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Kulessa M, Weyer-Menkhoff I, Viergutz L, Kornblum C, Claeys KG, Schneider I, Plöckinger U, Young P, Boentert M, Vielhaber S, Mawrin C, Bergmann M, Weis J, Ziagaki A, Stenzel W, Deschauer M, Nolte D, Hahn A, Schoser B, Schänzer A. An integrative correlation of myopathology, phenotype and genotype in late onset Pompe disease. Neuropathol Appl Neurobiol 2019; 46:359-374. [PMID: 31545528 DOI: 10.1111/nan.12580] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/07/2019] [Indexed: 12/29/2022]
Abstract
AIMS Pompe disease is caused by pathogenic mutations in the alpha 1,4-glucosidase (GAA) gene and in patients with late onset Pome disease (LOPD), genotype-phenotype correlations are unpredictable. Skeletal muscle pathology includes glycogen accumulation and altered autophagy of various degrees. A correlation of the muscle morphology with clinical features and the genetic background in GAA may contribute to the understanding of the phenotypic variability. METHODS Muscle biopsies taken before enzyme replacement therapy were analysed from 53 patients with LOPD. On resin sections, glycogen accumulation, fibrosis, autophagic vacuoles and the degree of muscle damage (morphology-score) were analysed and the results were compared with clinical findings. Additional autophagy markers microtubule-associated protein 1A/1B-light chain 3, p62 and Bcl2-associated athanogene 3 were analysed on cryosections from 22 LOPD biopsies. RESULTS The myopathology showed a high variability with, in most patients, a moderate glycogen accumulation and a low morphology-score. High morphology-scores were associated with increased fibrosis and autophagy highlighting the role of autophagy in severe stages of skeletal muscle damage. The morphology-score did not correlate with the patient's age at biopsy, disease duration, nor with the residual GAA enzyme activity or creatine-kinase levels. In 37 patients with LOPD, genetic analysis identified the most frequent mutation, c.-32-13T>G, in 95%, most commonly in combination with c.525delT (19%). No significant correlation was found between the different GAA genotypes and muscle morphology type. CONCLUSIONS Muscle morphology in LOPD patients shows a high variability with, in most cases, moderate pathology. Increased pathology is associated with more fibrosis and autophagy.
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Affiliation(s)
- M Kulessa
- Institute of Neuropathology, Justus Liebig University, Giessen, Germany
| | - I Weyer-Menkhoff
- Institute of Clinical Pharmacology, Goethe University, Frankfurt/Main, Germany
| | - L Viergutz
- Institute of Neuropathology, Justus Liebig University, Giessen, Germany
| | - C Kornblum
- Department of Neurology, University Hospital Bonn, Bonn, Germany.,Center for Rare Diseases, University Hospital Bonn, Bonn, Germany
| | - K G Claeys
- Department of Neurology, University Hospital Leuven, Leuven, Belgium.,Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - I Schneider
- Department of Neurology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - U Plöckinger
- Interdisciplinary Centre of Metabolism: Endocrinology, Diabetes and Metabolism, Charité-University Medicine Berlin, Berlin, Germany
| | - P Young
- Department of Sleep Medicine and Neuromuscular Disorders, Muenster University Hospital, Münster, Germany.,Medical Park Reithofpark, Bad Feilnbach, Germany
| | - M Boentert
- Department of Sleep Medicine and Neuromuscular Disorders, Muenster University Hospital, Münster, Germany
| | - S Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - C Mawrin
- Institute of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - M Bergmann
- Institute of Clinical Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany
| | - J Weis
- Institute of Neuropathology, RWTH University Hospital, Aachen, Germany
| | - A Ziagaki
- Interdisciplinary Centre of Metabolism: Endocrinology, Diabetes and Metabolism, Charité-University Medicine Berlin, Berlin, Germany
| | - W Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin, Berlin, Germany
| | - M Deschauer
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - D Nolte
- Institute of Human Genetics, Justus Liebig University Giessen, Giessen, Germany
| | - A Hahn
- Department of Child Neurology, Justus Liebig University Giessen, Giessen, Germany
| | - B Schoser
- Department of Neurology, Friedrich-Baur-Institute, LMU University Munich, Munich, Germany
| | - A Schänzer
- Institute of Neuropathology, Justus Liebig University, Giessen, Germany
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Bublitz S, Alhaddad B, Synofzik M, Kuhl V, Lindner A, Freiberg C, Schmidt H, Strom T, Haack T, Deschauer M. Expanding the phenotype of DNAJC3
mutations: A case with hypothyroidism additionally to diabetes mellitus and multisystemic neurodegeneration. Clin Genet 2017; 92:561-562. [DOI: 10.1111/cge.13069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- S.K. Bublitz
