with non-Mi-2 DM and patients with anti-synthetase syndrome (ASS) (n = 212) using the t test, Fisher exact test, and a logistic regression model. RESULTS Patients with anti-Mi-2 DM showed significantly higher severity scores in muscle fiber and inflammatory domains than non-Mi-2 DM patients. The presence of perifascicular necrosis, increased perimysial alkaline phosphatase activity, and sarcolemmal membrane attack complex deposition was more frequent in patients with anti-Mi-2 DM (p < 0.01). After Bonferroni correction, there were no significant differences in the percentages of the features mentioned above between the patients with anti-Mi-2 DM and those with ASS (p > 0.01). CONCLUSION Perifascicular necrosis and perimysial pathology, features previously reported in ASS, are common in patients with anti-Mi-2 DM. Our findings not only assist in differentiating anti-Mi-2 DM from other DM subtypes but also suggest the possibility of an overlapping mechanism between anti-Mi-2 DM and ASS. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the muscle biopsies of DM patients with anti-Mi-2 autoantibodies are more likely to demonstrate higher severity scores in muscle fiber and inflammatory domains.
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Affiliation(s)
- Jantima Tanboon
- From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan
| | - Michio Inoue
- From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan
| | - Shinya Hirakawa
- From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan
| | - Hisateru Tachimori
- From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan
| | - Shinichiro Hayashi
- From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan
| | - Satoru Noguchi
- From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan
| | - Shigeaki Suzuki
- From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan
| | - Naoko Okiyama
- From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan
| | - Manabu Fujimoto
- From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan
| | - Ichizo Nishino
- From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan.
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Lim D, Landon-Cardinal O, Ellezam B, Belisle A, Genois A, Sirois J, Bourré-Tessier J. Statin-associated anti-HMGCR immune-mediated necrotizing myopathy with dermatomyositis-like features: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20984120. [PMID: 33447390 PMCID: PMC7780312 DOI: 10.1177/2050313x20984120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) immune-mediated necrotizing myopathy is a subtype of idiopathic inflammatory myopathy which may be associated with statin exposure. It presents with severe proximal muscle weakness, high creatine kinase levels and muscle fiber necrosis. Treatment with intravenous immunoglobulins and immunosuppressants is often necessary. This entity is not commonly known among dermatologists as there are usually no extramuscular manifestations. We report a rare case of statin-associated anti-HMGCR immune-mediated necrotizing myopathy with dermatomyositis-like cutaneous features. The possibility of anti-HMGCR immune-mediated necrotizing myopathy should be considered in patients with cutaneous dermatomyositis-like features associated with severe proximal muscle weakness, highly elevated creatine kinase levels and possible statin exposure. This indicates the importance of muscle biopsy and specific autoantibody testing for accurate diagnosis, as well as significant therapeutic implications.
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Affiliation(s)
- Darosa Lim
- Division of Dermatology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Océane Landon-Cardinal
- Division of Rheumatology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Benjamin Ellezam
- Department of Pathology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Annie Belisle
- Department of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Annie Genois
- Division of Dermatology, Hôpital Pierre-Le Gardeur, Terrebonne, QC, Canada
| | - Jennifer Sirois
- Department of Anatomopathology, Hôpital Pierre-Le Gardeur, Terrebonne, QC, Canada
| | - Josiane Bourré-Tessier
- Division of Rheumatology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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Allenbach Y, Benveniste O, Stenzel W, Boyer O. Immune-mediated necrotizing myopathy: clinical features and pathogenesis. Nat Rev Rheumatol 2020; 16:689-701. [PMID: 33093664 DOI: 10.1038/s41584-020-00515-9] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Immune-mediated necrotizing myopathy (IMNM) is a group of inflammatory myopathies that was distinguished from polymyositis in 2004. Most IMNMs are associated with anti-signal recognition particle (anti-SRP) or anti-3-hydroxy-3-methylglutaryl-coA reductase (anti-HMGCR) myositis-specific autoantibodies, although ~20% of patients with IMNM remain seronegative. These associations have led to three subclasses of IMNM: anti-SRP-positive IMNM, anti-HMGCR-positive IMNM and seronegative IMNM. IMNMs are frequently rapidly progressive and severe, displaying high serum creatine kinase levels, and failure to treat IMNMs effectively may lead to severe muscle impairment. In patients with seronegative IMNM, disease can be concomitant with cancer. Research into IMNM pathogenesis has shown that anti-SRP and anti-HMGCR autoantibodies cause weakness and myofibre necrosis in mice, suggesting that, as well as being diagnostic biomarkers of IMNM, they may play a key role in disease pathogenesis. Therapeutically, treatments such as rituximab or intravenous immunoglobulins can now be discussed for IMNM, and targeted therapies, such as anticomplement therapeutics, may be a future option for patients with refractory disease.
