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Jungbluth H, Famili DT, Helmich RC, Previtali S, Voermans NC. "RYR1 and the cerebellum": scientific commentary on "Defective Cerebellar Ryanodine Receptor Type 1 and Endoplasmic Reticulum Calcium 'Leak' in Tremor Pathophysiology". Acta Neuropathol 2024; 147:33. [PMID: 38326582 PMCID: PMC10850253 DOI: 10.1007/s00401-024-02687-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina London Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, Children's Neurosciences Centre, F02 - Becket House, Lambeth Palace Road, London, SE1 7EU, UK.
- Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, UK.
| | - Dennis T Famili
- Department of Paediatric Neurology, Neuromuscular Service, Evelina London Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, Children's Neurosciences Centre, F02 - Becket House, Lambeth Palace Road, London, SE1 7EU, UK
| | - Rick C Helmich
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stefano Previtali
- Neuromuscular Repair Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicol C Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Osman V, Speigel I, Patel K, Hemmings HC. Isoflurane Alters Presynaptic Endoplasmic Reticulum Calcium Dynamics in Wild-Type and Malignant Hyperthermia-Susceptible Rodent Hippocampal Neurons. eNeuro 2023; 10:ENEURO.0114-23.2023. [PMID: 37591734 PMCID: PMC10467020 DOI: 10.1523/eneuro.0114-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
Volatile anesthetics reduce excitatory synaptic transmission by both presynaptic and postsynaptic mechanisms which include inhibition of depolarization-evoked increases in presynaptic Ca2+ concentration and blockade of postsynaptic excitatory glutamate receptors. The presynaptic sites of action leading to reduced electrically evoked increases in presynaptic Ca2+ concentration and Ca2+-dependent exocytosis are unknown. Endoplasmic reticulum (ER) of Ca2+ release via ryanodine receptor 1 (RyR1) and uptake by SERCA are essential for regulation intracellular Ca2+ and are potential targets for anesthetic action. Mutations in sarcoplasmic reticulum (SR) release channels mediate volatile anesthetic-induced malignant hyperthermia (MH), a potentially fatal pharmacogenetic condition characterized by unregulated Ca2+ release and muscle hypermetabolism. However, the impact of MH mutations on neuronal function are unknown. We used primary cultures of postnatal hippocampal neurons to analyze volatile anesthetic-induced changes in ER Ca2+ dynamics using a genetically encoded ER-targeted fluorescent Ca2+ sensor in both rat and mouse wild-type (WT) neurons and in mouse mutant neurons harboring the RYR1 T4826I MH-susceptibility mutation. The volatile anesthetic isoflurane reduced both baseline and electrical stimulation-evoked increases in ER Ca2+ concentration in neurons independent of its depression of presynaptic cytoplasmic Ca2+ concentrations. Isoflurane and sevoflurane, but not propofol, depressed depolarization-evoked increases in ER Ca2+ concentration significantly more in mouse RYR1 T4826I mutant neurons than in wild-type neurons. The RYR1 T4826I mutant neurons also showed markedly greater isoflurane-induced reductions in presynaptic cytosolic Ca2+ concentration and synaptic vesicle (SV) exocytosis. These findings implicate RyR1 as a molecular target for the effects of isoflurane on presynaptic Ca2+ handling.