- Department of Neurology, Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | - B. Alhaddad
- Institute of Human Genetics; Technische Universität München; München Germany
| | - M. Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH); University of Tübingen, and German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - V. Kuhl
- Department of Neurology; Marienhospital Stuttgart; Stuttgart Germany
| | - A. Lindner
- Department of Neurology; Marienhospital Stuttgart; Stuttgart Germany
| | - C. Freiberg
- Department of Pediatrics; Universitätsmedizin Göttingen; Göttingen Germany
| | - H. Schmidt
- Division of Pediatric Endocrinology; University Children's Hospital, Ludwig-Maximilian University; Munich Germany
| | - T.M. Strom
- Institute of Human Genetics; Helmholtz Zentrum München; Neuherberg Germany
| | - T.B. Haack
- Institute of Human Genetics; Technische Universität München; München Germany
| | - M. Deschauer
- Department of Neurology, Klinikum rechts der Isar; Technische Universität München; Munich Germany
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Deschauer M, Müller-Reible C, Rösler K, Schoser B, Wanschitz J, Weis J, Zierz S. Diagnostik von Myopathien. Akt Neurol 2016. [DOI: 10.1055/s-0042-120133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Deschauer
- Klinik und Poliklinik für Neurologie, Technische Universität München
| | | | - K. Rösler
- Neurologische Universitätsklinik, Inselspital Bern
| | - B. Schoser
- Friedrich-Baur-Institut, Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München
| | | | - J. Weis
- Institut für Neuropathologie, Universitätsklinikum der RWTH Aachen
| | - S. Zierz
- Klinik und Poliklinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg
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Semmler A, Sacconi S, Bach J, Liebe C, Bürmann J, Kley R, Ferbert A, Anderheiden R, Van den Bergh P, Martin J, Jonghe PD, Neuen-Jacob E, Müller O, Deschauer M, Bergmann M, Schröder J, Vorgerd M, Schulz J, Weis J, Kress W, Claeys K. A.P.3. Neuromuscul Disord 2014. [DOI: 10.1016/j.nmd.2014.06.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schneider I, Deschauer M, Hanisch F. Enzyme replacement therapy and antibodies in late-onset Pompe disease. Mol Genet Metab Rep 2014; 1:232-234. [PMID: 27896092 PMCID: PMC5121312 DOI: 10.1016/j.ymgmr.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 11/25/2022] Open
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Schüller A, Kornblum C, Deschauer M, Vorgerd M, Schrank B, Mengel E, Lukacs Z, Gläser D, Young P, Plöckinger U, Schoser B. Diagnose und Therapie des Late-onset-Morbus-Pompe. Nervenarzt 2013; 84:1467-72. [DOI: 10.1007/s00115-013-3947-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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7
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Güngör D, Schober AK, Kruijshaar ME, Plug I, Karabul N, Deschauer M, van Doorn PA, van der Ploeg AT, Schoser B, Hanisch F. Pain in adult patients with Pompe disease: a cross-sectional survey. Mol Genet Metab 2013; 109:371-6. [PMID: 23849261 DOI: 10.1016/j.ymgme.2013.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/31/2013] [Accepted: 05/31/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pompe disease is a rare hereditary metabolic myopathy caused by a deficiency of acid-α-glucosidase. We investigated the presence and severity of pain and its interference with daily activities in a large group of adults with Pompe disease, who we compared with an age-matched control group. METHODS Data were collected in a cross-sectional survey in Germany and The Netherlands. Pain was assessed using the short-form brief pain inventory (BPI). Patients also completed the Short Form-36 item (SF-36v2), the Hospital Anxiety and Depression Scale (HADS) and the Rotterdam Handicap Scale (RHS). RESULTS Forty-five percent of the 124 adult Pompe patients reported having had pain in the previous 24h, against 27% of the 111 controls (p=0.004). The median pain severity score in Pompe patients reporting pain was 3.1 (on a scale from 0 to 10), indicating mild pain; against 2.6 amongst controls (p=0.06). The median score of pain interference with daily activities in patients who reported pain was 3.3, against 1.3 in controls (p=0.001). Relative to patients without pain, those with pain had lower RHS scores (p=0.02), lower SF-36 Physical and Mental component summary scores (p<0.001 and p=0.049), and higher levels of depression and anxiety (p=0.005 and p=0.003). CONCLUSIONS To date, this is one of the largest studies on pain in a specific neuromuscular disorder. Nearly one in two Pompe patients had experienced pain in the previous 24h. Although pain severity and its interference with daily life were mild, pain was related to a reduced quality of life, less participation in daily life, and greater depression and anxiety. Its management should therefore be seen as part of clinical practice involving Pompe patients.
