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Scalco RS, Stemmerik M, Løkken N, Vissing CR, Madsen KL, Michalak Z, Pattni J, Godfrey R, Samandouras G, Bassett P, Holton JL, Krag T, Haller RG, Sewry C, Wigley R, Vissing J, Quinlivan R. Results of an open label feasibility study of sodium valproate in people with McArdle disease. Neuromuscul Disord 2020; 30:734-741. [PMID: 32811700 DOI: 10.1016/j.nmd.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Abstract
McArdle disease results from a lack of muscle glycogen phosphorylase in skeletal muscle tissue. Regenerating skeletal muscle fibres can express the brain glycogen phosphorylase isoenzyme. Stimulating expression of this enzyme could be a therapeutic strategy. Animal model studies indicate that sodium valproate (VPA) can increase expression of phosphorylase in skeletal muscle affected with McArdle disease. This study was designed to assess whether VPA can modify expression of brain phosphorylase isoenzyme in people with McArdle disease. This phase II, open label, feasibility pilot study to assess efficacy of six months treatment with VPA (20 mg/kg/day) included 16 people with McArdle disease. Primary outcome assessed changes in VO2peak during an incremental cycle test. Secondary outcomes included: phosphorylase enzyme expression in post-treatment muscle biopsy, total distance walked in 12 min, plasma lactate change (forearm exercise test) and quality of life (SF36). Safety parameters. 14 participants completed the trial, VPA treatment was well tolerated; weight gain was the most frequently reported drug-related adverse event. There was no clinically meaningful change in any of the primary or secondary outcome measures including: VO2peak, 12 min walk test and muscle biopsy to look for a change in the number of phosphorylase positive fibres between baseline and 6 months of treatment. Although this was a small open label feasibility study, it suggests that a larger randomised controlled study of VPA, may not be worthwhile.
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Affiliation(s)
- Renata S Scalco
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, United Kingdom; CAPES Foundation, Ministry of Education, Brazil
| | - Mads Stemmerik
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Christoffer R Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Karen L Madsen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Zuzanna Michalak
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, United Kingdom
| | - Jatin Pattni
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, United Kingdom
| | - Richard Godfrey
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, United Kingdom; Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, United Kingdom
| | - George Samandouras
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, United Kingdom
| | | | - Janice L Holton
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, United Kingdom
| | - Thomas Krag
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Ronald G Haller
- Department of Neurology, The University of Texas Southwestern Medical Center and Neuromuscular Centre, Institute for exercise and environmental medicine, Dallas, Texas, 75231, USA
| | - C Sewry
- RJAH Orthopaedic Hospital NHS Foundation Trust Oswestry, United Kingdom
| | - Ralph Wigley
- Great Ormond Street Hospital, London, United Kingdom
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Ros Quinlivan
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, United Kingdom.
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Krag TO, Pinós T, Nielsen TL, Brull A, Andreu AL, Vissing J. Differential Muscle Involvement in Mice and Humans Affected by McArdle Disease. J Neuropathol Exp Neurol 2016; 75:441-54. [PMID: 27030740 DOI: 10.1093/jnen/nlw018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
McArdle disease (muscle glycogenosis type V) is caused by myophosphorylase deficiency, which leads to impaired glycogen breakdown. We investigated how myophosphorylase deficiency affects muscle physiology, morphology, and glucose metabolism in 20-week-old McArdle mice and compared the findings to those in McArdle disease patients. Muscle contractions in the McArdle mice were affected by structural degeneration due to glycogen accumulation, and glycolytic muscles fatigued prematurely, as occurs in the muscles of McArdle disease patients. Homozygous McArdle mice showed muscle fiber disarray, variations in fiber size, vacuoles, and some internal nuclei associated with cytosolic glycogen accumulation and ongoing regeneration; structural damage was seen only in a minority of human patients. Neither liver nor brain isoforms of glycogen phosphorylase were upregulated in muscles, thus providing no substitution for the missing muscle isoform. In the mice, the tibialis anterior (TA) muscles were invariably more damaged than the quadriceps muscles. This may relate to a 7-fold higher level of myophosphorylase in TA compared to quadriceps in wild-type mice and suggests higher glucose turnover in the TA. Thus, despite differences, the mouse model of McArdle disease shares fundamental physiological and clinical features with the human disease and could be used for studies of pathogenesis and development of therapies.