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Affiliation(s)
- Vanessa Osman
- Department of Pharmacology, Weill Cornell Medical College, New York, NY 10065
| | - Iris Speigel
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY 10065
| | - Kishan Patel
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY 10065
| | - Hugh C Hemmings
- Department of Pharmacology, Weill Cornell Medical College, New York, NY 10065
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY 10065
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Aires CCG, de Souza RRL, Amorim JA, Santos FG, Diniz DA, Carneiro SCDAS, Vasconcellos RJDH. Malignant hyperthermia in maxillofacial surgery: Literature review supported by case presentation. SPECIAL CARE IN DENTISTRY 2023; 43:99-108. [PMID: 35667046 DOI: 10.1111/scd.12737] [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: 10/08/2021] [Revised: 03/24/2022] [Accepted: 05/13/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Malignant hyperthermia (MH) is characterized by a state of hypermetabolism after exposure to halogenated inhalational anesthetics or succinylcholine. The aims of this study were to carry out an updated review on the subject and report an illustrative case of MH in urgent maxillofacial surgery. MATERIAL AND METHODS A search of the PubMed/MEDLINE database using the keyword "malignant hyperthermia" was performed including articles published over the last 11 years in English, Spanish or Portuguese. Exclusion criteria were similar presentations but not associated with MH and cases not related to the use of anesthetic drugs as a trigger of the condition. CASE REPORT A 45-year-old man (75 kg, ASA status IE) with a negative family history for neuromuscular diseases, victim of a car accident with a facial fracture, underwent surgery under balanced general anesthesia and developed signs of MH 4 h after anesthesia induction. In our patient, the causative agent was sevoflurane and the diagnosis of MH was confirmed, subsequently, by muscle biopsy. RESULTS/DISCUSSION Overall, 44 cases of MH were found. According to the recent literature, MH shows a male predilection (3:1) and the mean age of patients is 32.2 ± 22.2 years. The most frequently cited causative agents were sevoflurane (30.5%), isoflurane (22.2%), and sevoflurane + succinylcholine (13.8%). The most common clinical indicators included hypercarbia (88.8%), hyperthermia (86.1%), and tachycardia (63.8%). Dantrolene was administered in 24 cases. The outcome was favorable in 31 cases (86.1%). The in vitro muscle contracture test (IVCT) was performed in only 15 patients and all of them tested positive. In our patient, the causative agent was sevoflurane and the diagnosis of MH was confirmed by muscle biopsy. CONCLUSION The mortality from MH is still high and an early clinical diagnosis and specific treatment with dantrolene are necessary for a favorable outcome. A complete understanding will allow better management of patients with MH. At present, the best management is to identify susceptible patients and to avoid triggering agents, combined with vigilant monitoring.
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Affiliation(s)
- Carolina Chaves Gama Aires
- Department of Oral and Maxillofacial Surgery, Dental School of Pernambuco, University of Pernambuco (FOP/UPE), Recife, Pernambuco, Brazil
| | - Rosa Rayanne Lins de Souza
- Department of Oral and Maxillofacial Surgery of the Hospital da Restauração (HR), Recife, Pernambuco, Brazil
| | - Jane Auxiliadora Amorim
- Department of Anesthesiology of the Hospital da Restauração (HR), Recife, Pernambuco, Brazil
| | - Fabiano Gouveia Santos
- Department of Anesthesiology of the Hospital da Restauração (HR), Recife, Pernambuco, Brazil
| | - Demóstenes Alves Diniz
- Department of Oral and Maxillofacial Surgery of the Hospital da Restauração (HR), Recife, Pernambuco, Brazil
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O’Connor TN, van den Bersselaar LR, Chen YS, Nicolau S, Simon B, Huseth A, Todd JJ, Van Petegem F, Sarkozy A, Goldberg MF, Voermans NC, Dirksena RT. RYR-1-Related Diseases International Research Workshop: From Mechanisms to Treatments Pittsburgh, PA, U.S.A., 21-22 July 2022. J Neuromuscul Dis 2023; 10:135-154. [PMID: 36404556 PMCID: PMC10023165 DOI: 10.3233/jnd-221609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Thomas N. O’Connor
- Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Luuk R. van den Bersselaar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Malignant Hyperthermia Investigation Unit, Department of Anaesthesia, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Yu Seby Chen