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Affiliation(s)
- Yves Allenbach
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Inserm U974, Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Olivier Benveniste
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Inserm U974, Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Paris, France.
| | - Werner Stenzel
- Department of Neuropathology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Olivier Boyer
- Normandie University, UNIROUEN, Inserm U1234, Department of Immunology and Biotherapy, Rouen University Hospital, Rouen, France
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Huang K, Aggarwal R. Antisynthetase syndrome: A distinct disease spectrum. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 5:178-191. [PMID: 35382516 PMCID: PMC8922626 DOI: 10.1177/2397198320902667] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/11/2019] [Indexed: 07/28/2023]
Abstract
The discovery of novel autoantibodies related to idiopathic inflammatory myopathies (collectively referred to as myositis) has not only advanced our understanding of the clinical, serological, and pathological correlation in the disease spectrum but also played a role in guiding management and prognosis. One group of the myositis-specific autoantibodies is anti-aminoacyl-tRNA synthetase (anti-ARS or anti-synthetase) which defines a syndrome with predominant interstitial lung disease, arthritis, and myositis. Autoantibodies to eight aminoacyl-tRNA synthetases have been identified with anti-Jo1 the most common in all of idiopathic inflammatory myopathies. Disease presentation and prognosis vary depending on which anti-aminoacyl-tRNA synthetase antibody is present. In this review, we will discuss the clinical characteristics, overlap features with other autoimmune diseases, prognostic factors, and management of the antisynthetase syndrome.
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Affiliation(s)
- Kun Huang
- Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rohit Aggarwal
- Arthritis and Autoimmunity Center and UPMC Myositis Center, Division of Rheumatology and Clinical Immunology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Danielsson O, Häggqvist B, Gröntoft L, Öllinger K, Ernerudh J. Apoptosis in idiopathic inflammatory myopathies with partial invasion; a role for CD8+ cytotoxic T cells? PLoS One 2020; 15:e0239176. [PMID: 32936839 PMCID: PMC7494097 DOI: 10.1371/journal.pone.0239176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
Polymyositis and inclusion body myositis are idiopathic inflammatory myopathies, with a pathology characterized by partial invasion of non-necrotic muscle fibres by CD8+ cytotoxic T-cells, leading to fibre degeneration. Although the main effector pathway of CD8+ T-cells is to induce apoptosis of target cells, it has remained unclear if apoptosis occurs in these diseases, and if so, if it is mediated by CD8+ T-cells. In consecutive biopsy sections from 10 patients with partial invasion, muscle fibres and inflammatory cells were assessed by immunohistochemistry and apoptotic nuclei by the TUNEL assay. Analysis of muscle fibre morphology, staining pattern and quantification were performed on digital images, and they were compared with biopsies from 10 dermatomyositis patients and 10 controls without muscle disease. Apoptotic myonuclei were found in muscle with partial invasion, but not in the invaded fibres. Fibres with TUNEL positive nuclei were surrounded by CD8+ T-cells, granzyme B+ cells and macrophages, but lacked FAS receptor expression. In contrast, apoptotic myonuclei were rare in dermatomyositis and absent in controls. The findings confirm that apoptosis occurs in idiopathic inflammatory myopathies and support that it is mediated by CD8+ cytotoxic T- cells, acting in parallel to the process of partial invasion.