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Affiliation(s)
- D Güngör
- Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Prause J, Goswami A, Katona I, Roos A, Schnizler M, Bushuven E, Dreier A, Buchkremer S, Johann S, Beyer C, Deschauer M, Troost D, Weis J. Altered localization, abnormal modification and loss of function of Sigma receptor-1 in amyotrophic lateral sclerosis. Hum Mol Genet 2013; 22:1581-600. [PMID: 23314020 DOI: 10.1093/hmg/ddt008] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intracellular accumulations of mutant, misfolded proteins are major pathological hallmarks of amyotrophic lateral sclerosis (ALS) and related disorders. Recently, mutations in Sigma receptor 1 (SigR1) have been found to cause a form of ALS and frontotemporal lobar degeneration (FTLD). Our goal was to pinpoint alterations and modifications of SigR1 in ALS and to determine how these changes contribute to the pathogenesis of ALS. In the present study, we found that levels of the SigR1 protein were reduced in lumbar ALS patient spinal cord. SigR1 was abnormally accumulated in enlarged C-terminals and endoplasmic reticulum (ER) structures of alpha motor neurons. These accumulations co-localized with the 20s proteasome subunit. SigR1 accumulations were also observed in SOD1 transgenic mice, cultured ALS-8 patient's fibroblasts with the P56S-VAPB mutation and in neuronal cell culture models. Along with the accumulation of SigR1 and several other proteins involved in protein quality control, severe disturbances in the unfolded protein response and impairment of protein degradation pathways were detected in the above-mentioned cell culture systems. Furthermore, shRNA knockdown of SigR1 lead to deranged calcium signaling and caused abnormalities in ER and Golgi structures in cultured NSC-34 cells. Finally, pharmacological activation of SigR1 induced the clearance of mutant protein aggregates in these cells. Our results support the notion that SigR1 is abnormally modified and contributes to the pathogenesis of ALS.
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Affiliation(s)
- J Prause
- Institute of Neuropathology, RWTH Aachen University and JARA Brain Translational Medicine, Pauwelsstr. 30, 52074 Aachen, Germany
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Abstract
Metabolic myopathies include a broad group of diseases involving inherited enzyme defects in the various metabolic pathways and skeletal musculature. They show an extensive phenotypic variability of symptoms and different ages of manifestation. Symptoms often included intolerance to duress or permanent paresis. Some forms of metabolic myopathy, in particular mitochondriopathy, are associated with multsystemic organ participation. The diagnostics must be adjusted to individual cases and carried out in stages. Primary investigations should include blood parameters (e.g. creatine kinase measurement, muscle load tests and determination of the acylcarnitine spectrum) and a second step includes muscle biopsy for histological and enzyme investigations and special molecular genetic tests although the causative enzyme defect cannot be clarified in every case. On the other hand by means of a thorough investigation it is particularly important in patients with load intolerance to differentiate between other causes, in particular psychosomatic diseases. If this is not done there is a danger of classifying the symptoms of a metabolic myopathy as a somatoform disorder. Therapy is mostly symptom-oriented as Pompe disease is the only one which can be treated with enzyme replacement therapy.
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Affiliation(s)
- M Vorgerd
- Neurologische Universitätsklinik, Muskelzentrum Ruhrgebiet, Kliniken Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la Camp-Platz 1, 44789 Bochum, Deutschland.
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11
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Abstract
Zusammenfassung
Die häufigste Manifestation einer Mitochondriopathie bei Erwachsenen ist die chronisch progressive externe Ophthalmoplegie (CPEO), die eine variable Multisystembeteiligung aufweist. Molekulargenetisch finden sich am häufigsten singuläre mtDNA-Deletionen, die meist mit einer sporadischen CPEO einhergehen. Es gibt aber auch autosomal-dominant und rezessiv vererbte CPEO-Formen durch Defekte in nukleären Genen, die für die mtDNA-Replikation wichtig sind, die zu multiplen mtDNA-Deletionen führen. Andere klassische multisystemische mitochondriale Erkrankungen sind z. B. das MELAS-Syndrom und das MERRF-Syndrom, sie entstehen durch maternal vererbte Punktmutationen der mtDNA. Die Lebersche Optikusneuropathie, ebenfalls durch mtDNA-Punktmutationen bedingt, ist eine häufige Mitochondriopathie ohne multisystemische Beteiligung, Über solch klassische mitochondriale Erkrankungen hinaus gibt es Mitochondriopathienpatienten mit weniger charakteristischen, manchmal monosymptomatischen Phänotypen (z. B. Myopathie oder Epilepsie), die schwieriger zu erkennen sind.
