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Hoxhaj D, Vadi G, Bianchi L, Fontanelli L, Torri F, Siciliano G, Ricci G. Cardiac comorbidities in McArdle disease: case report and systematic review. Neurol Sci 2024; 45:4757-4765. [PMID: 38802689 PMCID: PMC11422453 DOI: 10.1007/s10072-024-07600-x] [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: 12/23/2023] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION AND METHODS Myophosphorylase deficiency, also known as McArdle disease or Glycogen Storage Disease type V (GSD-V), is an autosomal recessive metabolic myopathy that results in impaired glycogen breakdown in skeletal muscle. Despite being labelled as a "pure myopathy," cardiac involvement has been reported in some cases, including various cardiac abnormalities such as electrocardiographic changes, coronary artery disease, and cardiomyopathy. Here, we present a unique case of a 72-year-old man with GSD-V and both mitral valvulopathy and coronary artery disease, prompting a systematic review to explore the existing literature on cardiac comorbidities in McArdle disease. RESULTS Our systematic literature revision identified 7 case reports and 1 retrospective cohort study. The case reports described 7 GSD-V patients, averaging 54.3 years in age, mostly male (85.7%). Coronary artery disease was noted in 57.1% of cases, hypertrophic cardiomyopathy in 28.5%, severe aortic stenosis in 14.3%, and genetic dilated cardiomyopathy in one. In the retrospective cohort study, five out of 14 subjects (36%) had coronary artery disease. DISCUSSION AND CONCLUSION Despite McArdle disease primarily affecting skeletal muscle, cardiac involvement has been observed, especially coronary artery disease, the frequency of which was moreover found to be higher in McArdle patients than in the background population in a previous study from a European registry. Exaggerated cardiovascular responses during exercise and impaired glycolytic metabolism have been speculated as potential contributors. A comprehensive cardiological screening might be recommended for McArdle disease patients to detect and manage cardiac comorbidities. A multidisciplinary approach is crucial to effectively manage both neurological and cardiac aspects of the disease and improve patient outcomes. Further research is required to establish clearer pathophysiological links between McArdle disease and cardiac manifestations in order to clarify the existing findings.
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Affiliation(s)
- Domeniko Hoxhaj
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - Gabriele Vadi
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
| | - Lorenzo Bianchi
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Lorenzo Fontanelli
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - Francesca Torri
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Via Roma 67, 56100, Pisa, Italy
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Collardeau-Frachon S. [Adult and pediatric thesaurismosis: Lysosomal, lipid and glycogen storage diseases]. Ann Pathol 2024:S0242-6498(24)00198-6. [PMID: 39358197 DOI: 10.1016/j.annpat.2024.09.010] [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: 09/02/2024] [Revised: 09/09/2024] [Accepted: 09/12/2024] [Indexed: 10/04/2024]
Abstract
Thesaurismosis or storage diseases are rare genetic disorders due to an abnormal accumulation of an organic compound or its metabolite within cells. These conditions are either secondary to a defect in catabolism caused by enzymatic dysfunction or to a deficiency in transport proteins. They encompass lysosomal storage diseases, lipid storage diseases or dyslipidemias, and glycogen storage disorders or glycogenoses. Diagnosis is typically based on clinical and biological anomalies but may be made or suggested by the pathologist when symptoms are atypical or when biochemical or genetic tests are challenging to interpret. For accurate diagnosis, it is crucial to freeze a portion of the samples. Special staining and electronic microscopy can also aid in the diagnostic process. As the diagnosis is multidisciplinary, collaboration with clinicians, biochemists and geneticists is essential.
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Affiliation(s)
- Sophie Collardeau-Frachon
- Institut de pathologie des hospices civils de Lyon, groupement hospitalier Est, 59, boulevard Pinel, 69677 Bron cedex, France.
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3
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Mishra K, Kakhlon O. Mitochondrial Dysfunction in Glycogen Storage Disorders (GSDs). Biomolecules 2024; 14:1096. [PMID: 39334863 PMCID: PMC11430448 DOI: 10.3390/biom14091096] [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: 06/30/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/30/2024] Open
Abstract
Glycogen storage disorders (GSDs) are a group of inherited metabolic disorders characterized by defects in enzymes involved in glycogen metabolism. Deficiencies in enzymes responsible for glycogen breakdown and synthesis can impair mitochondrial function. For instance, in GSD type II (Pompe disease), acid alpha-glucosidase deficiency leads to lysosomal glycogen accumulation, which secondarily impacts mitochondrial function through dysfunctional mitophagy, which disrupts mitochondrial quality control, generating oxidative stress. In GSD type III (Cori disease), the lack of the debranching enzyme causes glycogen accumulation and affects mitochondrial dynamics and biogenesis by disrupting the integrity of muscle fibers. Malfunctional glycogen metabolism can disrupt various cascades, thus causing mitochondrial and cell metabolic dysfunction through various mechanisms. These dysfunctions include altered mitochondrial morphology, impaired oxidative phosphorylation, increased production of reactive oxygen species (ROS), and defective mitophagy. The oxidative burden typical of GSDs compromises mitochondrial integrity and exacerbates the metabolic derangements observed in GSDs. The intertwining of mitochondrial dysfunction and GSDs underscores the complexity of these disorders and has significant clinical implications. GSD patients often present with multisystem manifestations, including hepatomegaly, hypoglycemia, and muscle weakness, which can be exacerbated by mitochondrial impairment. Moreover, mitochondrial dysfunction may contribute to the progression of GSD-related complications, such as cardiomyopathy and neurocognitive deficits. Targeting mitochondrial dysfunction thus represents a promising therapeutic avenue in GSDs. Potential strategies include antioxidants to mitigate oxidative stress, compounds that enhance mitochondrial biogenesis, and gene therapy to correct the underlying mitochondrial enzyme deficiencies. Mitochondrial dysfunction plays a critical role in the pathophysiology of GSDs. Recognizing and addressing this aspect can lead to more comprehensive and effective treatments, improving the quality of life of GSD patients. This review aims to elaborate on the intricate relationship between mitochondrial dysfunction and various types of GSDs. The review presents challenges and treatment options for several GSDs.
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Affiliation(s)
- Kumudesh Mishra
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem 9112102, Israel
| | - Or Kakhlon
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem 9112102, Israel
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Stefanik E, Dubińska-Magiera M, Lewandowski D, Daczewska M, Migocka-Patrzałek M. Metabolic aspects of glycogenolysis with special attention to McArdle disease. Mol Genet Metab 2024; 142:108532. [PMID: 39018613 DOI: 10.1016/j.ymgme.2024.108532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 07/19/2024]
Abstract
The physiological function of muscle glycogen is to meet the energy demands of muscle contraction. The breakdown of glycogen occurs through two distinct pathways, primarily cytosolic and partially lysosomal. To obtain the necessary energy for their function, skeletal muscles utilise also fatty acids in the β-oxidation. Ketogenesis is an alternative metabolic pathway for fatty acids, which provides an energy source during fasting and starvation. Diseases arising from impaired glycogenolysis lead to muscle weakness and dysfunction. Here, we focused on the lack of muscle glycogen phosphorylase (PYGM), a rate-limiting enzyme for glycogenolysis in skeletal muscles, which leads to McArdle disease. Metabolic myopathies represent a group of genetic disorders characterised by the limited ability of skeletal muscles to generate energy. Here, we discuss the metabolic aspects of glycogenosis with a focus on McArdle disease, offering insights into its pathophysiology. Glycogen accumulation may influence the muscle metabolic dynamics in different ways. We emphasize that a proper treatment approach for such diseases requires addressing three important and interrelated aspects, which include: symptom relief therapy, elimination of the cause of the disease (lack of a functional enzyme) and effective and early diagnosis.
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Affiliation(s)
- Ewa Stefanik
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wrocław, Poland..
| | - Magda Dubińska-Magiera
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wrocław, Poland..
| | - Damian Lewandowski
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wrocław, Poland..
| | - Małgorzata Daczewska
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wrocław, Poland..
| | - Marta Migocka-Patrzałek
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wrocław, Poland..
