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Abraham JR, Allen FM, Barnard J, Schlatzer D, Natowicz MR. Proteomic investigations of adult polyglucosan body disease: insights into the pathobiology of a neurodegenerative disorder. Front Neurol 2023; 14:1261125. [PMID: 38033781 PMCID: PMC10683643 DOI: 10.3389/fneur.2023.1261125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/26/2023] [Indexed: 12/02/2023] Open
Abstract
Inadequate glycogen branching enzyme 1 (GBE1) activity results in different forms of glycogen storage disease type IV, including adult polyglucosan body disorder (APBD). APBD is clinically characterized by adult-onset development of progressive spasticity, neuropathy, and neurogenic bladder and is histologically characterized by the accumulation of structurally abnormal glycogen (polyglucosan bodies) in multiple cell types. How insufficient GBE1 activity causes the disease phenotype of APBD is poorly understood. We hypothesized that proteomic analysis of tissue from GBE1-deficient individuals would provide insights into GBE1-mediated pathobiology. In this discovery study, we utilized label-free LC-MS/MS to quantify the proteomes of lymphoblasts from 3 persons with APBD and 15 age- and gender-matched controls, with validation of the findings by targeted MS. There were 531 differentially expressed proteins out of 3,427 detected between APBD subjects vs. controls, including pronounced deficiency of GBE1. Bioinformatic analyses indicated multiple canonical pathways and protein-protein interaction networks to be statistically markedly enriched in APBD subjects, including: RNA processing/transport/translation, cell cycle control/replication, mTOR signaling, protein ubiquitination, unfolded protein and endoplasmic reticulum stress responses, glycolysis and cell death/apoptosis. Dysregulation of these processes, therefore, are primary or secondary factors in APBD pathobiology in this model system. Our findings further suggest that proteomic analysis of GBE1 mutant lymphoblasts can be leveraged as part of the screening for pharmaceutical agents for the treatment of APBD.
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Affiliation(s)
- Joseph R. Abraham
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Frederick M. Allen
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - John Barnard
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Daniela Schlatzer
- Center for Proteomics, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Marvin R. Natowicz
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
- Pathology and Laboratory Medicine, Genomic Medicine, Neurological and Pediatrics Institutes, Cleveland Clinic, Cleveland, OH, United States
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2
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Van den Borre E, Cypers G, Vanhoenacker P, Dekeyzer S. Case 318: Adult Polyglucosan Body Disease. Radiology 2023; 309:e220598. [PMID: 37906012 DOI: 10.1148/radiol.220598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
HISTORY A 72-year-old man sought care for a cognitive deterioration over the past 5 years. There was a documented decline in his performance on the Mini-Mental State Examination (30 of 30 in 2016, 23 of 30 in 2021), with mainly episodic memory impairment. A more detailed history revealed a gait problem, paresthesia in both feet, and nocturnal urinary frequency. Clinical examination findings were suggestive of a length-dependent polyneuropathy. In addition, a right-sided Babinski sign was noted. Electromyography and a nerve conduction study corroborated a peripheral axonal sensorimotor neuropathy. MRI of the brain was performed.
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Affiliation(s)
- Eline Van den Borre
- From the Department of Neurology, Onze-Lieve-Vrouwziekenhuis vzw, Moorselbaan 164, 9300 Aalst, Belgium (E.V.d.B., G.C.); Department of Radiology, Universitair Ziekenhuis Gent, Gent, Belgium (P.V.); and Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (S.D.)
| | - Gert Cypers
- From the Department of Neurology, Onze-Lieve-Vrouwziekenhuis vzw, Moorselbaan 164, 9300 Aalst, Belgium (E.V.d.B., G.C.); Department of Radiology, Universitair Ziekenhuis Gent, Gent, Belgium (P.V.); and Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (S.D.)
| | - Piet Vanhoenacker
- From the Department of Neurology, Onze-Lieve-Vrouwziekenhuis vzw, Moorselbaan 164, 9300 Aalst, Belgium (E.V.d.B., G.C.); Department of Radiology, Universitair Ziekenhuis Gent, Gent, Belgium (P.V.); and Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (S.D.)
| | - Sven Dekeyzer
- From the Department of Neurology, Onze-Lieve-Vrouwziekenhuis vzw, Moorselbaan 164, 9300 Aalst, Belgium (E.V.d.B., G.C.); Department of Radiology, Universitair Ziekenhuis Gent, Gent, Belgium (P.V.); and Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (S.D.)