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Affiliation(s)
- M. Deschauer
- Aff1_344 grid.461820.9 0000000403901701 Klinik und Poliklinik für Neurologie Universitätsklinikum Halle Ernst-Grube-Str. 40 06097 Halle (Saale) Deutschland
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Büchner B, Gallenmüller C, Lautenschläger R, Kuhn K, Wittig I, Schöls L, Rapaport D, Seelow D, Freisinger P, Prokisch H, Sperl W, Wenz T, Behl C, Deschauer M, Kornblum C, Schneiderat P, Abicht A, Schuelke M, Meitinger T, Klopstock T. Das Deutsche Netzwerk für mitochondriale Erkrankungen (mitoNET). MED GENET-BERLIN 2012. [DOI: 10.1007/s11825-012-0338-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Das mitoNET wurde als interdisziplinäres, deutschlandweites Netzwerk mit dem Ziel konzipiert, eine Verbesserung der Patientenversorgung auf dem Gebiet der mitochondrialen Erkrankungen zu erreichen. Das horizontale klinische Netzwerk des mitoNET umfasst 8 neurologische und 13 pädiatrische Kliniken, die für die Patientenrekrutierung, deren Phänotypisierung und die Erfassung des natürlichen Verlaufs im Rahmen von jährlichen Kontrolluntersuchungen zuständig sind. Die Speicherung der erhobenen Daten erfolgt in einer eigens entwickelten webbasierten Registerdatenbank. Das Netzwerk betreibt 2 Biobanken zur Asservierung von DNA, RNA, Plasma sowie von diagnostisch gewonnenen Fibro- und Myoblasten. Vier Forschungsprojekte zielen auf eine Verbesserung des diagnostischen Spektrums durch Etablierung neuer Methoden, und ein Teilprojekt beschäftigt sich mit der Überprüfung neuer Therapiemöglichkeiten. Das mitoNET wird seit Anfang 2009 vom Bundesministerium für Bildung und Forschung (BMBF, Förderkennzeichen 01GM1113A) gefördert.
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Affiliation(s)
- B. Büchner
- Aff1_338 grid.411095.8 0000000404772585 Friedrich-Baur-Institut an der Neurologischen Klinik Klinikum der Universität München – Innenstadt Ziemssenstr. 1a 80336 München Deutschland
| | - C. Gallenmüller
- Aff1_338 grid.411095.8 0000000404772585 Friedrich-Baur-Institut an der Neurologischen Klinik Klinikum der Universität München – Innenstadt Ziemssenstr. 1a 80336 München Deutschland
| | - R. Lautenschläger
- Aff2_338 grid.15474.33 0000000404772438 Institut für Medizinische Statistik und Epidemiologie Klinikum rechts der Isar der Technischen Universität (TUM-MED) München Deutschland
| | - K. Kuhn
- Aff2_338 grid.15474.33 0000000404772438 Institut für Medizinische Statistik und Epidemiologie Klinikum rechts der Isar der Technischen Universität (TUM-MED) München Deutschland
| | - I. Wittig
- Aff3_338 grid.7839.5 0000000419369721 Molekulare Bioenergetik, Zentrum der Biologischen Chemie Universität Frankfurt Frankfurt Deutschland
| | - L. Schöls
- Aff4_338 grid.10392.39 0000000121901447 Neurologische Klinik Universität Tübingen Tübingen Deutschland
| | - D. Rapaport
- Aff5_338 grid.10392.39 0000000121901447 Interfakultäres Institut für Biochemie Universität Tübingen Tübingen Deutschland
| | - D. Seelow
- Aff6_338 grid.6363.0 0000000122184662 Klinik für Pädiatrie m. S. Neurologie Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum Berlin Deutschland
| | - P. Freisinger
- Aff7_338 grid.6936.a 0000000123222966 Kinderklinik Technische Universität München München Deutschland
- Aff7a_338 grid.440494.9 Klinik für Kinder und Jugendliche, Klinikum Reutlingen Reutlingen Deutschland
| | - H. Prokisch
- Aff8_338 grid.6936.a 0000000123222966 Institut für Humangenetik Technische Universität München München Deutschland
| | - W. Sperl
- Aff9_338 grid.21604.31 0000000405235263 Klinik für Kinder- und Jugendheilkunde Paracelsus Medizinische Privatuniversität Salzburg Österrreich
| | - T. Wenz
- Aff10_338 grid.6190.e 0000000085803777 Institut für Genetik Universität Köln Köln Deutschland
| | - C. Behl
- Aff11_338 grid.5802.f 0000000119417111 Institut für Pathobiochemie Universität Mainz Mainz Deutschland
| | - M. Deschauer
- Aff12_338 grid.9018.0 0000000106792801 Klinik für Neurologie Universität Halle-Wittenberg Halle Deutschland
| | - C. Kornblum
- Aff13_338 grid.15090.3d 000000008786803X Klinik und Poliklinik für Neurologie Universitätsklinikum Bonn Bonn Deutschland
| | - P. Schneiderat
- Aff1_338 grid.411095.8 0000000404772585 Friedrich-Baur-Institut an der Neurologischen Klinik Klinikum der Universität München – Innenstadt Ziemssenstr. 1a 80336 München Deutschland
| | - A. Abicht
- Aff1_338 grid.411095.8 0000000404772585 Friedrich-Baur-Institut an der Neurologischen Klinik Klinikum der Universität München – Innenstadt Ziemssenstr. 1a 80336 München Deutschland
| | - M. Schuelke