- Department of Biochemistry and Molecular Biology, The Life Sciences Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Stefan Nicolau
- Center for Gene Therapy, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | | | - Joshua J. Todd
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Filip Van Petegem
- Department of Biochemistry and Molecular Biology, The Life Sciences Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Anna Sarkozy
- The Dubowitz Neuromuscular Centre, Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | | | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robert T. Dirksena
- Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Riazi S, Bersselaar LRVD, Islander G, Heytens L, Snoeck MMJ, Bjorksten A, Gillies R, Dranitsaris G, Hellblom A, Treves S, Kunst G, Voermans NC, Jungbluth H. Pre-operative exercise and pyrexia as modifying factors in malignant hyperthermia (MH). Neuromuscul Disord 2022; 32:628-634. [PMID: 35738978 DOI: 10.1016/j.nmd.2022.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
Malignant hyperthermia (MH) is a life-threatening reaction triggered by volatile anesthetics and succinylcholine. MH is caused by mutations in the skeletal muscle ryanodine receptor (RYR1) gene, as is rhabdomyolysis triggered by exertion and/or pyrexia. The discrepancy between the prevalence of risk genotypes and actual MH incidence remains unexplained. We investigated the role of pre-operative exercise and pyrexia as potential MH modifying factors. We included cases from 5 MH referral centers with 1) clinical features suggestive of MH, 2) confirmation of MH susceptibility on Contracture Testing (IVCT or CHCT) and/or RYR1 genetic testing, and a history of 3) strenuous exercise within 72 h and/or pyrexia >37.5 °C prior to the triggering anesthetic. Characteristics of MH-triggering agents, surgery and succinylcholine use were collected. We identified 41 cases with general anesthesias resulting in an MH event (GA+MH, n = 41) within 72 h of strenuous exercise and/or pyrexia. We also identified previous general anesthesias without MH events (GA-MH, n = 51) in the index cases and their MH susceptible relatives. Apart from pre-operative exercise and/or pyrexia, trauma and acute abdomen as surgery indications, emergency surgery and succinylcholine use were also more common with GA+MH events. These observations suggest a link between pre-operative exercise, pyrexia and MH.
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Affiliation(s)
- Sheila Riazi
- Department of Anesthesia, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, Toronto, Canada
| | | | | | - Luc Heytens
- Department of Anaesthesiology, University Hospital Antwerp, Edegem, Belgium
| | - Marc M J Snoeck
- Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Andrew Bjorksten
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Robyn Gillies
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - George Dranitsaris
- Department of Anesthesia, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Anna Hellblom
- Department of Intensive and Perioperative Medicine, Skane University Hospital, Lund, Sweden; Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Susan Treves
- Department of Biomedicine, Basel University Hospital, Basel University, Basel, Switzerland
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Therapy, King's College Hospital, London, UK; School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Nicol C Voermans
- Department of Neurology, Radboud University, Nijmegen, The Netherlands
| | - Heinz Jungbluth
- Randall Centre Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK; Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK.
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van den Bersselaar LR, Riazi S, Snoeck M, Jungbluth H, Voermans NC. 259th ENMC international workshop: Anaesthesia and neuromuscular disorders 11 December, 2020 and 28-29 May, 2021. Neuromuscul Disord 2021; 32:86-97. [PMID: 34916120 DOI: 10.1016/j.nmd.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Affiliation(s)
- L R van den Bersselaar
- Department of Anaesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology, Radboud University Medical Center, Reinier Postlaan 4, P.O. Box 9101, 6500 HB, Nijmegen 6525 GC, the Netherlands
| | - S Riazi
- Department of Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Mmj Snoeck
- Department of Anaesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - N C Voermans
- Department of Neurology, Radboud University Medical Center, Reinier Postlaan 4, P.O. Box 9101, 6500 HB, Nijmegen 6525 GC, the Netherlands.