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Affiliation(s)
- Olof Danielsson
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- * E-mail:
| | - Bo Häggqvist
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Liv Gröntoft
- Division of Neurology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Karin Öllinger
- Division of Experimental Pathology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jan Ernerudh
- Division of Clinical Immunology and Transfusion Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Aljabban J, Syed S, Syed S, Rohr M, Weisleder N, McElhanon KE, Hasan L, Safeer L, Hoffman K, Aljabban N, Mukhtar M, Adapa N, Allarakhia Z, Panahiazar M, Neuhaus I, Kim S, Hadley D, Jarjour W. Investigating genetic drivers of dermatomyositis pathogenesis using meta-analysis. Heliyon 2020; 6:e04866. [PMID: 33015383 PMCID: PMC7522761 DOI: 10.1016/j.heliyon.2020.e04866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/17/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS Dermatomyositis (DM) is a progressive, idiopathic inflammatory myopathy with poorly understood pathogenesis. A hallmark of DM is an increased risk for developing breast, ovarian, and lung cancer. Since autoantibodies against anti-TIF-1-γ, a member of the tripartite motif (TRIM) proteins, has a strong association with malignancy, we examined expression of the TRIM gene family to identify pathways that may be contributing to DM pathogenesis. MATERIALS AND METHODS We employed the Search Tag Analyze Resource for GEO platform to search the NCBI Gene Expression Omnibus to elucidate TRIM family gene expression as well as oncogenic drivers in DM pathology. We conducted meta-analysis of the data from human skin (60 DM vs 34 healthy) and muscle (71 DM vs 22 healthy). KEY FINDINGS We identified genes involved in innate immunity, antigen presentation, metabolism, and other cellular processes as facilitators of DM disease activity and confirmed previous observations regarding the presence of a robust interferon signature. Moreover, analysis of DM muscle samples revealed upregulation of TRIM14, TRIM22, TRIM25, TRIM27, and TRIM38. Likewise, analysis of DM skin samples showed upregulation of TRIM5, TRIM6, TRIM 14, TRIM21, TRIM34, and TRIM38 and downregulation of TRIM73. Additionally, we noted upregulation of oncogenes IGLC1, IFI44, POSTN, MYC, NPM1, and IDO1 and related this change to interferon signaling. While the clinical data associated with genetic data that was analyzed did not contain clinical data regarding malignancy in these cohorts, the observed genetic changes may be associated with homeostatic and signaling changes that relate to the increased risk in malignancy in DM. SIGNIFICANCE Our results implicate previously unknown genes as potential drivers of DM pathology and suggest certain TRIM family members may have disease-specific roles with potential diagnostic and therapeutic implications.
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Affiliation(s)
- Jihad Aljabban
- University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Saad Syed
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sharjeel Syed
- University of Chicago Medical Center, Chicago, IL, USA
| | - Michael Rohr
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Noah Weisleder
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Laith Hasan
- Tulane School of Medicine, New Orleans, LA, USA
| | | | - Kalyn Hoffman
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Mohamed Mukhtar
- Michigan State University College of Human Medicine, Lansing, MI, USA
| | | | - Zahir Allarakhia
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Isaac Neuhaus
- University of California San Francisco, San Francisco, CA, USA
| | - Susan Kim
- University of California San Francisco, San Francisco, CA, USA
| | - Dexter Hadley
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Wael Jarjour
- The Ohio State University College of Medicine, Columbus, OH, USA
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Dittmayer C, Stenzel W, Goebel HH, Krusche M, Schneider U, Uruha A, Englert B. Morphological characteristics of the transition from juvenile to adult dermatomyositis. Neuropathol Appl Neurobiol 2020; 46:790-794. [PMID: 32686124 DOI: 10.1111/nan.12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/02/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- C Dittmayer
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - W Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - H-H Goebel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neuropathology, Universitätsmedizin Mainz, Mainz, Germany
| | - M Krusche
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - U Schneider
- Department of Rheumatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - A Uruha
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - B Englert
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität München, Munich, Germany