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5
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Karazi W, Coppers J, Maas D, Cup E, Bloemen B, Voet N, Groothuis JT, Pinós T, Marti Seves R, Quinlivan R, Løkken N, Vissing J, Bhai S, Wakelin A, Reason S, Voermans NC. Toward an Understanding of GSD5 (McArdle disease): How Do Individuals Learn to Live with the Metabolic Defect in Daily Life. J Neuromuscul Dis 2024; 11:103-116. [PMID: 38108358 PMCID: PMC10789332 DOI: 10.3233/jnd-230027] [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: 11/20/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Glycogen storage disease type 5 (GSD) is an autosomal recessive inherited metabolic myopathy caused by a deficiency of the enzyme muscle glycogen phosphorylase. Individuals with GSD5 experience physical activity intolerance. OBJECTIVE This patient-led study aimed to capture the daily life experiences of GSD5, with a focus on adapting to and coping with their physical activity intolerance. METHODS An online survey was composed in close collaboration with patient organizations. It consisted of customized and validated questionnaires on demographics, general health and comorbidities, physical activity, psychosocial well-being and functioning, pain, fatigue and adapting to and coping with GSD5. RESULTS One hundred sixty-two participants (16 countries) participated. The majority, n = 86 (69%) were from the Netherlands, USA or UK. We observed a high rate of misdiagnosis prior to GSD5 diagnosis (49%), surprisingly a relatively high proportion had not been diagnosed by DNA testing which is the gold standard. Being diagnosed had a strong impact on emotional status, daily life activities and important life choices. A large proportion had not received any rehabilitation (41%) nor medical treatment (57%) before diagnosis. Engagement in vigorous and moderate physical activity was reduced. Health related quality of life was low, most likely related to low physical health. The median Fatigue Severity Score was 4.3, indicating moderate to severe fatigue. Participants themselves had found various ways to adapt to and cope with their disability. The adaptations concerned all aspect of their life, including household chores, social and physical activities, and work. In addition to lack of support, participants reported limited availability of information sources. CONCLUSION Participants have provided guidance for newly diagnosed people, including the advice to accept one's limited abilities and maintain an active lifestyle. We conclude that adequate counseling on ways of adapting and coping is expected to increase both health-related quality of life and physical activity.
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Affiliation(s)
- Walaa Karazi
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline Coppers
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daphne Maas
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edith Cup
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Bloemen
- Department for Health Evidence, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole Voet
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tomàs Pinós
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Ramon Marti Seves
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, National Hospital, London, UK
| | - Nicoline Løkken
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Salman Bhai
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, TX, USA
| | - Andrew Wakelin
- Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, TX, USA
| | - Stacey Reason
- Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, TX, USA
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Slipsager A, Andersen LK, Voermans NC, Lucia A, Karazi W, Santalla A, Vissing J, Løkken N. Fatigue and associated factors in 172 patients with McArdle disease: An international web-based survey. Neuromuscul Disord 2024; 34:19-26. [PMID: 38042739 DOI: 10.1016/j.nmd.2023.11.003] [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: 04/12/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 12/04/2023]
Abstract
McArdle disease is an autosomal recessive inherited disease caused by pathogenic variants in the PYGM gene, resulting in virtual absence of the myophosphorylase enzyme in skeletal muscle. Patients experience physical activity intolerance, muscle pain, and muscle fatigue. This study aimed to investigate other fatigue domains with the Multidimensional Fatigue Inventory (MFI-20) along with an investigation of potential contributing factors, including relevant disease and lifestyle-related factors. We conducted a survey in an international cohort of patients with McArdle disease. The survey included questions on demographics and McArdle disease-related symptoms, and the questionnaires: MFI-20, Insomnia Severity Index (ISI), and International Physical Activity Questionnaire Short-Form (IPAQ-SF). One hundred seventy-four responses were included in the data analyses. We found relatively high fatigue scores in all five domains (general fatigue (12.9 ± 2.2), mental fatigue (10.1 ± 4.1), physical fatigue (13.7 ± 4.1), reduced activity (12.1 ± 4.1), and reduced motivation (10.4 ± 3.4)). Fatigue associated with McArdle symptom severity (p < 0.005), lower levels of physical activity (assessed by IPAQ-SF) (p < 0.05), and poor sleep (assessed by ISI) (p < 0.05). These findings call for clinical focus and future research into fatigue, sleep and mental health in patients with McArdle disease.
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Affiliation(s)
- Anna Slipsager
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Linda Kahr Andersen
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nicol Cornelia Voermans
- The Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Alejandro Lucia
- Physical Activity Health Research Group (PaHerg), Research Institute of Hospital 12 de Octubre ('i+12'). Madrid, Spain; Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Walaa Karazi
- The Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands
| | | | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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7
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Løkken N, Nielsen MR, Stemmerik MG, Ellerton C, Revsbech KL, Macrae M, Slipsager A, Krett B, Beha GH, Emanuelsson F, van Hall G, Quinlivan R, Vissing J. Can a modified ketogenic diet be a nutritional strategy for patients with McArdle disease? Results from a randomized, single-blind, placebo-controlled, cross-over study. Clin Nutr 2023; 42:2124-2137. [PMID: 37769369 DOI: 10.1016/j.clnu.2023.09.006] [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: 05/05/2023] [Revised: 07/13/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND McArdle disease is caused by myophosphorylase deficiency leading to blocked glycogenolysis in skeletal muscle. Consequently, individuals with McArdle disease have intolerance to physical activity, muscle fatigue, and pain. These symptoms vary according to the availability of alternative fuels for muscle contraction. In theory, a modified ketogenic diet (mKD) can provide alternative fuels in the form of ketone bodies and potentially boost fat oxidation. METHODS This randomized, single-blind, placebo-controlled, cross-over study aimed to investigate if a mKD improves exercise capacity in individuals with McArdle disease. Participants were randomized to follow a mKD (75-80% fat, 15% protein, 5-10% carbohydrates) or placebo diet (PD) first for three weeks, followed by a wash-out period, and then the opposite diet. The primary outcome was change in heart rate during constant-load cycling. Secondary outcomes included change in plasma metabolites, perceived exertion, indirect calorimetry measures, maximal exercise capacity, and patient-reported outcomes. RESULTS Fifteen out of 20 patients with genetically verified McArdle disease completed all study visits, and 14 were included in the data analyses. We found that the mKD induced a metabolic shift towards increased fat oxidation (∼60% increase), and a 19-fold increase in plasma β-hydroxybutyrate (p < 0.05). The mKD did not improve heart rate responses during constant-load cycling but did improve patient-reported outcomes and maximal exercise capacity (∼20% increase) compared to the PD. CONCLUSION The mKD did not alleviate all McArdle disease-related symptoms but did induce some positive changes. To date, no satisfactory treatment options exist other than exercise training. To that end, a mKD can be a possible nutritional strategy for some individuals with McArdle disease who are motivated to undertake a restrictive diet. CLINICAL TRIAL REGISTRATION clinical trials.gov: NCT04044508.
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Affiliation(s)
- Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Maja Risager Nielsen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Mads Godtfeldt Stemmerik
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Ellerton
- The Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Karoline Lolk Revsbech
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Margaret Macrae
- The Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Anna Slipsager
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bjørg Krett
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Gry Hatting Beha
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Frida Emanuelsson
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Gerrit van Hall
- Clinical Metabolomics Core Facility, Clinical Biochemistry, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rosaline Quinlivan
- The Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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von Loesch ET, Bačinović M, Farwick AL, Meinhardt A, Quast O. [Rhabdomyolysis of rare etiology]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:999-1004. [PMID: 37296329 DOI: 10.1007/s00108-023-01539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/12/2023]
Abstract
A 40-year-old Syrian man presented to the emergency department with a 5-day history of anuria. He had previously excreted dark urine. Major rhabdomyolysis and crush kidney were found, meaning that hemodialysis was immediately initiated. A detailed patient history in the patient's mother tongue revealed indications of metabolic myopathy. The PYGM-associated glycogen storage disease type V (McArdle disease) was confirmed by next generation sequencing panel diagnostics. The most important treatment approach is to avoid rhabdomyolysis through only moderate physical exertion.