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Gupta P, Bilmen J, Hopkins P. Anaesthetic management of a known or suspected malignant hyperthermia susceptible patient. BJA Educ 2021; 21:218-224. [PMID: 34026275 PMCID: PMC8134759 DOI: 10.1016/j.bjae.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- P.K. Gupta
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | - J.G. Bilmen
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | - P.M. Hopkins
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
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Oliveira PE, Salvador GH, Marchi-Salvador DP. Malignant Hyperthermia in Bariatric Surgery: A Case Study With Clinical, Pathophysiological, Biochemical and Biophysical Correlations. J Med Cases 2020; 11:379-387. [PMID: 34434350 PMCID: PMC8383552 DOI: 10.14740/jmc3577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/19/2020] [Indexed: 12/23/2022] Open
Abstract
Malignant hyperthermia (MH) is an acute pharmacogenetic disorder, which while uncommon is potentially fatal. MH is a calcium channelopathy of skeletal muscle in which a constant increase of intracytoplasmic Ca2+ concentration occurs causing a change in cellular metabolism. A hypermetabolic state develops when susceptible patients are exposed to halogenated volatile inhalational anesthetic agents and depolarizing muscle relaxants and/or extreme physical activity in hot environments. MH presents variable clinical expression. During an episode of MH, the patient may present clinical signs and laboratory findings including masseter muscle spasm, tachycardia, rise in end-tidal CO2 (EtCO2), tachypnea, hyperthermia, cyanosis, metabolic acidosis, rhabdomyolysis, hyperkalemia, myoglobinuria, hyperlactacidemia, and acute renal failure. The aim of this case report is to describe an episode of MH associated with the use of halogenated anesthetic during bariatric surgery. A 29-year-old Brazilian man was admitted to the hospital to undergo a bariatric surgery. The patient's relevant medical history included morbid obesity grade III, allergy to sulfa-based drugs and severe obstructive sleep apnea. Preoperative evaluations with cardiopulmonary exercise testing, echocardiogram and electrocardiogram showed no anatomical and functional changes of the patient's heart. Surgical procedures lasted for 4 h, without complications, but the evolution of the patient's condition indicated oliguria and acute breathing insufficiency. Five hours after the patient was placed under mechanical ventilation in the intensive care unit, he started to present clinical signs of hypermetabolic state, with tremors, excessive sweating, and rapid body temperature increases. In the postoperative period, the patient had hyperglycemia, hypocalcemia, hypernatremia, hyperkalemia, changes in creatine phosphokinase (CPK), aspartate transaminase (AST), alanine aminotransferase (ALT), urea and creatine concentrations, and metabolic and respiratory acidosis. Urinalysis showed traces of proteinuria, presence of ketones, leukocytes, red blood cells, and urobilinogen. In our case report, MH crisis was diagnosed late; the dantrolene was not administrated because it was not available and the patient died. This detailed case report of MH episode triggered by isoflurane anesthetic during bariatric surgery allowed us to describe the severity and lethality of this hypermetabolic syndrome. Dantrolene should be mandatory in all operating rooms. Knowledge of the symptoms, an early diagnosis and an adequate treatment can prevent the death of patients in MH crisis.
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Aleman M, Zhang R, Feng W, Qi L, Lopez JR, Crowe C, Dong Y, Cherednichenko G, Pessah IN. Dietary Caffeine Synergizes Adverse Peripheral and Central Responses to Anesthesia in Malignant Hyperthermia Susceptible Mice. Mol Pharmacol 2020; 98:351-363. [PMID: 32764093 DOI: 10.1124/mol.120.119412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/31/2020] [Indexed: 11/22/2022] Open
Abstract
Ryanodine receptor (RYR) mutations confer stress-triggered malignant hyperthermia (MH) susceptibility. Dietary caffeine (CAF) is the most commonly consumed psychoactive compound by humans. CAF-triggered Ca2+ release and its influences on skeletal muscle contractility are widely used as experimental tools to study RYR function/dysfunction and diagnose MH susceptibility. We hypothesize that dietary CAF achieving blood levels measured in human plasma exacerbates the penetrance of RYR1 MH susceptibility mutations triggered by gaseous anesthetic, affecting both central and peripheral adverse responses. Heterozygous R163C-RYR1 (HET) MH susceptible mice are used to investigate the influences of dietary CAF on both peripheral and central responses before and after induction of halothane (HAL) maintenance anesthesia under experimental conditions that maintain normal core body temperature. HET mice receiving CAF (plasma CAF 893 ng/ml) have significantly shorter times to respiratory arrest compared with wild type, without altering blood chemistry or displaying hyperthermia or muscle rigor. Intraperitoneal bolus dantrolene before HAL prolongs time to respiratory arrest. A pilot electrographic study using subcutaneous electrodes reveals that dietary CAF does not alter baseline electroencephalogram (EEG) total power, but significantly shortens delay to isoelectric EEG, which precedes respiratory and cardiac arrest. CAF ± HAL are studied on RYR1 single-channel currents and HET myotubes to define molecular mechanisms of gene-by-environment synergism. Strong pharmacological synergism between CAF and HAL is demonstrated in both single-channel and myotube preparations. Central and peripheral nervous systems mediate adverse responses to HAL in a HET model of MH susceptibility exposed to dietary CAF, a modifiable lifestyle factor that may mitigate risks of acute and chronic diseases associated with RYR1 mutations. SIGNIFICANCE STATEMENT: Dietary caffeine at a human-relevant dose synergizes adverse peripheral and central responses to anesthesia in malignant hyperthermia susceptible mice. Synergism of these drugs can be attributed to their actions at ryanodine receptors.