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Affiliation(s)
- Thomas O Krag
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (TOK, TLN, JV); and Mitochondrial Pathology and Neuromuscular Disorders Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain (TP, AB, ALA).
| | - Tomàs Pinós
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (TOK, TLN, JV); and Mitochondrial Pathology and Neuromuscular Disorders Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain (TP, AB, ALA)
| | - Tue L Nielsen
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (TOK, TLN, JV); and Mitochondrial Pathology and Neuromuscular Disorders Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain (TP, AB, ALA)
| | - Astrid Brull
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (TOK, TLN, JV); and Mitochondrial Pathology and Neuromuscular Disorders Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain (TP, AB, ALA)
| | - Antoni L Andreu
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (TOK, TLN, JV); and Mitochondrial Pathology and Neuromuscular Disorders Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain (TP, AB, ALA)
| | - John Vissing
- From the Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (TOK, TLN, JV); and Mitochondrial Pathology and Neuromuscular Disorders Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain (TP, AB, ALA)
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3
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Pinós T, Lucia A, Arenas J, Brull A, Andreu AL, Martin MA, Nogales-Gadea G. Minimal symptoms in McArdle disease: A real PYGM
genotype effect? Muscle Nerve 2015; 52:1136-7. [DOI: 10.1002/mus.24789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tomàs Pinós
- Departament de Patologia Mitocondrial i Neuromuscular; Hospital Universitari Vall d'Hebron, Institut de Recerca, Universitat Autónoma de Barcelona; Barcelona Spain
- Centre for Biomedical Network Research on Rare Diseases; Instituto de Salud Carlos III; Madrid Spain
| | - Alejandro Lucia
- Universidad Europea; Madrid Spain
- Instituto de Investigación Hospital 12 de Octubre; Madrid Spain
| | - Joaquin Arenas
- Centre for Biomedical Network Research on Rare Diseases; Instituto de Salud Carlos III; Madrid Spain
- Instituto de Investigación Hospital 12 de Octubre; Madrid Spain
| | - Astrid Brull
- Departament de Patologia Mitocondrial i Neuromuscular; Hospital Universitari Vall d'Hebron, Institut de Recerca, Universitat Autónoma de Barcelona; Barcelona Spain
- Centre for Biomedical Network Research on Rare Diseases; Instituto de Salud Carlos III; Madrid Spain
| | - Antoni L. Andreu
- Hospital Universitari de Bellvitge; Hospitalet del Llobregat Spain
| | - Miguel Angel Martin
- Centre for Biomedical Network Research on Rare Diseases; Instituto de Salud Carlos III; Madrid Spain
- Instituto de Investigación Hospital 12 de Octubre; Madrid Spain
| | - Gisela Nogales-Gadea
- Department of Neurosciences; Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol I Campus Can Ruti, Universitat Autònoma de Barcelona; Badalona Spain
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Nogales-Gadea G, Santalla A, Brull A, de Luna N, Lucia A, Pinós T. The pathogenomics of McArdle disease--genes, enzymes, models, and therapeutic implications. J Inherit Metab Dis 2015; 38:221-30. [PMID: 25053163 DOI: 10.1007/s10545-014-9743-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/17/2014] [Accepted: 06/25/2014] [Indexed: 11/24/2022]
Abstract
Numerous biomedical advances have been made since Carl and Gerty Cori discovered the enzyme phosphorylase in the 1940s and the Scottish physician Brian McArdle reported in 1951 a previously 'undescribed disorder characterized by a gross failure of the breakdown in muscle of glycogen'. Today we know that this disorder, commonly known as 'McArdle disease', is caused by inherited deficiency of the muscle isoform of glycogen phosphorylase (GP). Here we review the main aspects of the 'pathogenomics' of this disease including, among others: the spectrum of mutations in the gene (PYGM) encoding muscle GP; the interplay between the different tissue GP isoforms in cellular cultures and in patients; what can we learn from naturally occurring and recently laboratory-generated animal models of the disease; and potential therapies.