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Johal J, Castro Apolo R, Johnson MW, Persch MR, Edwards A, Varade P, Yacoub H. Adult polyglucosan body disease: an acute presentation leading to unmasking of this rare disorder. Hosp Pract (1995) 2021; 50:244-250. [PMID: 33412965 DOI: 10.1080/21548331.2021.1874182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Adult polyglucosan body disease (APBD) is an autosomal recessive leukodystrophy caused by abnormal intracellular accumulation of glycogen byproducts. This disorder is linked to a deficiency in glycogen branching enzyme-1 (GBE-1). Neurologic manifestations include upper and lower motor neuron signs, dementia, and peripheral neuropathy. APBD is typically a progressive disease. In this report, we discuss a novel case of APBD in a patient who had a sudden onset of spastic quadriparesis preceded by gradual difficulty with gait. Genetic and postmortem analysis confirmed the diagnosis of APBD.Case report: A 65-year-old man was evaluated for a new-onset of spastic quadriparesis, right-gaze preference, and left-sided beat nystagmus. Magnetic resonance imaging (MRI) of the brain revealed areas of white matter hyperintensities most prominent in the brainstem and periventricular regions. MRI of the cervical spine showed marked cord atrophy. Laboratory workup and cerebrospinal fluid analysis were unremarkable. Genetic testing supported the diagnosis of APBD due to GBE-1 deficiency. Postmortem analysis showed multiple white matter abnormalities suggestive of a leukodystrophy syndrome, and histopathologic testing revealed abnormal accumulation of polyglucosan bodies in samples from the patient's central nervous system supporting the diagnosis of APBD.Conclusion: APBD is a rare disorder that can affect the nervous system. The diagnosis can be confirmed with a combination of genetic testing and pathologic analysis of affected brain tissue.
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Affiliation(s)
- Jaspreet Johal
- Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA
| | | | - Michael W Johnson
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Pathology and Laboratory Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Michael R Persch
- St. George's University School of Medicine, West Indies, Grenada
| | - Adam Edwards
- Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Preet Varade
- Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Hussam Yacoub
- Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Carneiro I, Rodrigues M, Costa AJ, Cadilha R, Lima A. Adult polyglucosan body disease - Management and evolution in an intensive rehabilitation program. Rehabilitacion (Madr) 2020; 55:161-163. [PMID: 33139012 DOI: 10.1016/j.rh.2020.06.009] [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: 03/04/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
Adult polyglucosan body disease is a rare neuromuscular genetic disorder. It is characterized by accumulation of an abnormal structural form of glycogen, particularly in central and peripheral nervous system and muscles. Functional impairments and the rehabilitation approach of this entity is rarely reported. We present a case of a 65-year-old female with several years of undiagnosed symptoms. One year after the diagnosis, the patient was evaluated for the first time in a physical and rehabilitation consultation. We describe the inpatient rehabilitation program - an approach planned to achieve high levels of treatment intensity and with intervention of a multiprofessional and multidisciplinary team.
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Affiliation(s)
| | | | | | - R Cadilha
- North Rehabilitation Center, Portugal
| | - A Lima
- North Rehabilitation Center, Portugal
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Sagnelli A, Savoiardo M, Marchesi C, Morandi L, Mora M, Morbin M, Farina L, Mazzeo A, Toscano A, Pagliarani S, Lucchiari S, Comi G, Salsano E, Pareyson D. Adult polyglucosan body disease in a patient originally diagnosed with Fabry’s disease. Neuromuscul Disord 2014; 24:272-6. [DOI: 10.1016/j.nmd.2013.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022]
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Farmer JG, Crain BJ, Harris BT, Turner RS. Coexisting adult polyglucosan body disease with frontotemporal lobar degeneration with transactivation response DNA-binding protein-43 (TDP-43)-positive neuronal inclusions. Neurocase 2013; 19:67-75. [PMID: 22506890 PMCID: PMC3436935 DOI: 10.1080/13554794.2011.654217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Frontotemporal lobar degeneration with ubiquitin-positive inclusions (FTLD-U) is one of the most common pathological findings associated with the clinical FTLD syndromes. However, molecular characterization with genetic sequencing and protein expression techniques are recognizing many new subtypes for FTLDs. FTLDs are diverse and new nomenclature schemes have been proposed based on the molecular defects that are being discovered ( Mackenzie et al., 2010 , Acta Neuropathologica, 119, 1). Adult polyglucosan body disease (APBD) is a very rare disorder associated with systemic neurological signs and symptoms including progressive dementia with executive dysfunction and motor neuron disease. We report the clinical course of an individual with a clinical FTLD and the as yet unreported findings of coexistent APBD with FTLD-U and transactivation response DNA-binding protein-43 (TDP-43)-positive inclusions at autopsy (or more accurately, FTLD-TDP). It is unclear if these distinct findings are coincidental in this individual, or if pathogenic pathways may intersect to promote these coexisting pathologies.
