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Abd El Mutaleb ANH, Ibrahim FAR, Megahed FAK, Atta A, Ali BA, Omar TEI, Rashad MM. NAIP Gene Deletion and SMN2 Copy Number as Molecular Tools in Predicting the Severity of Spinal Muscular Atrophy. Biochem Genet 2024:10.1007/s10528-023-10657-6. [PMID: 38388850 DOI: 10.1007/s10528-023-10657-6] [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: 09/27/2023] [Accepted: 12/29/2023] [Indexed: 02/24/2024]
Abstract
Spinal muscular atrophy (SMA) is one of the most prevalent autosomal recessive illnesses with type I being the most severe type. Genomic alterations including survival motor neuron (SMN) copy number as well as deletions in SMN and Neuronal Apoptosis Inhibitory Protein (NAIP) are greatly implicated in the emergence of SMA. However, the association of such alterations with the severity of the disease is yet to be investigated. This study was directed to elucidate the molecular assessment of NAIP and SMN genomic alterations as a useful tool in predicting the severity of SMA among patients. This study included 65 SMA pediatric patients (30 type I and 35 type II) and 65 healthy controls. RFLP-PCR was employed to determine the genetic polymorphisms of the SMN1, SMN2, and NAIP genes. In addition, qRT-PCR was used to identify the expression of the SMN1 and SMN2 genes, and serum levels of creatine kinase were measured using a colorimetric method. DNA sequencing was performed on some samples to detect any single nucleotide polymorphisms in SMN1, SMN2, and NAIP genes. All SMA patients had a homozygous deficiency of SMN1 exon 7. The homozygous deficiency of SMN1 exons 7 and 8, with the deletion of NAIP exon 5 was found among the majority of Type I patients. In contrast, patients with the less severe condition (type II) had SMN1 exons 7 and 8 deleted but did not have any deletions in NAIP, additionally; 65.7% of patients had multiple copies of SMN2. Analysis of NAIP deletion alongside assessing SMN2 copy number might enhance the effectiveness of the diagnosis that can predict severity among Spinal Muscular Atrophy patients.
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Affiliation(s)
| | - Fawziya A R Ibrahim
- Department of Applied Medical Chemistry, Medical Research Institute, University of Alexandria, Alexandria, Egypt.
| | - Fayed A K Megahed
- Department of Nucleic Acid Research, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications, Alexandria, Egypt
| | - Ahmed Atta
- Department of Nucleic Acid Research, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications, Alexandria, Egypt
| | - Bahy A Ali
- Department of Nucleic Acid Research, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications, Alexandria, Egypt
| | - Tarek E I Omar
- Department of Pediatric Neurology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Mona M Rashad
- Department of Applied Medical Chemistry, Medical Research Institute, University of Alexandria, Alexandria, Egypt
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2
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Petry-Schmelzer JN, Wunderlich G. Reply to: Camptocormia due to myotinilopathy, Parkinson's disease, or both? Neurol Res Pract 2023; 5:54. [PMID: 37759273 PMCID: PMC10523718 DOI: 10.1186/s42466-023-00284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Affiliation(s)
- Jan Niklas Petry-Schmelzer
- Faculty of Medicine and University Hospital, Department of Neurology, University of Cologne, Cologne, Germany.
| | - Gilbert Wunderlich
- Faculty of Medicine and University Hospital, Department of Neurology, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Rare Diseases, University of Cologne, Cologne, Germany
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3
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De Paepe B. Incorporating circulating cytokines into the idiopathic inflammatory myopathy subclassification toolkit. Front Med (Lausanne) 2023; 10:1130614. [PMID: 37007787 PMCID: PMC10061103 DOI: 10.3389/fmed.2023.1130614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
Extensive diagnostic delays and deferred treatment impact the quality of life of patients suffering from an idiopathic inflammatory myopathy. In-depth subtyping of patients is a necessary effort to engage appropriate disease management and may require specialized and elaborate evaluation of the complex spectrum of clinical and pathological disease features. Blood samples are routinely taken for diagnostic purposes, with creatine kinase measurement and autoantibody typing representing standard diagnostic tools in the clinical setting. However, for many patients the diagnostic odyssey includes the invasive and time-consuming procedure of taking a muscle biopsy. It is proposed that further implementation of blood-based disease biomarkers represents a convenient alternative approach with the potential to reduce the need for diagnostic muscle biopsies substantially. Quantification of judicious combinations of circulating cytokines could be added to the diagnostic flowchart, and growth differentiation factor 15 and C-X-C motif chemokine ligand 10 come forward as particularly good candidates. These biomarkers can offer complementary information for diagnosis indicative of disease severity, therapeutic response and prognosis.