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Affiliation(s)
- Gisela Nogales-Gadea
- Neuromuscular Diseases Unit, Institut de Recerca del Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Maria Claret 167, 08025, Barcelona, Spain,
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Howell JM, Dunton E, Creed KE, Quinlivan R, Sewry C. Investigating sodium valproate as a treatment for McArdle disease in sheep. Neuromuscul Disord 2014; 25:111-9. [PMID: 25455802 DOI: 10.1016/j.nmd.2014.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/01/2014] [Accepted: 10/04/2014] [Indexed: 11/26/2022]
Abstract
McArdle disease is due to an absence of the enzyme muscle glycogen phosphorylase and results in significant physical impairment in humans. We hypothesised that sodium valproate, an HDAC inhibitor, might have the ability to up-regulate the enzyme. We treated McArdle sheep with sodium valproate given enterically at 20-60 mg/kg body wt. Compared with untreated control animals, there was increased expression of phosphorylase in muscle fibres. The response was dose dependent and reached a maximum 2 hours after the application and increased with repeated applications. Improvement in mobility could not be demonstrated. These findings suggest that sodium valproate is a potential therapeutic treatment for McArdle disease.
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Affiliation(s)
- J McC Howell
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia; Australian Neuro-Muscular Research Institute, CNND, University of Western Australia, Perth, Western Australia, Australia.
| | - E Dunton
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia
| | - K E Creed
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia
| | - R Quinlivan
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - C Sewry
- Robert Jones and Agnes Hunt Orthopaedic hospital, Oswestry, United Kingdom
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Howell JM, Walker KR, Creed KE, Dunton E, Davies L, Quinlivan R, Karpati G. Phosphorylase re-expression, increase in the force of contraction and decreased fatigue following notexin-induced muscle damage and regeneration in the ovine model of McArdle disease. Neuromuscul Disord 2013; 24:167-77. [PMID: 24309536 DOI: 10.1016/j.nmd.2013.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 10/07/2013] [Accepted: 10/18/2013] [Indexed: 11/19/2022]
Abstract
McArdle disease is caused by a deficiency of myophosphorylase and currently a satisfactory treatment is not available. The injection of notexin into, or the layering of notexin onto, the muscles of affected sheep resulted in necrosis followed by regeneration of muscle fibres with the expression of both non-muscle isoforms of phosphorylase within the fibres and a reduction of the amount of glycogen in the muscle with an increase in the strength of contraction and a decrease in fatiguability in the muscle fibres. The sustained re-expression of both the brain and liver isoforms of phosphorylase within the muscle fibres provides further emphasis that strategies to enhance the re-expression of these isoforms should be investigated as a possible treatment for McArdle disease.
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Affiliation(s)
- J McC Howell
- School of Veterinary and Life Sciences, Murdoch University, Perth 6150, Western Australia, Australia; Australian Neuro-Muscular Research Institute,CNND, University of Western Australia, Perth 6150, Western Australia, Australia.
| | - K R Walker
- Centre for Medical Research, University of Western Australia, Perth 6150, Western Australia, Australia
| | - K E Creed
- School of Veterinary and Life Sciences, Murdoch University, Perth 6150, Western Australia, Australia
| | - E Dunton
- School of Veterinary and Life Sciences, Murdoch University, Perth 6150, Western Australia, Australia
| | - L Davies
- School of Veterinary and Life Sciences, Murdoch University, Perth 6150, Western Australia, Australia
| | - R Quinlivan
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - G Karpati
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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Cell models for McArdle disease and aminoglycoside-induced read-through of a premature termination codon. Neuromuscul Disord 2012; 23:43-51. [PMID: 22818872 DOI: 10.1016/j.nmd.2012.06.348] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/29/2012] [Accepted: 06/19/2012] [Indexed: 01/02/2023]
Abstract
McArdle disease results from mutations in the gene encoding muscle glycogen phosphorylase (PYGM) protein and the two most common mutations are a premature termination codon (R50X) and a missense mutation (G205S). Myoblasts from patients cannot be used to create a cell model of McArdle disease because even normal myoblasts produce little or no PYGM protein in cell culture. We therefore created cell models by expressing wild-type or mutant (R50X or G205S) PYGM from cDNA integrated into the genome of Chinese hamster ovary cells. These cell lines enable the study of McArdle mutations in the absence of nonsense-mediated decay of mRNA transcripts. Although all cell lines produced stable mRNA, only wild-type produced detectable PYGM protein. Our data suggest that the G205S mutation affects PYGM by causing misfolding and accelerated protein turnover. Using the N-terminal region of PYGM containing the R50X mutation fused to green fluorescent protein, we were able to demonstrate both small amounts of truncated protein production and read-through of the R50X premature termination codon induced by the aminoglycoside, G418.