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Duchesne M, Leonard-Louis S, Landon-Cardinal O, Anquetil C, Mariampillai K, Monzani Q, Benveniste O, Allenbach Y. Edematous myositis: a clinical presentation first suggesting dermatomyositis diagnosis. Brain Pathol 2020; 30:867-876. [PMID: 32323412 DOI: 10.1111/bpa.12844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS Edema of the limbs is uncommon in idiopathic inflammatory myopathies (IIM). The few reported cases have been associated with severe and refractory dermatomyositis (DM), sometimes in association with cancers. We aimed to determine if edematous myositis is a homogeneous subtype based on clinical, serological and pathological features. METHODS This is a retrospective observational study performed between 2008 and 2015 in the French national referral center for myositis. All adult patients with an inflammatory muscle biopsy and upper limbs edema were included as well as IIM cases without limb edema as controls. Clinical, biological and pathological features were collected. RESULTS Seventeen edematous myositis were included and compared to 174 IIM without edema, including 50 DM controls. Edema was the first manifestation in 23% of patients. Muscle weakness was severe and symmetric, 71% of patients presented dysphagia and a restrictive ventilatory pattern was found in 40%. Fifty-two percent of patients had a typical DM skin rash and 23% had cancer within 3 years of diagnosing myositis. Fifty-three percent of patients presented a myositis specific antibody and only DM-specific antibodies were detected. Classic pathological DM features (perifascicular atrophy, perifascicular/perimysial perivascular inflammation) were uncommon but capillary C5b-9 deposition and MxA expression were seen in 79% and 73% of cases, respectively. A perimysial edema was found in 82% of cases. Seventeen percent of patients died (median follow up of 18 months). Edematous myositis demonstrated more marked capillary C5b-9 deposition compared to IIM controls. There was no clinical, biological or pathological difference with DM controls except for limb edema. CONCLUSION Our study underlines that limb edema could be a symptom of IIM and that edematous myositis are mostly DM. The vasculopathy seems to play a key role in its pathophysiology. Limb edema associated with muscle impairment should suggest the diagnosis of DM in clinical settings.
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Affiliation(s)
- Mathilde Duchesne
- Department of Pathology, University Hospital of Limoges, Limoges, France.,Laboratory of Neurology, University Hospital of Limoges, Limoges, France.,EA6309, University of Medicine and Pharmacology of Limoges, Limoges, France
| | - Sarah Leonard-Louis
- Department of Neuropathology, APHP, Pitié-Salpêtrière University Hospital, Sorbonne University, University Pierre et Marie Curie, Paris, France.,Department of Neuromyology, National Reference Center of Neuromuscular Disorders, APHP, Pitié-Salpêtrière University Hospital, Sorbonne University, University Pierre et Marie Curie, Paris, France
| | - Océane Landon-Cardinal
- Division of Rheumatology and Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Céline Anquetil
- Department of Internal Medicine and Clinical Immunology, National Reference Center of Neuromuscular disorders, APHP, Pitié-Salpêtrière University Hospital, Sorbonne University, University Pierre et Marie Curie, Paris, France
| | - Kuberaka Mariampillai
- Department of Internal Medicine and Clinical Immunology, National Reference Center of Neuromuscular disorders, APHP, Pitié-Salpêtrière University Hospital, Sorbonne University, University Pierre et Marie Curie, Paris, France
| | - Quentin Monzani
- Department of Radiology, APHP, Pitié-Salpêtrière University Hospital, Sorbonne University, University Pierre et Marie Curie, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, National Reference Center of Neuromuscular disorders, APHP, Pitié-Salpêtrière University Hospital, Sorbonne University, University Pierre et Marie Curie, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, National Reference Center of Neuromuscular disorders, APHP, Pitié-Salpêtrière University Hospital, Sorbonne University, University Pierre et Marie Curie, Paris, France.,INSERM, UMR974, Sorbonne University, University Pierre et Marie Curie, Paris, France
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Ayaki T, Murata K, Kanazawa N, Uruha A, Ohmura K, Sugie K, Kasagi S, Li F, Mori M, Nakajima R, Sasai T, Nishino I, Ueno S, Urushitani M, Furukawa F, Ito H, Takahashi R. Myositis with sarcoplasmic inclusions in Nakajo-Nishimura syndrome: a genetic inflammatory myopathy. Neuropathol Appl Neurobiol 2020; 46:579-587. [PMID: 32144790 DOI: 10.1111/nan.12614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/29/2020] [Indexed: 11/27/2022]
Abstract
AIMS Nakajo-Nishimura syndrome (NNS) is an autosomal recessive disease caused by biallelic mutations in the PSMB8 gene that encodes the immunoproteasome subunit β5i. There have been only a limited number of reports on the clinicopathological features of the disease in genetically confirmed cases. METHODS We studied clinical and pathological features of three NNS patients who all carry the homozygous p.G201V mutations in PSMB8. Patients' muscle specimens were analysed with histology and immunohistochemistry. RESULTS All patients had episodes of typical periodic fever and skin rash, and later developed progressive muscle weakness and atrophy, similar to previous reports. Oral corticosteroid was used for treatment but showed no obvious efficacy. On muscle pathology, lymphocytes were present in the endomysium surrounding non-necrotic fibres, as well as in the perimysium perivascular area. Nearly all fibres strongly expressed MHC-I in the sarcolemma. In the eldest patient, there were abnormal protein aggregates in the sarcoplasm, immunoreactive to p62, TDP-43 and ubiquitin antibodies. CONCLUSIONS These results suggest that inflammation, inclusion pathology and aggregation of abnormal proteins underlie the progressive clinical course of the NNS pathomechanism.