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Affiliation(s)
- Monica Aleman
- Department of Molecular Biosciences, School of Veterinary Medicine (R.Z., W.F., J.R.L., Y.D., G.C., I.N.P.), Department of Medicine and Epidemiology, The William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine (M.A., C.C.), and Department of Public Health Sciences, School of Medicine, School of Medicine (L.Q.), University of California, Davis, California
| | - Rui Zhang
- Department of Molecular Biosciences, School of Veterinary Medicine (R.Z., W.F., J.R.L., Y.D., G.C., I.N.P.), Department of Medicine and Epidemiology, The William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine (M.A., C.C.), and Department of Public Health Sciences, School of Medicine, School of Medicine (L.Q.), University of California, Davis, California
| | - Wei Feng
- Department of Molecular Biosciences, School of Veterinary Medicine (R.Z., W.F., J.R.L., Y.D., G.C., I.N.P.), Department of Medicine and Epidemiology, The William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine (M.A., C.C.), and Department of Public Health Sciences, School of Medicine, School of Medicine (L.Q.), University of California, Davis, California
| | - Lihong Qi
- Department of Molecular Biosciences, School of Veterinary Medicine (R.Z., W.F., J.R.L., Y.D., G.C., I.N.P.), Department of Medicine and Epidemiology, The William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine (M.A., C.C.), and Department of Public Health Sciences, School of Medicine, School of Medicine (L.Q.), University of California, Davis, California
| | - Jose R Lopez
- Department of Molecular Biosciences, School of Veterinary Medicine (R.Z., W.F., J.R.L., Y.D., G.C., I.N.P.), Department of Medicine and Epidemiology, The William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine (M.A., C.C.), and Department of Public Health Sciences, School of Medicine, School of Medicine (L.Q.), University of California, Davis, California
| | - Chelsea Crowe
- Department of Molecular Biosciences, School of Veterinary Medicine (R.Z., W.F., J.R.L., Y.D., G.C., I.N.P.), Department of Medicine and Epidemiology, The William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine (M.A., C.C.), and Department of Public Health Sciences, School of Medicine, School of Medicine (L.Q.), University of California, Davis, California
| | - Yao Dong
- Department of Molecular Biosciences, School of Veterinary Medicine (R.Z., W.F., J.R.L., Y.D., G.C., I.N.P.), Department of Medicine and Epidemiology, The William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine (M.A., C.C.), and Department of Public Health Sciences, School of Medicine, School of Medicine (L.Q.), University of California, Davis, California
| | - Genady Cherednichenko
- Department of Molecular Biosciences, School of Veterinary Medicine (R.Z., W.F., J.R.L., Y.D., G.C., I.N.P.), Department of Medicine and Epidemiology, The William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine (M.A., C.C.), and Department of Public Health Sciences, School of Medicine, School of Medicine (L.Q.), University of California, Davis, California
| | - Isaac N Pessah
- Department of Molecular Biosciences, School of Veterinary Medicine (R.Z., W.F., J.R.L., Y.D., G.C., I.N.P.), Department of Medicine and Epidemiology, The William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine (M.A., C.C.), and Department of Public Health Sciences, School of Medicine, School of Medicine (L.Q.), University of California, Davis, California
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Kaura V, Aboelsaod E, Hopkins P. Has malignant hyperthermia really disappeared with halothane? Comment on Br J Anaesth 2017; 119: i44–52. Br J Anaesth 2018; 121:980-981. [DOI: 10.1016/j.bja.2018.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022] Open
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A comprehensive review of malignant hyperthermia: Preventing further fatalities in orthopedic surgery. J Orthop 2018; 15:578-580. [PMID: 29881197 DOI: 10.1016/j.jor.2018.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/06/2018] [Indexed: 12/13/2022] Open