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Expression of glycogen phosphorylase isoforms in cultured muscle from patients with McArdle's disease carrying the p.R771PfsX33 PYGM mutation. PLoS One 2010; 5. [PMID: 20957198 PMCID: PMC2950139 DOI: 10.1371/journal.pone.0013164] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 09/11/2010] [Indexed: 11/24/2022] Open
Abstract
Background Mutations in the PYGM gene encoding skeletal muscle glycogen phosphorylase (GP) cause a metabolic disorder known as McArdle's disease. Previous studies in muscle biopsies and cultured muscle cells from McArdle patients have shown that PYGM mutations abolish GP activity in skeletal muscle, but that the enzyme activity reappears when muscle cells are in culture. The identification of the GP isoenzyme that accounts for this activity remains controversial. Methodology/Principal Findings In this study we present two related patients harbouring a novel PYGM mutation, p.R771PfsX33. In the patients' skeletal muscle biopsies, PYGM mRNA levels were ∼60% lower than those observed in two matched healthy controls; biochemical analysis of a patient muscle biopsy resulted in undetectable GP protein and GP activity. A strong reduction of the PYGM mRNA was observed in cultured muscle cells from patients and controls, as compared to the levels observed in muscle tissue. In cultured cells, PYGM mRNA levels were negligible regardless of the differentiation stage. After a 12 day period of differentiation similar expression of the brain and liver isoforms were observed at the mRNA level in cells from patients and controls. Total GP activity (measured with AMP) was not different either; however, the active GP activity and immunoreactive GP protein levels were lower in patients' cell cultures. GP immunoreactivity was mainly due to brain and liver GP but muscle GP seemed to be responsible for the differences. Conclusions/Significance These results indicate that in both patients' and controls' cell cultures, unlike in skeletal muscle tissue, most of the protein and GP activities result from the expression of brain GP and liver GP genes, although there is still some activity resulting from the expression of the muscle GP gene. More research is necessary to clarify the differential mechanisms of metabolic adaptations that McArdle cultures undergo in vitro.
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Howell JM, Walker KR, Davies L, Dunton E, Everaardt A, Laing N, Karpati G. Adenovirus and adeno-associated virus-mediated delivery of human myophosphorylase cDNA and LacZ cDNA to muscle in the ovine model of McArdle's disease: expression and re-expression of glycogen phosphorylase. Neuromuscul Disord 2008; 18:248-58. [PMID: 18343113 DOI: 10.1016/j.nmd.2007.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 09/11/2007] [Accepted: 10/30/2007] [Indexed: 11/26/2022]
Abstract
At present there is no satisfactory treatment for McArdle's disease, deficiency of myophosphorylase. Injection of modified adenovirus 5 (AdV5) and adeno-associated virus 2 (AAV2) vectors containing myophosphorylase expression cassettes, into semitendinosus muscle of sheep with McArdle's disease, produced expression of functional myophosphorylase and some re-expression of the non-muscle glycogen phosphorylase isoforms (both liver and brain) in regenerating fibres. Expression of both non-muscle isoforms was also seen after control injections of AdV5LacZ vectors. There was up to an order of magnitude greater expression of phosphorylase after myophosphorylase vector injection than after LacZ controls (62% of sections with over 1000 positive muscle fibres, versus 7%). The results presented here suggest that the use of viral vector-mediated phosphorylase gene transfer may be applicable to the treatment of McArdle's disease and that sustained re-expression of the brain and liver isoforms should also be investigated as a possible treatment.
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Affiliation(s)
- J McC Howell
- Department of Veterinary Biology and Biomedical Science, Murdoch University, Perth 6150, WA, Australia.
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Abstract
This review highlights recent advances in our understanding of McArdle's disease, including the mechanisms involved in the regulation of the clinical phenotype. The latest molecular genetic studies have demonstrated the genetic heterogeneity of the disorder, with more than 65 mutations identified to date. There is not a specific treatment for McArdle's disease, but some nutritional treatments in combination with aerobic conditioning could improve the quality of life in most patients.
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Affiliation(s)
- G Nogales-Gadea
- Dept Patologia Mitocondrial i Neuromuscular, Centre d'Investigacions en Bioguimica y Bioloqía Molecular, Institut de Recera Vall d'Hebron, Barcelona, Spain
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Getachew E, Prayson RA. Pathologic quiz case: a man with exertion-induced cramps and myoglobinuria. McArdle disease (glycogenosis type V or myophosphorylase deficiency). Arch Pathol Lab Med 2003; 127:1227-8. [PMID: 12951997 DOI: 10.5858/2003-127-1227-pqcamw] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eskender Getachew
- Department of Neurology, Cleveland Clinic Hospital, Weston, Fla, USA
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