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Affiliation(s)
- Jill G Farmer
- Memory Disorders Program, Department of Neurology, Georgetown University, Washington, DC 20057, USA
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Mochel F, Schiffmann R, Steenweg ME, Akman HO, Wallace M, Sedel F, Laforêt P, Levy R, Powers JM, Demeret S, Maisonobe T, Froissart R, Da Nobrega BB, Fogel BL, Natowicz MR, Lubetzki C, Durr A, Brice A, Rosenmann H, Barash V, Kakhlon O, Gomori JM, van der Knaap MS, Lossos A. Adult polyglucosan body disease: Natural History and Key Magnetic Resonance Imaging Findings. Ann Neurol 2012; 72:433-41. [PMID: 23034915 DOI: 10.1002/ana.23598] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Adult polyglucosan body disease (APBD) is an autosomal recessive leukodystrophy characterized by neurogenic bladder, progressive spastic gait, and peripheral neuropathy. Polyglucosan bodies accumulate in the central and peripheral nervous systems and are often associated with glycogen branching enzyme (GBE) deficiency. To improve clinical diagnosis and enable future evaluation of therapeutic strategies, we conducted a multinational study of the natural history and imaging features of APBD. METHODS We gathered clinical, biochemical, and molecular findings in 50 APBD patients with GBE deficiency from Israel, the United States, France, and the Netherlands. Brain and spine magnetic resonance images were reviewed in 44 patients. RESULTS The most common clinical findings were neurogenic bladder (100%), spastic paraplegia with vibration loss (90%), and axonal neuropathy (90%). The median age was 51 years for the onset of neurogenic bladder symptoms, 63 years for wheelchair dependence, and 70 years for death. As the disease progressed, mild cognitive decline may have affected up to half of the patients. Neuroimaging showed hyperintense white matter abnormalities on T2 and fluid attenuated inversion recovery sequences predominantly in the periventricular regions, the posterior limb of the internal capsule, the external capsule, and the pyramidal tracts and medial lemniscus of the pons and medulla. Atrophy of the medulla and spine was universal. p.Y329S was the most common GBE1 mutation, present as a single heterozygous (28%) or homozygous (48%) mutation. INTERPRETATION APBD with GBE deficiency, with occasional exceptions, is a clinically homogenous disorder that should be suspected in patients with adult onset leukodystrophy or spastic paraplegia with early onset of urinary symptoms and spinal atrophy.
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Affiliation(s)
- Fanny Mochel
- French Institute of Health and Medical Research, UMR S975, Paris, Frane.
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Adult polyglucosan body disease masquerading as "ALS with dementia of the Alzheimer type": an exceptional phenotype in a rare pathology. Alzheimer Dis Assoc Disord 2012; 26:96-9. [PMID: 21572310 DOI: 10.1097/wad.0b013e31821cc65d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe an exceptional clinical picture, namely, cognitive impairment of the Alzheimer disease type in a man who later developed manifestations typical of amyotrophic lateral sclerosis and who was subsequently found to have adult polyglucosan body disease (APGBD) upon postmortem neuropathologic explorations. The combined occurrence of amyotrophic lateral sclerosis and cognitive impairment of the Alzheimer disease type in APGBD has not been reported before. This case also underlines the diverse clinical presentation of this rare clinicopathologic entity (namely APGBD) and highlights the importance of recognizing the unusual association of clinical features in making the diagnosis.
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9
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Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the Gastro 2009 International Working Group. Acta Neuropathol 2009; 118:271-301. [PMID: 19360428 DOI: 10.1007/s00401-009-0527-y] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/19/2009] [Accepted: 03/22/2009] [Indexed: 01/30/2023]
Abstract
The term gastrointestinal neuromuscular disease describes a clinically heterogeneous group of disorders of children and adults in which symptoms are presumed or proven to arise as a result of neuromuscular, including interstitial cell of Cajal, dysfunction. Such disorders commonly have impaired motor activity, i.e. slowed or obstructed transit with radiological evidence of transient or persistent visceral dilatation. Whilst sensorimotor abnormalities have been demonstrated by a variety of methods in these conditions, standards for histopathological reporting remain relatively neglected. Significant differences in methodologies and expertise continue to confound the reliable delineation of normality and specificity of particular pathological changes for disease. Such issues require urgent clarification to standardize acquisition and handling of tissue specimens, interpretation of findings and make informed decisions on risk-benefit of full-thickness tissue biopsy of bowel or other diagnostic procedures. Such information will also allow increased certainty of diagnosis, facilitating factual discussion between patients and caregivers, as well as giving prognostic and therapeutic information. The following report, produced by an international working group, using established consensus methodology, presents proposed guidelines on histological techniques and reporting for adult and paediatric gastrointestinal neuromuscular pathology. The report addresses the main areas of histopathological practice as confronted by the pathologist, including suction rectal biopsy and full-thickness tissue obtained with diagnostic or therapeutic intent. For each, indications, safe acquisition of tissue, histological techniques, reporting and referral recommendations are presented.