- Aff6_338 grid.6363.0 0000000122184662 Klinik für Pädiatrie m. S. Neurologie Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum Berlin Deutschland
| | - T. Meitinger
- Aff8_338 grid.6936.a 0000000123222966 Institut für Humangenetik Technische Universität München München Deutschland
| | - T. Klopstock
- Aff1_338 grid.411095.8 0000000404772585 Friedrich-Baur-Institut an der Neurologischen Klinik Klinikum der Universität München – Innenstadt Ziemssenstr. 1a 80336 München Deutschland
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Deschauer M, Gaul C, Behrmann C, Prokisch H, Zierz S, Haack TB. C19orf12 mutations in neurodegeneration with brain iron accumulation mimicking juvenile amyotrophic lateral sclerosis. J Neurol 2012; 259:2434-9. [PMID: 22584950 DOI: 10.1007/s00415-012-6521-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/25/2012] [Accepted: 04/14/2012] [Indexed: 11/25/2022]
Affiliation(s)
- M Deschauer
- Department of Neurology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06097, Halle (Saale), Germany.
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Piceathly R, Smith C, Fratter C, Blakely E, Alston C, Deschauer M, Horvath R, Hanna M, Chinnery P, Turnbull D, Poulton J, Taylor R, Gorman G. P60 Expanding the phenotypic and genotypic spectrum of adult RRM2B-related mitochondrial disease. Neuromuscul Disord 2012. [DOI: 10.1016/s0960-8966(12)70068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Deschauer M, Joshi P, Gläser D, Hanisch F, Stoltenburg G, Zierz S. Muskeldystrophie infolge Anoctamin-5-Mutationen. Nervenarzt 2011; 82:1596-603. [DOI: 10.1007/s00115-011-3325-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mueller T, Kraya T, Stoltenburg G, Stock K, Deschauer M, Zierz S. P34-7 Matrin3 myopathy: Distal and axial myopathy without vocal cord involvement. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)61252-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Funke AD, Esser M, Krüttgen A, Weis J, Mitne-Neto M, Lazar M, Nishimura AL, Sperfeld AD, Trillenberg P, Senderek J, Krasnianski M, Zatz M, Zierz S, Deschauer M. The p.P56S mutation in the VAPB gene is not due to a single founder: the first European case. Clin Genet 2010; 77:302-3. [PMID: 20447143 PMCID: PMC2847198 DOI: 10.1111/j.1399-0004.2009.01319.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Tacik P, Joshi P, Deschauer M, Zierz S, Nikolin S, Weis J. Examination of mitochondrial changes in patients with idiopathic inflammatory myopathies. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1251017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Clajus C, Kornhuber M, Zierz S, Deschauer M. Polyneuropathy as a multisystemic plus symptom in chronic progressive external ophthalmoplegia: Phenotypic differences in between singular deletions and multiple deletions of mitochondrial DNA. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1251022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lorenz M, Zierz S, Deschauer M. Multiplex Ligation-dependent Probe Amplification (MLPA) for identification of mitochondrial DNA alterations in patients with mitochondrial disorders. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1251020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Müller TJ, Kraya T, Stoltenburg G, Stock K, Deschauer M, Weis J, Zierz S. Matrin3 myopathy: Distal and axial myopathy with pathology of the nucleus and the perinuclear region. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1251016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schara U, Barisic N, Deschauer M, Lindberg C, Straub V, Strigl-Pill N, Wendt M, Abicht A, Müller J, Lochmüller H. Ephedrine therapy in eight patients with congenital myasthenic syndrome due to DOK7 mutations. Neuromuscul Disord 2009; 19:828-32. [DOI: 10.1016/j.nmd.2009.09.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 09/21/2009] [Indexed: 10/20/2022]
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Tacik P, Joshi P, Knape M, Nikolin S, Weis J, Deschauer M, Zierz S. Untersuchung mitochondrialer Veränderungen bei Patienten mit idiopathischen Myositiden. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Joshi P, Tacik P, Nikolin S, Weis J, Deschauer M, Zierz S. G.P.16.10 Analysis of mtDNA deletions in patients with different forms of idiopathic myositis. Neuromuscul Disord 2009. [DOI: 10.1016/j.nmd.2009.06.341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Strothotte S, Strigl-Pill N, Grunert B, Kornblum C, Eger K, Wessig C, Deschauer M, Breunig F, Glocker FX, Vielhaber S, Brejova A, Hilz M, Reiners K, Müller-Felber W, Mengel E, Spranger M, Schoser B. Enzyme replacement therapy with alglucosidase alfa in 44 patients with late-onset glycogen storage disease type 2: 12-month results of an observational clinical trial. J Neurol 2009; 257:91-7. [DOI: 10.1007/s00415-009-5275-3] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 07/07/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