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Freigang M, Wurster CD, Hagenacker T, Stolte B, Weiler M, Kamm C, Schreiber-Katz O, Osmanovic A, Petri S, Kowski A, Meyer T, Koch JC, Cordts I, Deschauer M, Lingor P, Aust E, Petzold D, Ludolph AC, Falkenburger B, Hermann A, Günther R. Serum creatine kinase and creatinine in adult spinal muscular atrophy under nusinersen treatment. Ann Clin Transl Neurol 2021; 8:1049-1063. [PMID: 33792208 PMCID: PMC8108420 DOI: 10.1002/acn3.51340] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine whether serum creatine kinase activity (CK) and serum creatinine concentration (Crn) are prognostic and predictive biomarkers for disease severity, disease progression, and nusinersen treatment effects in adult patients with 5q-associated spinal muscular atrophy (SMA). METHODS Within this retrospective, multicenter observational study in 206 adult patients with SMA, we determined clinical subtypes (SMA types, ambulatory ability) and repeatedly measured CK and Crn and examined disease severity scores (Hammersmith Functional Motor Scale Expanded, Revised Upper Limb Module, and revised Amyotrophic Lateral Sclerosis Functional Rating Scale). Patients were followed under nusinersen treatment for 18 months. RESULTS CK and Crn differed between clinical subtypes and correlated strongly with disease severity scores (e.g., for Hammersmith Functional Motor Scale Expanded: (CK) ρ = 0.786/ (Crn) ρ = 0.558). During the 18 months of nusinersen treatment, CK decreased (∆CK = -17.56%, p < 0.0001), whereas Crn slightly increased (∆Crn = +4.75%, p < 0.05). INTERPRETATION Serum creatine kinase activity and serum creatinine concentration reflect disease severity of spinal muscular atrophy and are promising biomarkers to assess patients with spinal muscular atrophy during disease course and to predict treatment response. The decrease of creatine kinase activity, combined with the tendency of creatinine concentration to increase during nusinersen treatment, suggests reduced muscle mass wasting with improved muscle energy metabolism.
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Affiliation(s)
- Maren Freigang
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Tim Hagenacker
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Benjamin Stolte
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Kamm
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Alexander Kowski
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Meyer
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan C Koch
- Department of Neurology, University Medicine Göttingen, Göttingen, Germany
| | - Isabell Cordts
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marcus Deschauer
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Paul Lingor
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Elisa Aust
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Daniel Petzold
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Albert C Ludolph
- Department of Neurology, Ulm University, Ulm, Germany.,German Center for Neurodegenerative Diseases (DZNE) Ulm, Ulm, Germany
| | - Björn Falkenburger
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Andreas Hermann
- Department of Neurology, Translational Neurodegeneration Section "Albrecht-Kossel", University Medical Center Rostock, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - René Günther
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
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Abstract
Skeletal muscle biopsy remains an important investigative tool in the diagnosis of a variety of muscle disorders. Traditionally, someone with a limb-girdle muscle weakness, myopathic changes on electrophysiology and raised serum creatine kinase (CK) would have a muscle biopsy. However, we are living through a genetics revolution, and so do all such patients still need a biopsy? When should we undertake a muscle biopsy in patients with a distal, scapuloperoneal or other patterns of muscle weakness? When should patients with myositis, rhabdomyolysis, myalgia, hyperCKaemia or a drug-related myopathy have a muscle biopsy? What does normal muscle histology look like and what changes occur in neurogenic and myopathic disorders? As with Kipling's six honest serving men, we hope that by addressing these issues we can all become more confident about when to request a muscle biopsy and develop clearer insights into muscle pathology.
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Affiliation(s)
| | - Atik Baborie
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
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Abstract
Creatine kinase (CK) remains an essential tool for assessment of muscular weakness and pain in children despite the advent of advanced diagnostic tests in this field. It is also useful in diagnosing and monitoring various other conditions. This article will explore the physiology of CK and clinical situations where the estimation of CK can help the clinicians' decision-making process with the diagnosis and management of these conditions. Some clinical scenarios are used to highlight how the tests can be used in different clinical situations. The role of CK as a biomarker of myocardial injury has been purposefully omitted in this article.