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Affiliation(s)
- E Thassilo von Loesch
- Klinik für Hämatologie, Onkologie und Nephrologie, Stammzelltransplantation, Agaplesion Diakonie Klinikum Rotenburg, Elise-Averdieck-Str. 17, 27356, Rotenburg/Wümme, Deutschland.
| | - Mustafa Bačinović
- Klinik für Hämatologie, Onkologie und Nephrologie, Stammzelltransplantation, Agaplesion Diakonie Klinikum Rotenburg, Elise-Averdieck-Str. 17, 27356, Rotenburg/Wümme, Deutschland
| | - Anna-Lena Farwick
- Klinik für Hämatologie, Onkologie und Nephrologie, Stammzelltransplantation, Agaplesion Diakonie Klinikum Rotenburg, Elise-Averdieck-Str. 17, 27356, Rotenburg/Wümme, Deutschland
| | - Achim Meinhardt
- Klinik für Hämatologie, Onkologie und Nephrologie, Stammzelltransplantation, Agaplesion Diakonie Klinikum Rotenburg, Elise-Averdieck-Str. 17, 27356, Rotenburg/Wümme, Deutschland
| | - Oliver Quast
- Neurologische Klinik, Agaplesion Diakonie Klinikum Rotenburg, Rotenburg/Wümme, Deutschland
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9
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Batten K, Bhattacharya K, Simar D, Broderick C. Exercise testing and prescription in patients with inborn errors of muscle energy metabolism. J Inherit Metab Dis 2023; 46:763-777. [PMID: 37350033 DOI: 10.1002/jimd.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023]
Abstract
Skeletal muscle is a dynamic organ requiring tight regulation of energy metabolism in order to provide bursts of energy for effective function. Several inborn errors of muscle energy metabolism (IEMEM) affect skeletal muscle function and therefore the ability to initiate and sustain physical activity. Exercise testing can be valuable in supporting diagnosis, however its use remains limited due to the inconsistency in data to inform its application in IEMEM populations. While exercise testing is often used in adults with IEMEM, its use in children is far more limited. Once a physiological limitation has been identified and the aetiology defined, habitual exercise can assist with improving functional capacity, with reports supporting favourable adaptations in adult patients with IEMEM. Despite the potential benefits of structured exercise programs, data in paediatric populations remain limited. This review will focus on the utilisation and limitations of exercise testing and prescription for both adults and children, in the management of McArdle Disease, long chain fatty acid oxidation disorders, and primary mitochondrial myopathies.
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Affiliation(s)
- Kiera Batten
- School of Health Sciences, University of New South Wales, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
| | - Kaustuv Bhattacharya
- The Children's Hospital at Westmead, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - David Simar
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Carolyn Broderick
- School of Health Sciences, University of New South Wales, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
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10
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Karazi W, Scalco RS, Stemmerik MG, Løkken N, Lucia A, Santalla A, Martinuzzi A, Vavla M, Reni G, Toscano A, Musumeci O, Kouwenberg CV, Laforêt P, Millán BS, Vieitez I, Siciliano G, Kühnle E, Trost R, Sacconi S, Durmus H, Kierdaszuk B, Wakelin A, Andreu AL, Pinós T, Marti R, Quinlivan R, Vissing J, Voermans NC. Data from the European registry for patients with McArdle disease (EUROMAC): functional status and social participation. Orphanet J Rare Dis 2023; 18:210. [PMID: 37488619 PMCID: PMC10367320 DOI: 10.1186/s13023-023-02825-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The European registry for individuals with GSD5 and other muscle glycogenosis (EUROMAC) was launched to register rare muscle glycogenosis in Europe, to facilitate recruitment for research trials and to learn about the phenotypes and disseminate knowledge about the diseases. A network of twenty collaborating partners from eight European countries and the US contributed data on rare muscle glycogenosis in the EUROMAC registry. METHODS Following the initial report on demographics, neuromuscular features and comorbidity (2020), we here present the data on social participation, previous and current treatments (medication, supplements, diet and rehabilitation) and limitations. Furthermore, the following questionnaires were used: Fatigue severity scale (FSS), WHO Disability Assessment Scale (DAS 2.0), health related quality of life (SF36) and International Physical Activity Questionnaire (IPAQ). RESULTS Of 282 participants with confirmed diagnoses of muscle glycogenosis, 269 had GSD5. Of them 196 (73%) completed all questionnaires; for the others, the data were incomplete. The majority, 180 (67%) were currently working. Previous medical treatments included pain medication (23%) and rehabilitation treatment (60%). The carbohydrate-rich diet was reported to be beneficial for 68%, the low sucrose diet for 76% and the ketogenic diet for 88%. Almost all participants (93%) reported difficulties climbing stairs. The median FSS score was 5.22, indicating severe fatigue. The data from the WHODAS and IPAQ was not of sufficient quality to be interpreted. CONCLUSIONS The EUROMAC registry have provided insight into the functional and social status of participants with GSD5: most participants are socially active despite limitations in physical and daily life activities. Regular physical activity and different dietary approaches may alleviate fatigue and pain.
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Affiliation(s)
- Walaa Karazi
- Neuromuscular Center Nijmegen, Department of Neurology, 910, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Renata S Scalco
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, National Hospital, London, UK
| | - Mads G Stemmerik
- Copenhagen Neuromuscular Center, Section 8077, , Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Nicoline Løkken
- Copenhagen Neuromuscular Center, Section 8077, , Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Instituto de Investigación Hospital, 12 de Octubre (imas12), Madrid, Spain
| | - Alfredo Santalla
- Instituto de Investigación Hospital, 12 de Octubre (imas12), Madrid, Spain
- Universidad Pablo de Olavide, Seville, Spain
| | - Andrea Martinuzzi
- Departments of Neurorehabilitation, IRCCS Medea Scientifc Insitute, Conegliano-Pieve Di Soligo, Italy
| | - Marinela Vavla
- Departments of Neurorehabilitation, IRCCS Medea Scientifc Insitute, Conegliano-Pieve Di Soligo, Italy
| | - Gianluigi Reni
- Department of Information Technology, Autonomous Province of Bolzano, Bolzano, Italy
| | - Antonio Toscano
- Neurology and Neuromuscular Diseases Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Olimpia Musumeci
- Neurology and Neuromuscular Diseases Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carlyn V Kouwenberg
- Neuromuscular Center Nijmegen, Department of Neurology, 910, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Pascal Laforêt
- Neurology Department, Raymond Poincaré University Hospital, APHP, Garches, France
| | - Beatriz San Millán
- Pathology Department, Alvaro Cunqueiro Hospital, Vigo, Spain
- Rare Diseases and Pediatric Medicine Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGASUVIGO, Vigo, Spain
| | - Irene Vieitez
- Rare Diseases and Pediatric Medicine Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGASUVIGO, Vigo, Spain
| | - Gabriele Siciliano
- Neurology and Neuromuscular Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Kühnle
- Department of Neurology, Heimer Institute for Muscle Research, University Hospital Bochum, Bochum, Germany
| | - Rebecca Trost
- Department of Neurology, Heimer Institute for Muscle Research, University Hospital Bochum, Bochum, Germany
| | - Sabrina Sacconi
- Peripheral Nervous System and Muscle Department, CHU Nice, Université Côte D'Azur, Institute for Research On Cancer and Aging of Nice (IRCAN), INSERM U1081, CNRS UMR 7284, Faculty of Medicine, Université Côte D'Azur (UCA), Nice, France
| | - Hacer Durmus
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Biruta Kierdaszuk
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Andrew Wakelin
- Association for Glycogen Storage Disease (UK), Bristol, UK
| | - Antoni L Andreu
- EATRIS, European Infrastructure for Translational Medicine, 1081 HZ, Amsterdam, The Netherlands
| | - Tomàs Pinós
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Ramon Marti
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, National Hospital, London, UK
| | - John Vissing
- Copenhagen Neuromuscular Center, Section 8077, , Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Nicol C Voermans
- Neuromuscular Center Nijmegen, Department of Neurology, 910, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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11
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Gümüş E, Özen H. Glycogen storage diseases: An update. World J Gastroenterol 2023; 29:3932-3963. [PMID: 37476587 PMCID: PMC10354582 DOI: 10.3748/wjg.v29.i25.3932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/15/2023] [Accepted: 04/30/2023] [Indexed: 06/28/2023] Open
Abstract