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Deschauer M. Therapie hereditärer metabolischer Myopathien. Akt Neurol 2009. [DOI: 10.1055/s-0029-1220349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- M Wendt
- Department of Neurology, Martin Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, 06097 Halle (Saale), Germany.
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Joshi PR, Gläser D, Schmidt S, Vorgerd M, Winterholler M, Eger K, Zierz S, Deschauer M. Molecular diagnosis of German patients with late-onset glycogen storage disease type II. J Inherit Metab Dis 2008; 31 Suppl 2:S261-5. [PMID: 18607768 DOI: 10.1007/s10545-008-0820-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/11/2008] [Accepted: 04/22/2008] [Indexed: 11/24/2022]
Abstract
UNLABELLED In patients with late-onset glycogen storage disease type II, one mutation, c.-32-13T>G, in the α-glucosidase (GAA) gene is identified frequently in European populations from different regions along with many rarer mutations. We have performed molecular genetic investigations in 18 German index patients with late-onset disease. The c.-32-13T>G, c.525delT (p.Glu176fsX45), and c.2481+102_2646+31del mutations were detected by PCR/restriction enzyme digest. Other mutations were detected by sequencing. All patients were compound heterozygous and 17 patients harboured the c.-32-13T>G mutation. Seven other previously described mutations (including the c.-32-13T>G) were identified, of which the p.C103G (c.307T>G) and the c.2481+102_2646+31del mutations were present each in three unrelated patients. Sequencing revealed five novel mutations. CONCLUSIONS Genetic testing was able to identify the genetic defects in all patients and screening of the c.-32-13T>G mutation identified 94% of the cases. This is important for quick and reliable diagnosis, especially in view of enzyme replacement. Among the rarer mutations, c.2481+102_2646+31del and p.C103G are rather frequent in Germany.
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Affiliation(s)
- P R Joshi
- Neurologische Universitätsklinik, Halle, Germany.
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Tacik P, Deschauer M, Zierz S. G.P.3.02 Diagnostic relevance of myohistological examination in patients with mitochondrial disorders. Neuromuscul Disord 2008. [DOI: 10.1016/j.nmd.2008.06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tacik P, Deschauer M, Zierz S. Diagnostische Bedeutung myohistologischer Untersuchungen bei Patienten mit Mitochondriopathien. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Knape M, Joshi P, Zierz S, Deschauer M. Biochemical and molecular genetic identification of patients with phosphoglycerate mutase deficiency. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tzoulis C, Bindoff LA, Deschauer M, Turnbull DM, Taylor RW. MELAS ASSOCIATED WITH MUTATIONS IN THE POLG1 GENE. Neurology 2008; 70:1054; author reply 1054-5. [DOI: 10.1212/01.wnl.0000307661.98694.c3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Schulte-Mattler W, Deschauer M, Kornhuber M, Zierz S. Pathologische späte Reizantworten nach transkranieller Magnetstimulation bei Patienten mit Stiff-Man-Syndrom. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Winchester B, Bali D, Bodamer OA, Caillaud C, Christensen E, Cooper A, Cupler E, Deschauer M, Fumić K, Jackson M, Kishnani P, Lacerda L, Ledvinová J, Lugowska A, Lukacs Z, Maire I, Mandel H, Mengel E, Müller-Felber W, Piraud M, Reuser A, Rupar T, Sinigerska I, Szlago M, Verheijen F, van Diggelen OP, Wuyts B, Zakharova E, Keutzer J. Methods for a prompt and reliable laboratory diagnosis of Pompe disease: report from an international consensus meeting. Mol Genet Metab 2008; 93:275-81. [PMID: 18078773 DOI: 10.1016/j.ymgme.2007.09.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 09/11/2007] [Indexed: 11/20/2022]
Abstract