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Affiliation(s)
- T Ayaki
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Murata
- Center for Educational Research and Development, Wakayama Medical University, Wakayama, Japan
| | - N Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - A Uruha
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan.,Department of Genome Medicine Development, Medical Genome Center, Kodaira, Tokyo, Japan.,Department of Neuropathology, Charité - Universitätsmedizin, Berlin, Germany
| | - K Ohmura
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - K Sugie
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - S Kasagi
- Minato Motomachi Internal Medicine Clinic, Kobe, Hyogo, Japan
| | - F Li
- Department of Neurology, Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - M Mori
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - R Nakajima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - T Sasai
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - I Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, Japan
| | - S Ueno
- Department of Neurology, Nara Medical University School of Medicine, Kashihara, Nara, Japan
| | - M Urushitani
- Department of Neurology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City, Shiga, Japan
| | - F Furukawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - H Ito
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - R Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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42
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Seilhean D. Neuropathology in Pitié-Salpêtrière hospital: Past, present and prospect. Neuropathology 2019; 40:3-13. [PMID: 31802544 DOI: 10.1111/neup.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022]
Abstract
Pitié and La Salpêtrière, both founded in the17th century, were for long two distinct hospitals until they merged in 1964. The name La Salpêtrière is inherited from the initial purpose of the buildings designed to produce saltpeter for gun powder. But the place was soon transformed into an asylum to shelter the poor and the insane. From the care of this underprivileged population, alienists such as Pinel have paved the way for modern medicine for the mentally ill at the time of the French Revolution. In the second half of the 19th century, Jean-Martin Charcot and his students laid the foundations of modern neurology from the observation of the large population hosted in La Salpêtrière, mostly women with severe chronic diseases. Charcot led clinicopathological studies in almost all the fields of nervous system disorders. His successors (including Raymond, Dejerine, Pierre Marie) maintained the same close relationship between clinical neurology and neuropathology. In parallel with the development of neurosurgery at Pitié hospital, neuropathology first spread through small laboratories attached to clinical departments. The merger of the two hospitals in the early '60s coincided with the creation of a large university hospital in which the care and study of diseases of the nervous system were preponderant. An independent laboratory of neuropathology was created, led by Raymond Escourolle. This period was on the eve of important developments in neuroscience around the world. Today, the Pitié-Salpêtrière neuropathology laboratory still plays a central role between neurology and neurosurgery clinics and major research institutes such as the Brain Institute, callled Institut du Cerveau et de la Moelle (ICM), and the Institute of Myology.