Glycogen storage diseases (GSDs), also referred to as glycogenoses, are inherited metabolic disorders of glycogen metabolism caused by deficiency of enzymes or transporters involved in the synthesis or degradation of glycogen leading to aberrant storage and/or utilization. The overall estimated GSD incidence is 1 case per 20000-43000 live births. There are over 20 types of GSD including the subtypes. This heterogeneous group of rare diseases represents inborn errors of carbohydrate metabolism and are classified based on the deficient enzyme and affected tissues. GSDs primarily affect liver or muscle or both as glycogen is particularly abundant in these tissues. However, besides liver and skeletal muscle, depending on the affected enzyme and its expression in various tissues, multiorgan involvement including heart, kidney and/or brain may be seen. Although GSDs share similar clinical features to some extent, there is a wide spectrum of clinical phenotypes. Currently, the goal of treatment is to maintain glucose homeostasis by dietary management and the use of uncooked cornstarch. In addition to nutritional interventions, pharmacological treatment, physical and supportive therapies, enzyme replacement therapy (ERT) and organ transplantation are other treatment approaches for both disease manifestations and long-term complications. The lack of a specific therapy for GSDs has prompted efforts to develop new treatment strategies like gene therapy. Since early diagnosis and aggressive treatment are related to better prognosis, physicians should be aware of these conditions and include GSDs in the differential diagnosis of patients with relevant manifestations including fasting hypoglycemia, hepatomegaly, hypertransaminasemia, hyperlipidemia, exercise intolerance, muscle cramps/pain, rhabdomyolysis, and muscle weakness. Here, we aim to provide a comprehensive review of GSDs. This review provides general characteristics of all types of GSDs with a focus on those with liver involvement.
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Affiliation(s)
- Ersin Gümüş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ihsan Dogramaci Children’s Hospital, Ankara 06230, Turkey
| | - Hasan Özen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hacettepe University Faculty of Medicine, Ihsan Dogramaci Children’s Hospital, Ankara 06230, Turkey
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12
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Urtizberea JA, Severa G, Malfatti E. Metabolic Myopathies in the Era of Next-Generation Sequencing. Genes (Basel) 2023; 14:genes14050954. [PMID: 37239314 DOI: 10.3390/genes14050954] [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: 03/09/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Metabolic myopathies are rare inherited disorders that deserve more attention from neurologists and pediatricians. Pompe disease and McArdle disease represent some of the most common diseases in clinical practice; however, other less common diseases are now better-known. In general the pathophysiology of metabolic myopathies needs to be better understood. Thanks to the advent of next-generation sequencing (NGS), genetic testing has replaced more invasive investigations and sophisticated enzymatic assays to reach a final diagnosis in many cases. The current diagnostic algorithms for metabolic myopathies have integrated this paradigm shift and restrict invasive investigations for complicated cases. Moreover, NGS contributes to the discovery of novel genes and proteins, providing new insights into muscle metabolism and pathophysiology. More importantly, a growing number of these conditions are amenable to therapeutic approaches such as diets of different kinds, exercise training protocols, and enzyme replacement therapy or gene therapy. Prevention and management-notably of rhabdomyolysis-are key to avoiding serious and potentially life-threatening complications and improving patients' quality of life. Although not devoid of limitations, the newborn screening programs that are currently mushrooming across the globe show that early intervention in metabolic myopathies is a key factor for better therapeutic efficacy and long-term prognosis. As a whole NGS has largely increased the diagnostic yield of metabolic myopathies, but more invasive but classical investigations are still critical when the genetic diagnosis is unclear or when it comes to optimizing the follow-up and care of these muscular disorders.
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Affiliation(s)
| | - Gianmarco Severa
- Department of Medical, Surgical and Neurological Sciences, Neurology-Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 5310 Siena, Italy
- Université Paris Est, U955, IMRB, INSERM, APHP, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, 94000 Créteil, France
| | - Edoardo Malfatti
- Université Paris Est, U955, IMRB, INSERM, APHP, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, 94000 Créteil, France
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13
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Løkken N, Voermans NC, Andersen LK, Karazi W, Reason SL, Zweers H, Wilms G, Santalla A, Susanibar E, Lucia A, Vissing J. Patient-Reported Experiences with a Low-Carbohydrate Ketogenic Diet: An International Survey in Patients with McArdle Disease. Nutrients 2023; 15:nu15040843. [PMID: 36839201 PMCID: PMC9964801 DOI: 10.3390/nu15040843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
The low-carbohydrate ketogenic diet (LCKD) has attracted increased attention in recent years as a potential treatment option for individuals with McArdle disease (glycogen storage disease type V), and despite the absence of strong scientific evidence of the LCKD's benefits, increased numbers of individuals with McArdle disease have tried a LCKD. The objective of this study was to collect patient-reported experiences with a LCKD. We aimed to estimate the immediate prevalence of individuals that had tried a LCKD in an international McArdle disease cohort, and we aimed to report on the patient-reported experiences with the diet, both positive and negative. A total of 183 responses were collected from individuals with McArdle disease from 18 countries. We found that one-third of the cohort had tried a LCKD, and almost 90% experienced some degree of positive effect, with the most prominent effects on McArdle disease-related core symptoms (e.g., activity intolerance, muscle pain, and muscle fatigue). Adverse effects were rare and generally rated as mild to moderate. These patient-reported findings underline the need for randomized clinical trials to decisively determine if a LCKD is a suitable nutritional strategy for patients with McArdle disease. The results from this study can prompt and contribute to the design of such a clinical trial.
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Affiliation(s)
- Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-35458748
| | - Nicol C. Voermans
- The Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Linda K. Andersen
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Walaa Karazi
- The Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Stacey L. Reason
- International Association for Muscle Glycogen Storage Disease, Torrance, CA 90505, USA
| | - Heidi Zweers
- Department of Gastroenterology and Hepatology-Dietetics, Radboudumc, 6500 HB Nijmegen, The Netherlands
| | - Gustav Wilms
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Alfredo Santalla
- Department of Sport and Computer Science, Section of Physical Education and Sports, Faculty of Sport, Universidad Pablo de Olavide, 41013 Seville, Spain
| | - Edward Susanibar
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Physical Activity Health Research Group (PaHerg), Research Institute of Hospital 12 de Octubre (‘i+12’), 28040 Madrid, Spain
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK-2200 Copenhagen, Denmark
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14
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Villarreal-Salazar M, Santalla A, Real-Martínez A, Nogales-Gadea G, Valenzuela PL, Fiuza-Luces C, Andreu AL, Rodríguez-Aguilera JC, Martín MA, Arenas J, Vissing J, Lucia A, Krag TO, Pinós T. Low aerobic capacity in McArdle disease: A role for mitochondrial network impairment? Mol Metab 2022; 66:101648. [PMID: 36455789 PMCID: PMC9758572 DOI: 10.1016/j.molmet.2022.101648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND McArdle disease is caused by myophosphorylase deficiency and results in complete inability for muscle glycogen breakdown. A hallmark of this condition is muscle oxidation impairment (e.g., low peak oxygen uptake (VO2peak)), a phenomenon traditionally attributed to reduced glycolytic flux and Krebs cycle anaplerosis. Here we hypothesized an additional role for muscle mitochondrial network alterations associated with massive intracellular glycogen accumulation. METHODS We analyzed in depth mitochondrial characteristics-content, biogenesis, ultrastructure-and network integrity in skeletal-muscle from McArdle/control mice and two patients. We also determined VO2peak in patients (both sexes, N = 145) and healthy controls (N = 133). RESULTS Besides corroborating very poor VO2peak values in patients and impairment in muscle glycolytic flux, we found that, in McArdle muscle: (a) damaged fibers are likely those with a higher mitochondrial and glycogen content, which show major disruption of the three main cytoskeleton components-actin microfilaments, microtubules and intermediate filaments-thereby contributing to mitochondrial network disruption in skeletal muscle fibers; (b) there was an altered subcellular localization of mitochondrial fission/fusion proteins and of the sarcoplasmic reticulum protein calsequestrin-with subsequent alteration in mitochondrial dynamics/function; impairment in mitochondrial content/biogenesis; and (c) several OXPHOS-related complex proteins/activities were also affected. CONCLUSIONS In McArdle disease, severe muscle oxidative capacity impairment could also be explained by a disruption of the mitochondrial network, at least in those fibers with a higher capacity for glycogen accumulation. Our findings might pave the way for future research addressing the potential involvement of mitochondrial network alterations in the pathophysiology of other glycogenoses.