Pompe disease is an autosomal recessive disorder of glycogen metabolism caused by a deficiency of the lysosomal enzyme acid alpha-glucosidase (GAA). It presents at any age, with variable rates of progression ranging from a rapidly progressive course, often fatal by one-year of age, to a more slowly, but nevertheless relentlessly progressive course, resulting in significant morbidity and premature mortality. In infants, early initiation of enzyme replacement therapy is needed to gain the maximum therapeutic benefit, underscoring the need for early diagnosis. Several new methods for measuring GAA activity have been developed. The Pompe Disease Diagnostic Working Group met to review data generated using the new methods, and to establish a consensus regarding the application of the methods for the laboratory diagnosis of Pompe disease. Skin fibroblasts and muscle biopsy have traditionally been the samples of choice for measuring GAA activity. However, new methods using blood samples are rapidly becoming adopted because of their speed and convenience. Measuring GAA activity in blood samples should be performed under acidic conditions (pH 3.8-4.0), using up to 2 mM of the synthetic substrate 4-methylumbelliferyl-alpha-D-glucoside or glycogen (50 mg/mL), in the presence of acarbose (3-9 microM) to inhibit the isoenzyme maltase-glucoamylase. The activity of a reference enzyme should also be measured to confirm the quality of the sample. A second test should be done to support the diagnosis of Pompe disease until a program for external quality assurance and proficiency testing of the enzymatic diagnosis in blood is established.
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Mihaylova V, Müller T, Petrova I, Tournev I, Cherninkova S, Walter MC, Deschauer M. Unique PABPN1 gene mutation in a large Bulgarian family with OPMD. J Neurol 2008; 255:609-11. [DOI: 10.1007/s00415-008-0769-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 09/19/2007] [Accepted: 10/05/2007] [Indexed: 11/30/2022]
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Schara U, Deschauer M, Wendt M, Strigl-Pill N, Müller J, Abicht A, Lochmüller H. G.P.10.03 Therapeutic effects of ephedrine in congenital myasthenic syndrome due to DOK7 mutations. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Esser M, Funke A, Deschauer M, Zierz S, Brauers E, Reiss K, Weis J, Kruettgen A. G.P.11.04 ALS8: Description of the first European case and investigations on the functional effects of the causative VAPB mutation. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jordan B, Eger K, Deschauer M, Zierz S. G.P.10.05 Successful long-term treatment of MuSK antibody-positive myasthenia gravis with rituximab, a follow up. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Eger K, Traufeller K, Hobohm J, Deschauer M, Zierz S. G.P.7.03 Facioscapulohumeral dystrophy presenting as axial myopathy. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wendt M, Taylor R, Rokicka A, Zierz S, Deschauer M. M.P.1.07 Detection of single mtDNA deletions by Long-Range-PCR in blood of patients with CPEO. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hanisch F, Müller CR, Grimm D, Xue L, Traufeller K, Merkenschlager A, Zierz S, Deschauer M. Frequency of calpain-3 c.550delA mutation in limb girdle muscular dystrophy type 2 and isolated hyperCKemia in German patients. Clin Neuropathol 2007; 26:157-63. [PMID: 17702496 DOI: 10.5414/npp26157] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Calpain-3 deficiency is the most common cause of autosomal-recessive limb girdle muscular dystrophy (LGMD2). The c.550delA mutation in the CAPN3 gene was frequently identified in LGMD2A patients from Eastern Europe and is considered a Slavic founder mutation. METHODS We screened for the c.550delA mutation in unrelated German patients with LGMD2 (n = 98) and in patients with asymptomatic or minimally symptomatic (myalgia or fatigue) hyperCKemia of unknown origin (n = 102). Results of Western blot analysis were available in 75 patients with LGMD2 and 65 patients with hyperCKemia. In samples that were heterozygous for the c.550delA mutation, the whole CAPN3 gene was analyzed by sequencing in order to detect the second mutation. RESULTS The c.550delA mutation was found in 8.1% of LGMD2 (n = 1 homozygous, n = 7 heterozygous) and 1.9% of hyperCKemia patients (n = 2 heterozygous). In 8 of the 9 hetrozygous patients, a second CAPN3 mutation was identified by direct sequencing. Two mutations (Val509Phe and Gln565Stop) have not been reported before. Absent or deficient calpain-3 protein in Western blot analysis was found in 22.5% of the LGMD2 patients and 11% of the patients with hyperCKemia. Western blot results were available in 9 out of the 10 patients with genetically confirmed LGMD2A and were clearly abnormal in 6 patients, suspicious in 2 and entirely normal in 1. Two LGMD2 patients with the c.550delA mutation and onset within the first 2 decades had joint contractures. Muscle biopsy revealed inflammatory changes in three patients. CONCLUSION The CAPN3 gene mutation c.550delA is rather frequently observed in German patients with LGMD2, but also occasionally in cases with isolated hyperCKemia.