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Affiliation(s)
- Danielle Seilhean
- Raymond Escourolle Department of Neuropathology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
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43
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Liu Y, Zheng Y, Gang Q, Xie Z, Jin Y, Zhang X, Deng X, Hao H, Gao F, Zhang Z, Xiong H, Zhang W, Wang Z, Yuan Y. Perimysial microarteriopathy in dermatomyositis with anti‐nuclear matrix protein‐2 antibodies. Eur J Neurol 2019; 27:514-521. [PMID: 31571350 DOI: 10.1111/ene.14097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/27/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Y. Liu
- Department of Neurology Peking University First Hospital Beijing China
| | - Y. Zheng
- Department of Neurology Peking University First Hospital Beijing China
| | - Q. Gang
- Department of Neurology Peking University First Hospital Beijing China
| | - Z. Xie
- Department of Neurology Peking University First Hospital Beijing China
| | - Y. Jin
- Department of Pediatrics Peking University First Hospital Beijing China
| | - X. Zhang
- Department of Rheumatology and Clinical Immunology Peking University First Hospital Beijing China
| | - X. Deng
- Department of Rheumatology and Clinical Immunology Peking University First Hospital Beijing China
| | - H. Hao
- Department of Neurology Peking University First Hospital Beijing China
| | - F. Gao
- Department of Neurology Peking University First Hospital Beijing China
| | - Z. Zhang
- Department of Rheumatology and Clinical Immunology Peking University First Hospital Beijing China
| | - H. Xiong
- Department of Pediatrics Peking University First Hospital Beijing China
| | - W. Zhang
- Department of Neurology Peking University First Hospital Beijing China
| | - Z. Wang
- Department of Neurology Peking University First Hospital Beijing China
| | - Y. Yuan
- Department of Neurology Peking University First Hospital Beijing China
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44
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45
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Aussy A, Fréret M, Gallay L, Bessis D, Vincent T, Jullien D, Drouot L, Jouen F, Joly P, Marie I, Meyer A, Sibilia J, Bader‐Meunier B, Hachulla E, Hamidou M, Huë S, Charuel J, Fabien N, Viailly P, Allenbach Y, Benveniste O, Cordel N, Boyer O. The IgG2 Isotype of Anti–Transcription Intermediary Factor 1γ Autoantibodies Is a Biomarker of Cancer and Mortality in Adult Dermatomyositis. Arthritis Rheumatol 2019; 71:1360-1370. [DOI: 10.1002/art.40895] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 03/14/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Audrey Aussy
- Normandy UniversityUniversity of RouenINSERM U1234Rouen University Hospital Rouen France
| | - Manuel Fréret
- Normandy UniversityUniversity of RouenINSERM U1234Rouen University Hospital Rouen France
| | | | - Didier Bessis
- St. Eloi Hospital and Montpellier University HospitalINSERM U1051 Montpellier France
| | - Thierry Vincent
- St. Eloi Hospital and Montpellier University Hospital Montpellier France
| | - Denis Jullien
- Lyon University and Édouard Herriot University Hospital Lyon France
| | - Laurent Drouot
- Normandy UniversityUniversity of RouenINSERM U1234Rouen University Hospital Rouen France
| | - Fabienne Jouen
- Normandy UniversityUniversity of RouenINSERM U1234Rouen University Hospital Rouen France
| | - Pascal Joly
- Normandy UniversityUniversity of RouenINSERM U1234Rouen University Hospital Rouen France
| | - Isabelle Marie
- Normandy UniversityUniversity of RouenINSERM U1234Rouen University Hospital Rouen France
| | - Alain Meyer
- Strasbourg University Hospital and Centre de Référence des Maladies Autoimmunes Rares Strasbourg France
| | - Jean Sibilia
- Strasbourg University Hospital and Centre de Référence des Maladies Autoimmunes Rares Strasbourg France
| | | | - Eric Hachulla
- European Reference Network on Connective Tissue and Musculoskeletal DiseasesUniversity of LilleHospital Claude Huriez Lille France
| | | | - Sophie Huë
- AP‐HPHenri Mondor Hospital Créteil France
| | | | | | | | - Yves Allenbach
- AP‐HPPitié‐Salpêtrière University HospitalCentre de Référence Maladies Neuro‐Musculaires, DHU i2B, INSERM UMRS 974 Paris France
| | - Olivier Benveniste
- AP‐HPPitié‐Salpêtrière University HospitalCentre de Référence Maladies Neuro‐Musculaires, DHU i2B, INSERM UMRS 974 Paris France
| | - Nadège Cordel
- Normandy UniversityUniversity of RouenINSERM U1234Rouen University Hospital, Rouen, France, and French West Indies University and Pointe‐à‐Pitre University Hospital Pointe‐à‐Pitre Guadeloupe France
| | - Olivier Boyer
- Normandy UniversityUniversity of RouenINSERM U1234Rouen University Hospital Rouen France
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46
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Benveniste O, Goebel HH, Stenzel W. Biomarkers in Inflammatory Myopathies-An Expanded Definition. Front Neurol 2019; 10:554. [PMID: 31214105 PMCID: PMC6558048 DOI: 10.3389/fneur.2019.00554] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/08/2019] [Indexed: 12/21/2022] Open
Abstract
Biomarkers as parameters of pathophysiological conditions can be of outmost relevance for inflammatory myopathies. They are particularly warranted to inform about diagnostic, prognostic, and therapeutic questions. As biomarkers become more and more relevant in daily routine, this review focusses on relevant aspects particularly addressing myopathological features. However, the level of evidence to use them in daily routine at presence is low, still since none of them has been validated in large cohorts of patients and rarely in independent biopsy series. Hence, they should be read as mere expert opinions. The evaluation of biomarkers as well as key biological parameters is an ongoing process, and we start learning about relevance of them, as we must recognize that pathophysiology of myositis is biologically incompletely understood. As such this approach should be considered an essay toward expansion of the definition “biomarker” to myositis, an emerging field of interest in biomedical research.