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Affiliation(s)
- M Villarreal-Salazar
- Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - A Santalla
- Universidad Pablo de Olavide, Sevilla, Spain
| | - A Real-Martínez
- Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - G Nogales-Gadea
- Grup de Recerca en Malalties Neuromusculars i Neuropediàtriques, Department of Neurosciences, Institut d'Investigacio en Ciencies de la Salut Germans Trias i Pujol i Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Spain
| | - P L Valenzuela
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain
| | - C Fiuza-Luces
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain
| | - A L Andreu
- EATRIS, European Infrastructure for Translational Medicine, Amsterdam, Netherlands
| | - J C Rodríguez-Aguilera
- Universidad Pablo de Olavide, Sevilla, Spain; Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide, Sevilla, Spain
| | - M A Martín
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Mitochondrial and Neuromuscular Diseases Laboratory, 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - J Arenas
- Mitochondrial and Neuromuscular Diseases Laboratory, 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - J Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Lucia
- Faculty of Sport Sciences, European University, Madrid, Spain
| | - T O Krag
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - T Pinós
- Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.
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15
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Løkken N, Revsbech KL, Jacobsen LN, Martinuzzi A, Martin MÁ, Díaz-Manera J, Dominguez-Gonzalez C, Brondani G, Musumeci O, Granata F, Stefan C, Merino-Sanchez C, Peralta CN, Khawajazada T, Alonso-Pérez J, Toscano A, Vissing J. Muscle MRI in McArdle Disease: A European Multicenter Observational Study. Neurology 2022; 99:e1664-e1675. [PMID: 35853747 DOI: 10.1212/wnl.0000000000200914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Glycogen storage disease type V (GSDV) or McArdle disease is a muscle glycogenosis that classically manifests with exercise intolerance and exercise-induced muscle pain. Muscle weakness and wasting may occur, but it is typically mild and described as located around the shoulder girdle in elderly patients. Paraspinal muscle involvement has received little attention in the literature. This study aimed to quantify fat replacement of paraspinal, shoulder, and lower limb muscles by magnetic resonance imaging in a European cohort of patients with GSDV. METHODS This observational study included patients with verified GSDV and healthy controls (HCs). Whole-body MRIs and clinical data were collected. The degree of muscle fat replacement was evaluated on T1-weighted images with the semiquantitative visual Mercuri scale and on Dixon images where individual muscle fat fractions (FFs) were quantitatively calculated. RESULTS MRIs and clinical data from a total of 57 patients with GSDV (age 44.3 ± 15.2 years) from 5 European centers were assessed and compared with findings in 30 HCs (age 42.4 ± 14.8 years). Patients with GSDV had significantly more fat replacement of the paraspinal muscles compared with HCs on all levels investigated, detected by both the Mercuri and the Dixon method (Dixon, paraspinal composite FF [GSDV vs HC] at the cervical level: 31.3 ± 13.1 vs 15.4 ± 7.8; thoracic level: 34.5±19.0 vs 16.9±8.6; and lumbar level: 43.9 ± 19.6 vs 21.8 ± 10.2 [p < 0.0001]). Patients with GSDV also had significantly more fat replacement of the shoulder muscles (evaluated by the Mercuri scale), along with significantly, but numerically less, fat replacement of thigh and calf muscles compared with HC (Dixon, lower limb composite FF [GSDV vs HC] at the thigh level: 12.0 ± 5.6 vs 8.8 ± 2.7 and calf level: 13.1 ± 6.7 vs 9.1 ± 2.9 [p ≤ 0.05]). DISCUSSION The primary findings are that patients with GSDV exhibit severe fat replacement of the paraspinal muscles, which can have important implications for the future management of patients with GSDV, and also significant fat replacement of shoulder girdle muscles as previously described. The clinical relevance of the discrete increases in lower limb FF is uncertain. The changes were found to be age-related in both groups, but an accelerated effect was found in GSDV, probably due to continuous muscle damage.
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Affiliation(s)
- Nicoline Løkken
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy.
| | - Karoline Lolk Revsbech
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Laura Nørager Jacobsen
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Andrea Martinuzzi
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Miguel Ángel Martin
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Jordi Díaz-Manera
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Cristina Dominguez-Gonzalez
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Giovanni Brondani
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Olimpia Musumeci
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Francesca Granata
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Cristina Stefan
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Concepción Merino-Sanchez
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Claudia Nuñez Peralta
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Tahmina Khawajazada
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Jorge Alonso-Pérez
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Antonio Toscano
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - John Vissing
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
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Cabrera-Serrano M, Ravenscroft G. Recent advances in our understanding of genetic rhabdomyolysis. Curr Opin Neurol 2022; 35:651-657. [PMID: 35942668 DOI: 10.1097/wco.0000000000001096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW This review summarizes recent advances in our understanding of the genetics of rhabdomyolysis. RECENT FINDINGS Rhabdomyolysis is the acute breakdown of myofibres resulting in systemic changes that can be life-threatening. Environmental triggers, including trauma, exercise, toxins and infections, and/or gene defects can precipitate rhabdomyolysis. A schema (aptly titled RHABDO) has been suggested for evaluating whether a patient with rhabdomyolysis is likely to harbour an underlying genetic defect. It is becoming increasingly recognized that defects in muscular dystrophy and myopathy genes can trigger rhabdomyolysis, even as the sole or presenting feature. Variants in genes not previously associated with human disease have been identified recently as causative of rhabdomyolysis, MLIP , MYH1 and OBSCN . Our understanding of the pathomechanisms contributing to rhabdomyolysis have also improved with an increased awareness of the role of mitochondrial dysfunction in LPIN1 , FDX2 , ISCU and TANGO2 -mediated disease. SUMMARY An accurate genetic diagnosis is important for optimal clinical management of the patient, avoiding associated triggers and genetic counselling and cascade screening. Despite recent advances in our understanding of the genetics contributing to rhabdomyolysis, many patients remain without an accurate genetic diagnosis, suggesting there are many more causative genes, variants and disease mechanisms to uncover.