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Affiliation(s)
- Tanmoy Chakrabarty
- Department of Paediatric Neurology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Sandya Tirupathi
- Department of Paediatric Neurology, Belfast Health and Social Care Trust, Belfast, Belfast, UK
| | - Andrew Thompson
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
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Joshi PR, Deschauer M, Zierz S. McArdle Disease: Clinical, Biochemical, Histological and Molecular Genetic Analysis of 60 Patients. Biomedicines 2020; 8:biomedicines8020033. [PMID: 32075227 PMCID: PMC7168270 DOI: 10.3390/biomedicines8020033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/25/2022] Open
Abstract
A clinical, biochemical, histological and molecular genetic analysis of 60 McArdle patients (33 males and 27 females; mean age at diagnosis: 37 years) was performed. The objective of this study was to identify a possible genotype–phenotype correlation in McArdle disease. All patients complained of exercise-induced myalgia and fatigue; permanent weakness was present in 47% of the patients. Five percent of patients conveyed of masticatory muscle weakness. Age of onset was <15 years in 92% patients. Serum creatine kinase was elevated 5 to13-fold. Forearm ischemic test showed decreased lactate production but excessively increased ammonia upon exercise (n = 16). Muscle biopsies revealed highly reduced or missing myophosphorylase activity (n = 20) (mean: 0.17 ± 0.35 U/g tissue; normal: 12–61) and histologically, sub-sarcolemmal glycogen accumulation (n = 9). Molecular genetic analysis revealed the common p.Arg50Ter mutation in 68% of the patients. Other rather frequent mutations were p.Arg270Ter (allele frequency: 5%) followed by c.2262delA and p.Met1Val (allele frequencies: 3%). Twenty-four other rare mutations were also identified. No genotype–phenotype correlation was observed. The analysis highlights that testing of the p.Arg50Ter mutation could be performed first in molecular genetic testing of patients with exercise intolerance possibly due to McArdle disease. However, there is enormous mutation heterogeneity in McArdle disease thus sequencing of the myophosphorylase gene is needed in patients highly suspicious of McArdle disease.
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Affiliation(s)
- Pushpa Raj Joshi
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany; (M.D.); (S.Z.)
- Correspondence: ; Tel.: +49-345-557-5259
| | - Marcus Deschauer
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany; (M.D.); (S.Z.)
- Department of Neurology, School of Medicine, Technical University Munich, 81675 Munich, Germany
| | - Stephan Zierz
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany; (M.D.); (S.Z.)
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Ke Q, Zhang L, He C, Zhao Z, Qi M, Griggs RC, Gatheridge MA. China's shift from population control to population quality: Implications for neurology. Neurology 2018; 87:e85-8. [PMID: 27550901 DOI: 10.1212/wnl.0000000000003010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Qing Ke
- From the Department of Neurology, the First Affiliated Hospital (Q.K.), Department of Child Health Care, The Children's Hospital (Z.Z.), and Center for Genetic & Genomic Medicine (M.Q.), Zhejiang University School of Medicine; Department of Rehabilitation Medicine (L.Z.), Zhejiang Provincial People's Hospital; Family Planning Publicity and Technical Guidance Station of Hangzhou City (C.H.), Hangzhou, China; and the Department of Neurology (R.C.G., M.A.G.), University of Rochester School of Medicine and Dentistry, NY
| | - Li Zhang
- From the Department of Neurology, the First Affiliated Hospital (Q.K.), Department of Child Health Care, The Children's Hospital (Z.Z.), and Center for Genetic & Genomic Medicine (M.Q.), Zhejiang University School of Medicine; Department of Rehabilitation Medicine (L.Z.), Zhejiang Provincial People's Hospital; Family Planning Publicity and Technical Guidance Station of Hangzhou City (C.H.), Hangzhou, China; and the Department of Neurology (R.C.G., M.A.G.), University of Rochester School of Medicine and Dentistry, NY
| | - Chaying He
- From the Department of Neurology, the First Affiliated Hospital (Q.K.), Department of Child Health Care, The Children's Hospital (Z.Z.), and Center for Genetic & Genomic Medicine (M.Q.), Zhejiang University School of Medicine; Department of Rehabilitation Medicine (L.Z.), Zhejiang Provincial People's Hospital; Family Planning Publicity and Technical Guidance Station of Hangzhou City (C.H.), Hangzhou, China; and the Department of Neurology (R.C.G., M.A.G.), University of Rochester School of Medicine and Dentistry, NY
| | - Zhengyan Zhao
- From the Department of Neurology, the First Affiliated Hospital (Q.K.), Department of Child Health Care, The Children's Hospital (Z.Z.), and Center for Genetic & Genomic Medicine (M.Q.), Zhejiang University School of Medicine; Department of Rehabilitation Medicine (L.Z.), Zhejiang Provincial People's Hospital; Family Planning Publicity and Technical Guidance Station of Hangzhou City (C.H.), Hangzhou, China; and the Department of Neurology (R.C.G., M.A.G.), University of Rochester School of Medicine and Dentistry, NY
| | - Ming Qi
- From the Department of Neurology, the First Affiliated Hospital (Q.K.), Department of Child Health Care, The Children's Hospital (Z.Z.), and Center for Genetic & Genomic Medicine (M.Q.), Zhejiang University School of Medicine; Department of Rehabilitation Medicine (L.Z.), Zhejiang Provincial People's Hospital; Family Planning Publicity and Technical Guidance Station of Hangzhou City (C.H.), Hangzhou, China; and the Department of Neurology (R.C.G., M.A.G.), University of Rochester School of Medicine and Dentistry, NY
| | - Robert C Griggs
- From the Department of Neurology, the First Affiliated Hospital (Q.K.), Department of Child Health Care, The Children's Hospital (Z.Z.), and Center for Genetic & Genomic Medicine (M.Q.), Zhejiang University School of Medicine; Department of Rehabilitation Medicine (L.Z.), Zhejiang Provincial People's Hospital; Family Planning Publicity and Technical Guidance Station of Hangzhou City (C.H.), Hangzhou, China; and the Department of Neurology (R.C.G., M.A.G.), University of Rochester School of Medicine and Dentistry, NY
| | - Michele A Gatheridge
- From the Department of Neurology, the First Affiliated Hospital (Q.K.), Department of Child Health Care, The Children's Hospital (Z.Z.), and Center for Genetic & Genomic Medicine (M.Q.), Zhejiang University School of Medicine; Department of Rehabilitation Medicine (L.Z.), Zhejiang Provincial People's Hospital; Family Planning Publicity and Technical Guidance Station of Hangzhou City (C.H.), Hangzhou, China; and the Department of Neurology (R.C.G., M.A.G.), University of Rochester School of Medicine and Dentistry, NY.