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Affiliation(s)
- Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Assistance Public-Hôpitaux de Paris, Sorbonne-Université, INSERM, UMR974, Paris, France
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Berlin Institute of Health (BIH), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neuropathology, Mainz - Universitätsmedizin, Johannes Gutenberg- University, Mainz, Germany
| | - Werner Stenzel
- Department of Neuropathology, Berlin Institute of Health (BIH), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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47
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Inoue M, Tanboon J, Okubo M, Theerawat K, Saito Y, Ogasawara M, Indrawati LA, Uruha A, Okiyama N, Fujimoto M, Suzuki S, Nishino I. Absence of sarcoplasmic myxovirus resistance protein A (MxA) expression in antisynthetase syndrome in a cohort of 194 cases. Neuropathol Appl Neurobiol 2019; 45:523-524. [DOI: 10.1111/nan.12551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. Inoue
- Department of Neuromuscular Research National Institute of Neuroscience National Center of Neurology and Psychiatry Tokyo Japan
- Medical Genome Center National Center of Neurology and Psychiatry Tokyo Japan
| | - J. Tanboon
- Department of Neuromuscular Research National Institute of Neuroscience National Center of Neurology and Psychiatry Tokyo Japan
- Medical Genome Center National Center of Neurology and Psychiatry Tokyo Japan
| | - M. Okubo
- Department of Neuromuscular Research National Institute of Neuroscience National Center of Neurology and Psychiatry Tokyo Japan
- Medical Genome Center National Center of Neurology and Psychiatry Tokyo Japan
| | - K. Theerawat
- Department of Neuromuscular Research National Institute of Neuroscience National Center of Neurology and Psychiatry Tokyo Japan
- Medical Genome Center National Center of Neurology and Psychiatry Tokyo Japan
| | - Y. Saito
- Department of Neuromuscular Research National Institute of Neuroscience National Center of Neurology and Psychiatry Tokyo Japan
- Medical Genome Center National Center of Neurology and Psychiatry Tokyo Japan
| | - M. Ogasawara
- Department of Neuromuscular Research National Institute of Neuroscience National Center of Neurology and Psychiatry Tokyo Japan
- Medical Genome Center National Center of Neurology and Psychiatry Tokyo Japan
| | - L. A. Indrawati
- Department of Neuromuscular Research National Institute of Neuroscience National Center of Neurology and Psychiatry Tokyo Japan
- Medical Genome Center National Center of Neurology and Psychiatry Tokyo Japan
| | - A. Uruha
- Department of Neurology Tokyo Metropolitan Neurological Hospital Tokyo Japan
| | - N. Okiyama
- Department of Dermatology Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - M. Fujimoto
- Department of Dermatology Graduate School of Medicine Osaka University Osaka Japan
| | - S. Suzuki
- Department of Neurology Keio University School of Medicine Tokyo Japan
| | - I. Nishino
- Department of Neuromuscular Research National Institute of Neuroscience National Center of Neurology and Psychiatry Tokyo Japan
- Medical Genome Center National Center of Neurology and Psychiatry Tokyo Japan
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