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Affiliation(s)
- Macarena Cabrera-Serrano
- Harry Perkins Institute of Medical Research
- Centre for Medical Research, University of Western Australia, Nedlands, Western Australia, Australia
- Unidad de Enfermedades Neuromusculares, Servicio de Neurologia y Neurofisiologia and Instituto de Biomedicina de Sevilla (IBiS)., Hospital Virgen del Rocio, Sevilla, Spain
| | - Gianina Ravenscroft
- Harry Perkins Institute of Medical Research
- Centre for Medical Research, University of Western Australia, Nedlands, Western Australia, Australia
- School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
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Long JC, Best S, Nic Giolla Easpaig B, Hatem S, Fehlberg Z, Christodoulou J, Braithwaite J. Needs of people with rare diseases that can be supported by electronic resources: a scoping review. BMJ Open 2022; 12:e060394. [PMID: 36581982 PMCID: PMC9438091 DOI: 10.1136/bmjopen-2021-060394] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Rare diseases are characterised by low incidence, often with little evidence for effective treatments. Isolated patients and specialist centres for rare diseases are increasingly connected, thanks to the internet. This scoping review aimed to identify issues facing people with a rare disease that authors report may be addressed by electronic resources (mobile applications, websites, social media platforms, telehealth and online portals). DESIGN Scoping review guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. DATA SOURCES Medline, Embase and PsycInfo were searched, supplemented by hand searches of selected journals, in July 2021. ELIGIBILITY CRITERIA Peer-reviewed literature in English was searched using terms for rare disease (incidence <1:2000), electronic modalities (eg, mobile phone) and patient support terms. No date limit was set. Conference abstracts were included. DATA EXTRACTION AND SYNTHESIS Data extracted: rare disease/group of diseases, name of the e-resource, need identified in the patient cohort, features of the e-resource, any other findings or observations of interest. From this, a framework was developed synthesising features across diseases and resources. RESULTS Seventy-two papers were found (from 383). Fifty-six electronic resources were described in 64 papers, while 12 papers were exploratory studies. Cystic fibrosis (n=28) was the most frequently addressed, followed by haemophilia (n=16).Four domains and 23 subdomains of needs were extracted from the papers. The domains of needs were: support for self-management, access to high-quality information, access to appropriate specialist services, and social support. Subdomains are sometimes related to needs of individual rare diseases (eg, social isolation due to infection risk in people with cystic fibrosis). Fifteen electronic resources were identified that supported parents of children with rare disorders. CONCLUSIONS While it can be argued that rare diseases, per se, may be no less distressing or onerous to care for than a high prevalence disease, rare diseases have unique features: the lengthy odyssey to find a diagnosis, then appropriate specialists, the lack of evidence around effective treatments, guidelines or access to knowledgeable general health service providers. Designers of electronic resources are urged to consult key stakeholders to enhance the effectiveness and usability of resources for people with a rare disease.
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Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Zoe Fehlberg
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics Health Alliance, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - John Christodoulou
- Brain and Mitochondrial Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Santalla A, Valenzuela PL, Rodriguez-Lopez C, Rodríguez-Gómez I, Nogales-Gadea G, Pinós T, Arenas J, Martín MA, Santos-Lozano A, Morán M, Fiuza-Luces C, Ara I, Lucia A. Long-Term Exercise Intervention in Patients with McArdle Disease: Clinical and Aerobic Fitness Benefits. Med Sci Sports Exerc 2022; 54:1231-1241. [PMID: 35320153 DOI: 10.1249/mss.0000000000002915] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The long-term effects of exercise in patients with McArdle disease-the paradigm of "exercise intolerance"-are unknown. This is an important question because the severity of the disease frequently increases with time. PURPOSE This study aimed to study the effects of a long-term exercise intervention on clinical and fitness-related outcomes in McArdle patients. METHODS Seventeen patients (exercise group: n = 10, 6 male, 38 ± 18 yr; control: n = 7, 4 male, 38 ± 18 yr) participated in a 2-yr unsupervised intervention including moderate-intensity aerobic (cycle-ergometer exercise for 1 h) and resistance (high load-low repetition circuit) training on 5 and 2-3 d·wk -1 , respectively. Patients were assessed at baseline and postintervention. Besides safety, outcomes included clinical severity (e.g., exercise intolerance features) on a 0-3 scale (primary outcome), and aerobic fitness, gross muscle efficiency, and body composition (total/regional fat, muscle, and bone mass; secondary outcomes). RESULTS The exercise program was safe and resulted in a reduction of 1 point (-1.0; 95% confidence interval, -1.6 to -0.5; P = 0.025) in clinical severity versus the control group, with 60% of participants in the exercise group becoming virtually asymptomatic and with no functional limitation in daily life activities. Compared with controls, the intervention induced significant and large benefits (all P < 0.05) in the workload eliciting the ventilatory threshold (both in absolute (watts, +37%) and relative units (watts per kilogram of total body mass or of lower-limb muscle mass, +44%)), peak oxygen uptake (in milliliters per kilogram per minute, +28%), and peak workload (in absolute (+27%) and relative units (+33%)). However, no significant changes were found for muscle efficiency or for any measure of body composition. CONCLUSIONS A 2-yr unsupervised intervention including aerobic and resistance exercise is safe and induces major benefits in the clinical course and aerobic fitness of patients with McArdle disease.
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Affiliation(s)
| | | | | | | | - Gisela Nogales-Gadea
- Neuromuscular and Neuropediatric Research Group, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, SPAIN
| | | | | | | | | | | | - Carmen Fiuza-Luces
- Instituto de Investigación Sanitaria Hospital "12 de Octubre" ("imas12"), Madrid, SPAIN
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García-Consuegra I, Asensio-Peña S, Garrido-Moraga R, Pinós T, Domínguez-González C, Santalla A, Nogales-Gadea G, Serrano-Lorenzo P, Andreu AL, Arenas J, Zugaza JL, Lucia A, Martín MA. Identification of Potential Muscle Biomarkers in McArdle Disease: Insights from Muscle Proteome Analysis. Int J Mol Sci 2022; 23:4650. [PMID: 35563042 PMCID: PMC9100117 DOI: 10.3390/ijms23094650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/03/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023] Open
Abstract
Glycogen storage disease type V (GSDV, McArdle disease) is a rare genetic myopathy caused by deficiency of the muscle isoform of glycogen phosphorylase (PYGM). This results in a block in the use of muscle glycogen as an energetic substrate, with subsequent exercise intolerance. The pathobiology of GSDV is still not fully understood, especially with regard to some features such as persistent muscle damage (i.e., even without prior exercise). We aimed at identifying potential muscle protein biomarkers of GSDV by analyzing the muscle proteome and the molecular networks associated with muscle dysfunction in these patients. Muscle biopsies from eight patients and eight healthy controls showing none of the features of McArdle disease, such as frequent contractures and persistent muscle damage, were studied by quantitative protein expression using isobaric tags for relative and absolute quantitation (iTRAQ) followed by artificial neuronal networks (ANNs) and topology analysis. Protein candidate validation was performed by Western blot. Several proteins predominantly involved in the process of muscle contraction and/or calcium homeostasis, such as myosin, sarcoplasmic/endoplasmic reticulum calcium ATPase 1, tropomyosin alpha-1 chain, troponin isoforms, and alpha-actinin-3, showed significantly lower expression levels in the muscle of GSDV patients. These proteins could be potential biomarkers of the persistent muscle damage in the absence of prior exertion reported in GSDV patients. Further studies are needed to elucidate the molecular mechanisms by which PYGM controls the expression of these proteins.