Abstract
Most frequently associated with orthopedic surgery, malignant hyperthermia is a rare genetic condition linked to volatile anesthetics and succinylcholine. If not treated quickly with appropriate measures, death may result. To aid in the prevention of further fatalities, this review seeks to educate clinicians and staff on the presentation and treatment of this disease, as well as to provide a comprehensive overview by further addressing prevalence, similar conditions, pathogenesis and other aspects. Although the number of deaths due to malignant hyperthermia has greatly declined in the last several years, increased knowledge may eliminate associated mortalities, particularly in the orthopedic setting.
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Abstract
PURPOSE OF REVIEW This article reviews adult presentations of the major congenital myopathies - central core disease, multiminicore disease, centronuclear myopathy and nemaline myopathy - with an emphasis on common genetic backgrounds, typical clinicopathological features and differential diagnosis. RECENT FINDINGS The congenital myopathies are a genetically heterogeneous group of conditions with characteristic histopathological features. Although essentially considered paediatric conditions, some forms - in particular those due to dominant mutations in the skeletal muscle ryanodine receptor (RYR1), the dynamin 2 (DNM2), the amphiphysin 2 (BIN1) and the Kelch repeat-and BTB/POZ domain-containing protein 13 (KBTBD13) gene - may present late into adulthood. Moreover, dominant RYR1 mutations associated with the malignant hyperthermia susceptibility trait have been recently identified as a common cause of (exertional) rhabdomyolysis presenting throughout life. In addition, improved standards of care and development of new therapies will result in an increasing number of patients with early-onset presentations transitioning to the adult neuromuscular clinic. Lastly, if nemaline rods are the predominant histopathological feature, acquired treatable conditions have to be considered in the differential diagnosis. SUMMARY Recently identified genotypes and phenotypes indicate a spectrum of the congenital myopathies extending into late adulthood, with important implications for clinical practice.
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Nicoll BK, Ferreira C, Hopkins PM, Shaw MA, Hope IA. Aging Effects of Caenorhabditis elegans Ryanodine Receptor Variants Corresponding to Human Myopathic Mutations. G3 (BETHESDA, MD.) 2017; 7:1451-1461. [PMID: 28325813 PMCID: PMC5427508 DOI: 10.1534/g3.117.040535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/07/2017] [Indexed: 12/31/2022]
Abstract
Delaying the decline in skeletal muscle function will be critical to better maintenance of an active lifestyle in old age. The skeletal muscle ryanodine receptor, the major intracellular membrane channel through which calcium ions pass to elicit muscle contraction, is central to calcium ion balance and is hypothesized to be a significant factor for age-related decline in muscle function. The nematode Caenorhabditis elegans is a key model system for the study of human aging, and strains were generated with modified C. elegans ryanodine receptors corresponding to human myopathic variants linked with malignant hyperthermia and related conditions. The altered response of these strains to pharmacological agents reflected results of human diagnostic tests for individuals with these pathogenic variants. Involvement of nerve cells in the C. elegans responses may relate to rare medical symptoms concerning the central nervous system that have been associated with ryanodine receptor variants. These single amino acid modifications in C. elegans also conferred a reduction in lifespan and an accelerated decline in muscle integrity with age, supporting the significance of ryanodine receptor function for human aging.