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Lilleker JB, Keh YS, Roncaroli F, Sharma R, Roberts M. Metabolic myopathies: a practical approach. Pract Neurol 2017; 18:14-26. [PMID: 29223996 DOI: 10.1136/practneurol-2017-001708] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 12/20/2022]
Abstract
Metabolic myopathies are a diverse group of rare genetic disorders and their associated muscle symptoms may be subtle. Patients may present with indolent myopathic features, exercise intolerance or recurrent rhabdomyolysis. Diagnostic delays are common and clinicians need a high index of suspicion to recognise and differentiate metabolic myopathies from other conditions that present in a similar fashion. Standard laboratory tests may be normal or non-specific, particularly between symptomatic episodes. Targeted enzyme activity measurement and next-generation genetic sequencing are increasingly used. There are now specific enzyme replacement therapies available, and other metabolic strategies and gene therapies are undergoing clinical trials. Here, we discuss our approach to the adult patient with suspected metabolic myopathy. We outline key features in the history and examination and discuss some mimics of metabolic myopathies. We highlight some disorders of glycogen and fatty acid utilisation that present in adulthood and outline current recommendations on management.
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Affiliation(s)
- James B Lilleker
- Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Yann Shern Keh
- Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Federico Roncaroli
- Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Reena Sharma
- The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Mark Roberts
- Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
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10
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Nikolić-Kokić A, Marinković D, Perić S, Stević Z, Spasić MB, Blagojević D, Rakocˇević-Stojanović V. Redox imbalance in peripheral blood of type 1 myotonic dystrophy patients. Redox Rep 2016; 21:232-7. [PMID: 26817806 DOI: 10.1080/13510002.2015.1107311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The aim of our study was to determine if redox imbalance caused by the activities of antioxidant enzymes existed in erythrocytes of type 1 myotonic dystrophy (DM1) patients. METHODS The activities of erythrocyte superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase were measured in 30 DM1 patients and 15 healthy controls (HCs). The obtained values were correlated with the Muscular Impairment Rating Scale (MIRS) score and creatine kinase (CK). RESULTS Superoxide dismutase and catalase activities were lower in DM1 patients compared to HCs. A positive correlation was found between disease duration and MIRS score as well as with glutathione reductase activity. In DM1 patients, there were positive correlations between catalase, glutathione peroxidase, and glutathione reductase activities. After sub-dividing DM1 patients according to CK levels, superoxide dismutase activity was still statistically different from HCs. However, catalase activity was significantly lower only in DM1 patients with increased CK. DISCUSSION Undesirable alterations in antioxidant enzyme activities during DM1 disease progression may result in conditions favoring oxidative stress and changes in metabolism which together could contribute to muscle wasting.
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Affiliation(s)
- Aleksandra Nikolić-Kokić
- a Department of Physiology, Institute for Biological Research Siniša Stanković , University of Belgrade , Serbia
| | - Dragan Marinković
- b Faculty for Special Education and Rehabilitation , University of Belgrade , Serbia
| | - Stojan Perić
- c Neurology Clinic, Clinical Centre of Serbia, School of Medicine , University of Belgrade , Serbia
| | - Zorica Stević
- c Neurology Clinic, Clinical Centre of Serbia, School of Medicine , University of Belgrade , Serbia
| | - Mihajlo B Spasić
- a Department of Physiology, Institute for Biological Research Siniša Stanković , University of Belgrade , Serbia
| | - Duško Blagojević
- a Department of Physiology, Institute for Biological Research Siniša Stanković , University of Belgrade , Serbia
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