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Affiliation(s)
- F Hanisch
- Klinik und Poliklinik für Neurologie, Universität Halle-Wittenberg, Germany.
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Affiliation(s)
- M Deschauer
- Department of Neurology, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
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Deschauer M, Morgenroth A, Joshi PR, Gläser D, Chinnery PF, Aasly J, Schreiber H, Knape M, Zierz S, Vorgerd M. Analysis of spectrum and frequencies of mutations in McArdle disease. Identification of 13 novel mutations. J Neurol 2007; 254:797-802. [PMID: 17404776 DOI: 10.1007/s00415-006-0447-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 10/02/2006] [Accepted: 10/19/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND McArdle disease, a common metabolic myopathy with autosomal recessive inheritance, is caused by a frequent R50X mutation and many rare mutations in the myophosphorylase gene. OBJECTIVES To identify spectrum and frequencies of myophosphorylase gene mutations in a large cohort of patients with McArdle disease, to discuss diagnostic implications, and to analyse genotype-phenotype relationship. METHODS Molecular genetic analysis of 56 index patients with muscle biopsy-proven myophosphorylase deficiency from Germany (n = 35), UK (n = 13), and several other countries (n = 8) was performed using direct sequencing. RESULTS Allele frequency of the R50X mutation was 58%, and 71% of the patients carried this mutation at least on one allele. We detected 26 other less common mutations, 13 of which are novel: G157V, R161C, Q337R, E384K, S450L, G486D, R570W, K575E, IVS6-2A>T, IVS10+1G>A, R650X, c.1354insC, c.1155_1156delGG. There was no genotype-phenotype correlation with respect to age of onset and severity. R270X was the most frequent mutation among the less common mutations reaching an allele frequency of 5% followed by R94W and G686R representing a frequency of 4% each. CONCLUSIONS The study further extends the genetic heterogeneity of myophosphorylase gene mutations showing no mutational hotspot and no genotype-phenotype correlation. Most novel missense mutations were located in secondary structures or active sites of the enzyme. Some of the less common mutations are recurrent with different frequencies within Europe. Ethnic origin and frequency of less common mutations must be considered to establish efficient strategies in molecular genetic testing. Performing molecular testing can avoid muscle biopsy.
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Affiliation(s)
- M Deschauer
- Klinik und Poliklinik für Neurologie, Martin-Luther Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06097 Halle/Saale, Germany.
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Traufeller K, Eger K, Hobohm J, Deschauer M, Zierz S. Facioscapulohumeral dystrophy presenting as axial myopathy. Akt Neurol 2007. [DOI: 10.1055/s-2007-987878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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47
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Mende S, Herr A, Schmiedel J, Deschauer M, Klopstock T, Kostic V, Storch A, Reichmann H. Genome-wide expression profiling of A3243G MELAS patients in quest for potential disease-modifying target genes. Akt Neurol 2007. [DOI: 10.1055/s-2007-987636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Deschauer M, Bau V, Clajus C, Rokicka A, Wendt M, Kornhuber ME, Zierz S. Chronisch progressive externe Ophthalmoplegie: Phänotypische Unterschiede zwischen Patienten mit singulären und multiplen Deletionen der mitochondrialen DNA. Akt Neurol 2007. [DOI: 10.1055/s-2007-987615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schrank B, Müller H, Sommer C, Zierz S, Deschauer M. Kleinwuchs, Diabetes und Schwerhörigkeit als Frühzeichen einer Mitochondriopathie mit großer Variabilität des Krankheitsverlaufs. Akt Neurol 2007. [DOI: 10.1055/s-2007-987890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Müller TJ, Deschauer M, Zierz S. Oxidative metabolism in mitochondrial disease evaluated with near-infrared spectroscopy of skeletal muscle. Akt Neurol 2007. [DOI: 10.1055/s-2007-987879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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