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Affiliation(s)
- Baines K Nicoll
- Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, LS9 7TF, United Kingdom
- School of Biology, Faculty of Biological Sciences, University of Leeds, LS2 9JT, United Kingdom
| | - Célia Ferreira
- School of Biology, Faculty of Biological Sciences, University of Leeds, LS2 9JT, United Kingdom
| | - Philip M Hopkins
- Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, LS9 7TF, United Kingdom
| | - Marie-Anne Shaw
- Leeds Institute of Biomedical and Clinical Sciences, St James's University Hospital, LS9 7TF, United Kingdom
| | - Ian A Hope
- School of Biology, Faculty of Biological Sciences, University of Leeds, LS2 9JT, United Kingdom
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15
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Voermans NC, Snoeck M, Jungbluth H. RYR1-related rhabdomyolysis: A common but probably underdiagnosed manifestation of skeletal muscle ryanodine receptor dysfunction. Rev Neurol (Paris) 2016; 172:546-558. [PMID: 27663056 DOI: 10.1016/j.neurol.2016.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/29/2016] [Indexed: 01/04/2023]
Abstract
Mutations in the skeletal muscle ryanodine receptor (RYR1) gene are associated with a wide spectrum of inherited myopathies presenting throughout life. Malignant hyperthermia susceptibility (MHS)-related RYR1 mutations have emerged as a common cause of exertional rhabdomyolysis, accounting for up to 30% of rhabdomyolysis episodes in otherwise healthy individuals. Common triggers are exercise and heat and, less frequently, viral infections, alcohol and drugs. Most subjects are normally strong and have no personal or family history of malignant hyperthermia. Heat intolerance and cold-induced muscle stiffness may be a feature. Recognition of this (probably not uncommon) rhabdomyolysis cause is vital for effective counselling, to identify potentially malignant hyperthermia-susceptible individuals and to adapt training regimes. Studies in various animal models provide insights regarding possible pathophysiological mechanisms and offer therapeutic perspectives.
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Affiliation(s)
- N C Voermans
- Department of Neurology, Radboud University Medical Centre, R. Postlaan 4 (route 935), P.O. Box 9101, 6500 Nijmegen (935), The Netherlands.
| | - M Snoeck
- Department of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; Randall Division of Cell and Molecular Biophysics, Muscle Signalling Section, London, UK; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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16
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Jungbluth H, Dowling JJ, Ferreiro A, Muntoni F, Bönnemann C, Dirksen R, Faure J, Hamilton S, Hopkins P, Marks A, Marty I, Meilleur K, Riazi S, Sewry C, Treves S, Voermans N, Zorzato F. 217th ENMC International Workshop: RYR1-related myopathies, Naarden, The Netherlands, 29–31 January 2016. Neuromuscul Disord 2016; 26:624-33. [DOI: 10.1016/j.nmd.2016.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 06/02/2016] [Indexed: 12/22/2022]
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17
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Snoeck M, Treves S, Molenaar JP, Kamsteeg EJ, Jungbluth H, Voermans NC. "Human Stress Syndrome" and the Expanding Spectrum of RYR1-Related Myopathies. Cell Biochem Biophys 2016; 74:85-7. [PMID: 26972305 DOI: 10.1007/s12013-015-0704-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- M Snoeck
- National MH Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - S Treves
- Departments of Biomedicine and Anesthesia, University Hospital Basel, Basel, Switzerland
| | - J P Molenaar
- Department of Neurology, Radboud University Medical Centre, 935, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - E J Kamsteeg
- Department of Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK.,Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, 935, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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18
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Hopkins P, Rüffert H, Snoeck M, Girard T, Glahn K, Ellis F, Müller C, Urwyler A. European Malignant Hyperthermia Group guidelines for investigation of malignant hyperthermia susceptibility. Br J Anaesth 2015; 115:531-9. [DOI: 10.1093/bja/aev225] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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