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Shelly S, Soontrapa P, Madigan NN, Polzin MJ, Singh TD, Sista SRS, Paul P, Braksick SA, Liao B, Windebank AJ, Boon AJ, Litchy WJ, Milone M, Liewluck T. Compound Muscle Action Potential and Myosin-Loss Pathology in Patients With Critical Illness Myopathy: Correlation and Prognostication. Neurology 2024; 103:e209496. [PMID: 38870464 DOI: 10.1212/wnl.0000000000209496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Prolonged compound muscle action potential (CMAP) duration and preferential loss of myosin are considered the diagnostic hallmarks of critical illness myopathy (CIM); however, their correlation and prognostic values have not been studied. We aimed to investigate the correlation between CMAP duration and myosin loss and their effect on mortality by comparing between patients with CIM with and without myosin loss. METHODS We searched the Mayo Clinic Electromyography Laboratory databases (1986-2021) for patients diagnosed with CIM on the basis of prolonged distal CMAP durations (>15 msec in fibular motor nerve studies recording over the tibialis anterior or >8 msec in other motor nerves) and needle EMG findings compatible with myopathy. Electrodiagnostic studies were generally performed within 24 hours after weakness became noticeable. We included only patients who underwent muscle biopsy. Clinical, electrophysiologic, and myopathologic data were reviewed. We conducted myosin/actin ratio analysis when muscle tissue was available. We used the Fisher exact test for categorical data comparisons and the Mann-Whitney 2-tailed test for continuous data. We applied the Kaplan-Meier technique to analyze survival rates. RESULTS Twenty patients (13 female patients) were identified [median age at diagnosis of 62.5 years (range: 19-80 years)]. The median onset of weakness was 24 days (range: 1-128) from the first day of intensive care unit admission. Muscle biopsy showed myosin loss in 14 patients, 9 of whom had >50% of myofibers affected (high grade). Type 2 fiber atrophy was observed in 19 patients, 13 of whom also had myosin loss. Patients with myosin loss had higher frequency of steroid exposure (14 vs 3; p = 0.004); higher median number of necrotic fibers per low-power field (2.5 vs 1, p = 0.04); and longer median CMAP duration (msec) of fibular (13.4 vs 8.75, p = 0.02), tibial (10 vs 7.8, p = 0.01), and ulnar (11.1 vs 7.95, p = 0.002) nerves compared with those without. Only patients with high-grade myosin loss had reduced myosin/actin ratios (<1.7). Ten patients died during median follow-up of 3 months. The mortality rate was similar between patients with and without myosin loss. Patients with high-grade myosin loss had a lower overall survival rate than those with low-grade or no myosin loss, but this was not statistically significant (p = 0.05). DISCUSSION Myosin loss occurred in 70% of the patients with CIM with prolonged CMAP duration. Longer CMAP duration predicts myosin-loss pathology. The extent of myosin loss marginally correlates with the mortality rate. Our findings highlight the potential prognostic values of CMAP duration and myosin loss severity in predicting disease outcome.
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Affiliation(s)
- Shahar Shelly
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Pannathat Soontrapa
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Nicolas N Madigan
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Michael J Polzin
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Tarun D Singh
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Sri Raghav S Sista
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Pritikanta Paul
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Sherri A Braksick
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Bing Liao
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Anthony J Windebank
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Andrea J Boon
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - William J Litchy
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Margherita Milone
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
| | - Teerin Liewluck
- From the Department of Neurology (S.S., P.S., N.N.M., M.J.P., S.A.B., A.J.W., A.J.B., W.J.L., M.M., T.L.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.), Rambam Medical Center, Haifa, Israel; Division of Neurology (P.S.), Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (T.D.S.), University of Michigan, Ann Arbor; Department of Neurology (S.R.S.S.), University of Texas Health Sciences at Houston; Department of Neurology (P.P.), University of California, San Francisco; Department of Neurology (B.L.), Houston Methodist Hospital, TX; and Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic, Rochester, MN
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Nicolau S, Dasgupta A, Dasari S, Charlesworth MC, Johnson KL, Pandey A, Doles JD, Milone M. Molecular signatures of inherited and acquired sporadic late onset nemaline myopathies. Acta Neuropathol Commun 2023; 11:20. [PMID: 36703211 PMCID: PMC9878979 DOI: 10.1186/s40478-023-01518-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
Acquired sporadic late onset nemaline myopathy (SLONM) and inherited nemaline myopathy (iNM) both feature accumulation of nemaline rods in muscle fibers. Unlike iNM, SLONM is amenable to therapy. The distinction between these disorders is therefore crucial when the diagnosis remains ambiguous after initial investigations. We sought to identify biomarkers facilitating this distinction and to investigate the pathophysiology of nemaline rod formation in these different disorders. Twenty-two muscle samples from patients affected by SLONM or iNM underwent quantitative histological analysis, laser capture microdissection for proteomic analysis of nemaline rod areas and rod-free areas, and transcriptomic analysis. In all iNM samples, nemaline rods were found in subsarcolemmal or central aggregates, whereas they were diffusely distributed within muscle fibers in most SLONM samples. In SLONM, muscle fibers harboring nemaline rods were smaller than those without rods. Necrotic fibers, increased endomysial connective tissue, and atrophic fibers filled with nemaline rods were more common in SLONM. Proteomic analysis detected differentially expressed proteins between nemaline rod areas and rod-free areas, as well as between SLONM and iNM. These differentially expressed proteins implicated immune, structural, metabolic, and cellular processes in disease pathophysiology. Notably, immunoglobulin overexpression with accumulation in nemaline rod areas was detected in SLONM. Transcriptomic analysis corroborated proteomic findings and further revealed substantial gene expression differences between SLONM and iNM. Overall, we identified unique pathological and molecular signatures associated with SLONM and iNM, suggesting distinct underlying pathophysiological mechanisms. These findings represent a step towards enhanced diagnostic tools and towards development of treatments for SLONM.
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Affiliation(s)
- Stefan Nicolau
- grid.66875.3a0000 0004 0459 167XDepartment of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA ,grid.240344.50000 0004 0392 3476Center for Gene Therapy, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Aneesha Dasgupta
- grid.66875.3a0000 0004 0459 167XDepartment of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905 USA ,grid.257413.60000 0001 2287 3919Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN 46202 USA ,grid.257413.60000 0001 2287 3919Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Surendra Dasari
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905 USA
| | - M. Cristine Charlesworth
- grid.66875.3a0000 0004 0459 167XProteomics Core, Medical Genomics Facility, Mayo Clinic, Rochester, MN 55905 USA
| | - Kenneth L. Johnson
- grid.66875.3a0000 0004 0459 167XProteomics Core, Medical Genomics Facility, Mayo Clinic, Rochester, MN 55905 USA
| | - Akhilesh Pandey
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905 USA ,grid.411639.80000 0001 0571 5193Manipal Academy of Higher Education (MAHE), Manipal, Karnataka 576104 India
| | - Jason D. Doles
- grid.66875.3a0000 0004 0459 167XDepartment of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905 USA ,grid.257413.60000 0001 2287 3919Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN 46202 USA ,grid.257413.60000 0001 2287 3919Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Margherita Milone
- grid.66875.3a0000 0004 0459 167XDepartment of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
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