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Affiliation(s)
- Inés García-Consuegra
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
| | - Sara Asensio-Peña
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
| | - Rocío Garrido-Moraga
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
| | - Tomàs Pinós
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
- Mitochondrial and Neuromuscular Disorders Unit, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Cristina Domínguez-González
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
| | - Alfredo Santalla
- Department of Computer and Sport Sciences, Universidad Pablo de Olavide, 41013 Sevilla, Spain;
| | - Gisela Nogales-Gadea
- Grup de Recerca en Malalties Neuromusculars i Neuropediàtriques, Department of Neurosciences, Institut d’Investigacio en Ciencies de la Salut Germans Trias i Pujol i Campus Can Ruti, Universitat Autònoma de Barcelona, 08916 Barcelona, Spain;
| | - Pablo Serrano-Lorenzo
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
| | - Antoni L. Andreu
- EATRIS, European Infrastructure for Translational Medicine, 1019 Amsterdam, The Netherlands;
| | - Joaquín Arenas
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
| | - José L. Zugaza
- Achucarro Basque Center for Neuroscience, Science Park of the UPV/EHU, and Department of Genetics, Physical Anthropology, and Animal Physiology, Faculty of Science and Technology, UPV/EHU, 48940 Leioa, Spain;
- IKERBASQUE, Basque Foundation for Science, Plaza Euskadi 5, 48009 Bilbao, Spain
| | - Alejandro Lucia
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Miguel A. Martín
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
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20
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Bordoli C, Murphy E, Varley I, Sharpe G, Hennis P. A Systematic Review investigating the Effectiveness of Exercise training in Glycogen Storage Diseases. THERAPEUTIC ADVANCES IN RARE DISEASE 2022; 3:26330040221076497. [PMID: 37180413 PMCID: PMC10032442 DOI: 10.1177/26330040221076497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/04/2022] [Indexed: 05/16/2023]
Abstract
Introduction Glycogen storage diseases (GSDs) are rare inborn errors of carbohydrate metabolism typically with skeletal muscle and liver involvement. In those with skeletal muscle involvement, the majority display symptoms of exercise intolerance which can cause profound exercise limitation and impair everyday living and quality of life (QoL). There are no curative treatments for GSDs, thus therapeutic options, such as exercise training, are aimed at improving QoL by alleviating signs and symptoms. In order to investigate the effectiveness of exercise training in adults with GSDs, we systematically reviewed the literature. Methods In this review we conducted searches within SCOPUS and MEDLINE to identify potential papers for inclusion. These papers were independently assessed for inclusion and quality by two authors. We identified 23 studies which included aerobic training, strength training or respiratory muscle training in patients with McArdles (n = 41) and Pompe disease (n = 139). Results In McArdle disease, aerobic exercise training improved aerobic capacity (VO2 peak) by 14-111% with further benefits to functional capacity and well-being. Meanwhile, strength training increased muscle peak power by 100-151% and reduced disease severity. In Pompe disease, a combination of aerobic and strength training improved VO2 peak by 9-10%, muscle peak power by 64%, functional capacity and well-being. Furthermore, respiratory muscle training (RMT) improved respiratory muscular strength [maximum inspiratory pressure (MIP) increased by up to 65% and maximum expiratory pressure (MEP) by up to 70%], with additional benefits shown in aerobic capacity, functional capacity and well-being. Conclusion This adds to the growing body of evidence which suggests that supervised exercise training is safe and effective in improving aerobic capacity and muscle function in adults with McArdle or Pompe disease. However, the literature base is limited in quality and quantity with a dearth of literature regarding exercise training in other GSD subtypes.
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Affiliation(s)
- Claire Bordoli
- Sport, Health and Performance Enhancement
(SHAPE) Research Centre, Nottingham Trent University, Clifton Lane, Clifton,
Nottingham NG11 8NS, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, The National
Hospital for Neurology and Neurosurgery, London, UK
| | - Ian Varley
- Sport, Health and Performance Enhancement
(SHAPE) Research Centre, Nottingham Trent University, Nottingham, UK
| | - Graham Sharpe
- Sport, Health and Performance Enhancement
(SHAPE) Research Centre, Nottingham Trent University, Nottingham, UK
| | - Philip Hennis
- Sport, Health and Performance Enhancement
(SHAPE) Research Centre, Nottingham Trent University, Nottingham, UK
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21
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Lucia A, Martinuzzi A, Nogales-Gadea G, Quinlivan R, Reason S. Clinical practice guidelines for glycogen storage disease V & VII (McArdle disease and Tarui disease) from an international study group. Neuromuscul Disord 2021; 31:1296-1310. [PMID: 34848128 DOI: 10.1016/j.nmd.2021.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandro Lucia
- Faculty of Sports Sciences, Universidad Europea de Madrid, Spain; Centro de Investigación Biomédica en Red en Fragilidad y Envejecimiento Saludable (CIBERFES) and Research Institute of the Hospital 12 de Octubre ('imas12', PaHerg group), Madrid, Spain
| | | | - Gisela Nogales-Gadea
- Institut d'Investigació Germans Trias i Pujol, Camí de les Escoles, Barcelona, Spain
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | - Stacey Reason
- International Association for Muscle Glycogen Storage Disease, California, USA.
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22
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Salazar-Martínez E, Santalla A, Valenzuela PL, Nogales-Gadea G, Pinós T, Morán M, Santos-Lozano A, Fiuza-Luces C, Lucia A. The Second Wind in McArdle Patients: Fitness Matters. Front Physiol 2021; 12:744632. [PMID: 34721068 PMCID: PMC8555491 DOI: 10.3389/fphys.2021.744632] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/27/2021] [Indexed: 12/28/2022] Open
Abstract
Background: The “second wind” (SW) phenomenon—commonly referring to both an initial period of marked intolerance to dynamic exercise (e.g., brisk walking) that is not followed by perceived improvement and disappearance of previous tachycardia (i.e., the actual “SW”) until 6–10 min has elapsed—is an almost unique feature of McArdle disease that limits adherence to an active lifestyle. In this regard, an increase in the workload eliciting the SW could potentially translate into an improved patients’ exercise tolerance in daily life. We aimed to determine whether aerobic fitness and physical activity (PA) levels are correlated with the minimum workload eliciting the SW in McArdle patients—as well as with the corresponding heart rate value. We also compared the SW variables and aerobic fitness indicators in inactive vs. active patients. Methods: Fifty-four McArdle patients (24 women, mean ± SD age 33 ± 12 years) performed 12-min constant-load and maximum ramp-like cycle-ergometer tests for SW detection and aerobic fitness [peak oxygen uptake (VO2peak) and workload and ventilatory threshold] determination, respectively. They were categorized as physically active/inactive during the prior 6 months (active = reporting ≥150 min/week or ≥75 min/week in moderate or vigorous-intensity aerobic PA, respectively) and were also asked on their self-report of the SW. Results: Both peak and submaximal indicators of aerobic fitness obtained in the ramp tests were significantly correlated with the workload of the SW test, with a particularly strong correlation for the VO2peak and peak workload attained by the patients (both Pearson’s coefficients > 0.70). Twenty (seven women) and 24 patients (18 women) were categorized as physically active and inactive, respectively. Not only the aerobic fitness level [∼18–19% higher values of VO2peak (ml⋅kg–1⋅min–1)] but also the workload of the SW tests was significantly higher in active than in inactive patients. All the inactive patients reported that they experienced the SW during walking/brisk walking in daily life, whereas active patients only reported experiencing this phenomenon during more strenuous activities (very brisk walking/jogging and bicycling). Conclusion: A higher aerobic fitness and an active lifestyle are associated with a higher workload eliciting the so-called SW phenomenon in patients with McArdle disease, which has a positive impact on their exercise tolerance during daily living.
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Affiliation(s)
| | - Alfredo Santalla
- Department of Sports and Computing, Pablo de Olavide University, Seville, Spain.,EVOPRED Research Group, Universidad Europea de Canarias, Tenerife, Spain
| | | | - Gisela Nogales-Gadea
- Neuromuscular and Neuropediatric Research Group, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomàs Pinós
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Morán
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Mitochondrial and Neuromuscular Diseases Laboratory, Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain.,Physical Activity and Health Research Group, Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain
| | - Carmen Fiuza-Luces
- Physical Activity and Health Research Group, Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,Physical Activity and Health Research Group, Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain
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23
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Pizzamiglio C, Mahroo OA, Khan KN, Patasin M, Quinlivan R. Phenotype and genotype of 197 British patients with McArdle disease: An observational single-centre study. J Inherit Metab Dis 2021; 44:1409-1418. [PMID: 34534370 DOI: 10.1002/jimd.12438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 01/10/2023]
Abstract
McArdle disease is caused by recessive mutations in PYGM gene. The condition is considered to cause a "pure" muscle phenotype with symptoms including exercise intolerance, inability to perform isometric activities, contracture, and acute rhabdomyolysis leading to acute renal failure. This is a retrospective observational study aiming to describe phenotypic and genotypic features of a large cohort of patients with McArdle disease between 2011 and 2019. Data relating to genotype and phenotype, including frequency of rhabdomyolysis, fixed muscle weakness, gout and comorbidities, inclusive of retinal disease (pattern retinal dystrophy) and thyroid disease, were collected. Data from 197 patients are presented. Seven previously unpublished PYGM mutations are described. Exercise intolerance (100%) and episodic rhabdomyolysis (75.6%) were the most common symptoms. Fixed muscle weakness was present in 82 (41.6%) subjects. Unexpectedly, ptosis was observed in 28 patients (14.2%). Hyperuricaemia was a common finding present in 88 subjects (44.7%), complicated by gout in 25% of cases. Thyroid dysfunction was described in 30 subjects (15.2%), and in 3 cases, papillary thyroid cancer was observed. Pattern retinal dystrophy was detected in 15 out of the 41 subjects that underwent an ophthalmic assessment (36.6%). In addition to fixed muscle weakness, ptosis was a relatively common finding. Surprisingly, dysfunction of thyroid and retinal abnormalities were relatively frequent comorbidities. Further studies are needed to better clarify this association, although our finding may have important implication for patient management.
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Affiliation(s)
- Chiara Pizzamiglio
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Omar A Mahroo
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital, London, UK
- Section of Ophthalmology, King's College London, St Thomas' Hospital Campus, London, UK
| | - Kamron N Khan
- Leeds Centre for Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Ophthalmology, Calderdale and Huddersfield NHS Trust, Huddersfield, UK
| | - Maria Patasin
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Rosaline Quinlivan
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
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24
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The phenotypic and genotypic features of a Scottish cohort with McArdle disease. Neuromuscul Disord 2021; 31:695-700. [PMID: 34215481 DOI: 10.1016/j.nmd.2021.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/01/2021] [Accepted: 05/25/2021] [Indexed: 11/20/2022]
Abstract
This retrospective study evaluated the phenotypic and genotypic features of 14 patients with McArdle disease attending the West of Scotland adult muscle clinic. Although all patients experienced exercise-induced cramps, exercise intolerance and hyperCKaemia, only 71% (n = 10) experienced the second wind phenomenon, rhabdomyolysis and/or myoglobinuria. We observed a high rate of fixed muscle weakness (50%; n = 7), coronary artery disease (36%; n = 5), and psychological comorbidity (50%; n = 7). Although 79% had symptom onset in the first decade of life, the mean age at presentation and at genetic diagnosis was 43.8 years and 47.7 years, respectively. 93% had at least one copy of the common PYGM pathogenic variant, c.148C > T, p.(Arg50*), with 50% (n = 7) of the cohort being homozygous. Our cohort highlights the phenotypic variability seen in McArdle disease and underscores the potential for late-onset presentations. It emphasises the need for improved awareness and recognition of this condition amongst neurologists, rheumatologists and general physicians. A history of exercise intolerance and second wind phenomenon may not always be volunteered by the patient, underscoring the need to ask specific questions in clinic to extrapolate the relevant symptoms in this patient cohort.
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25
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Migocka-Patrzałek M, Elias M. Muscle Glycogen Phosphorylase and Its Functional Partners in Health and Disease. Cells 2021; 10:cells10040883. [PMID: 33924466 PMCID: PMC8070155 DOI: 10.3390/cells10040883] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 02/07/2023] Open
Abstract
Glycogen phosphorylase (PG) is a key enzyme taking part in the first step of glycogenolysis. Muscle glycogen phosphorylase (PYGM) differs from other PG isoforms in expression pattern and biochemical properties. The main role of PYGM is providing sufficient energy for muscle contraction. However, it is expressed in tissues other than muscle, such as the brain, lymphoid tissues, and blood. PYGM is important not only in glycogen metabolism, but also in such diverse processes as the insulin and glucagon signaling pathway, insulin resistance, necroptosis, immune response, and phototransduction. PYGM is implicated in several pathological states, such as muscle glycogen phosphorylase deficiency (McArdle disease), schizophrenia, and cancer. Here we attempt to analyze the available data regarding the protein partners of PYGM to shed light on its possible interactions and functions. We also underline the potential for zebrafish to become a convenient and applicable model to study PYGM functions, especially because of its unique features that can complement data obtained from other approaches.
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26
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Pinós T, Andreu AL, Bruno C, Hadjigeorgiou GM, Haller RG, Laforêt P, Lucía A, Martín MA, Martinuzzi A, Navarro C, Oflazer P, Pouget J, Quinlivan R, Sacconi S, Scalco RS, Toscano A, Vissing J, Vorgerd M, Wakelin A, Martí R. Creation and implementation of a European registry for patients with McArdle disease and other muscle glycogenoses (EUROMAC registry). Orphanet J Rare Dis 2020; 15:187. [PMID: 33054807 PMCID: PMC7558742 DOI: 10.1186/s13023-020-01455-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International patient registries are of particular importance for rare disorders, as they may contribute to overcome the lack of knowledge derived from low number of patients and limited awareness of these diseases, and help to learn more about their geographical or population-based specificities, which is relevant for research purposes and for promoting better standards of care and diagnosis. Our objective was to create and implement a European registry for patients with McArdle disease and other muscle glycogenoses (EUROMAC) and to disseminate the knowledge of these disorders. RESULTS Teams from nine different countries (United Kingdom, Spain, Italy, France, Germany, Denmark, Greece, Turkey and USA) created a consortium that developed the first European registry dedicated to rare muscle glycogenoses. A work plan was implemented to design the database and platform that constitute the registry, by choosing clinical, genetics and molecular variables of interest, based on experience gained from previous national registries for similar metabolic disorders. Among dissemination activities, several teaching events were organized in different countries, especially those where the consortium considered the awareness of these diseases needs to be promoted among health professionals and patients. CONCLUSION EUROMAC represents a step forward in the knowledge of those disorders to which it is dedicated, and will have relevant clinical outcomes at the diagnostic, epidemiological, clinical and research level.
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Affiliation(s)
- Tomàs Pinós
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119, 08035, Barcelona, Catalonia, Spain
| | - Antoni L Andreu
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119, 08035, Barcelona, Catalonia, Spain
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Ronald G Haller
- Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, TX, USA
| | - Pascal Laforêt
- Nord/Est/Ile de France Neuromuscular Reference Center, Neurology Department, Raymond-Poincaré Teaching Hospital, AP-HP, Garches, France
- INSERM U1179, END-ICAP, Paris Saclay University, Paris, France
| | - Alejandro Lucía
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and 12 de Octubre University Hospital Research Institute, ('imas12'), Madrid, Spain
| | - Miguel A Martín
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and 12 de Octubre University Hospital Research Institute, ('imas12'), Madrid, Spain
| | - Andrea Martinuzzi
- Department of Conegliano-Pieve di Soligo, IRCCS Eugenio Medea-Associazione "La Nostra Famiglia" Scientific Institute, Bosisio Parini, Italy
| | | | - Piraye Oflazer
- Department of Neurology, Neuromuscular Unit, Istanbul University, Istanbul, Turkey
| | - Jean Pouget
- Centre de Référence Maladies Neuromusculaires, Assistance Publique-Hopitaux de Marseille, Marseille, France
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, National Hospital, London, UK
| | | | - Renata S Scalco
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, National Hospital, London, UK
| | - Antonio Toscano
- Neurology and Neuromuscular Diseases Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - John Vissing
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Vorgerd
- Heimer Institute for Muscle Research, University Hospital Bergmannsheil Bochum, Bochum, Germany
| | | | - Ramon Martí
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119, 08035, Barcelona, Catalonia, Spain.
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