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Sedel F, Barnerias C, Dubourg O, Desguerres I, Lyon-Caen O, Saudubray JM. Peripheral neuropathy and inborn errors of metabolism in adults. J Inherit Metab Dis 2007; 30:642-53. [PMID: 17879144 DOI: 10.1007/s10545-007-0684-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 07/09/2007] [Accepted: 07/11/2007] [Indexed: 01/14/2023]
Abstract
Although they are classically viewed as paediatric diseases, it is now recognized that inborn errors of metabolism (IEMs) can present at any age from childhood to adulthood. IEMs can involve the peripheral nervous system, mostly as part of a more diffuse neurological or systemic clinical picture. However, in some cases, the neuropathy can be the unique initial sign. Here, based on our personal experience and on a comprehensive literature analysis, we review IEMs causing neuropathies in adults. Diseases were classified according to the predominant type of neuropathies into (1) acute neuropathies, (2) mononeuropathy multiplex, (3) chronic axonal polyneuropathies, (4) chronic demyelinating polyneuropathies, (5) small-fibre neuropathies, and (6) lower motor neuron disease.
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Affiliation(s)
- F Sedel
- Federation of Nervous System Diseases, Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75651, Paris cedex 13, France.
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Abstract
Adult polyglucosan body disease (APBD) is a rare neurological disease, characterized by adult onset (fifth to seventh decades), progressive sensorimotor or pure motor peripheral neuropathy, upper motor neuron symptoms, neurogenic bladder, and cognitive impairment. APBD is confirmed by a sural nerve biopsy that shows the widespread presence of polyglucosan bodies in the nerve. We report a 70 year old male patient who exhibited progressive weakness in all extremities and dementia. His electrodiagnostic studies showed sensorimotor polyneuropathy and muscle pathology that consisted of polyglucosan bodies located in small peripheral nerves. This is the first case of APBD reported in Korea.
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Affiliation(s)
- Seung-Yeob Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hyeon Park
- Department of Neurology, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Se Hun Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Tai-Seung Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Won-Joo Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Krim E, Vital A, Macia F, Yekhlef F, Tison F. Erratum: Atypical parkinsonism combining α‐synuclein inclusions and polyglucosan body disease. Mov Disord 2005;20:200–204. Mov Disord 2005. [DOI: 10.1002/mds.20337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Elsa Krim
- Service de Neurologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Anne Vital
- Service d'Anatomopathologie, Centre Hospitalier Universitaire de Bordeaux, France
| | - Frederic Macia
- Service de Neurologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Farid Yekhlef
- Service de Neurologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - François Tison
- Service de Neurologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Krim E, Vital A, Macia F, Yekhlef F, Tison F. Atypical parkinsonism combining α‐synuclein inclusions and polyglucosan body disease. Mov Disord 2004; 20:200-4. [PMID: 15382212 DOI: 10.1002/mds.20285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Adult polyglucosan body disease (APGBD) is a rare disorder affecting the central and peripheral nervous systems and in which parkinsonism is unusual. A 71-year-old man presented levodopa-unresponsive parkinsonism with urinary incontinence and recurrent syncopes of 6 years standing masquerading as atypical parkinsonism of the multiple system atrophy (MSA-P) type. Brain histopathology demonstrated massive accumulation of polyglucosan bodies particularly in the putamen. In addition, there were dense alpha-synuclein-positive cytoplasmic oligodendroglial inclusions in the pons and in the middle cerebellar peduncle. These inclusions may be either due to the chance association of MSA-P with APGBD, or pathologically related to APGBD.
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Affiliation(s)
- Elsa Krim
- Service de Neurologie, Centre Hospitalier Universitaire de Bordeaux, France
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Knowles CH, Nickols CD, Feakins R, Martin JE. A systematic analysis of polyglucosan bodies in the human gastrointestinal tract in health and disease. Acta Neuropathol 2003; 105:410-3. [PMID: 12624795 DOI: 10.1007/s00401-002-0662-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2002] [Revised: 11/11/2002] [Accepted: 11/11/2002] [Indexed: 11/24/2022]
Abstract
Polyglucosan inclusion bodies have been described in smooth muscle of the gastrointestinal tract of aged dogs, and rarely in association with enteric dysmotility in humans. We have systematically examined the human small and large bowel for the presence of such inclusions in health and motility disorders. Systematic, blinded, dual observer analysis of colonic and ileal tissue from patients (n=80, age 20-92 years) undergoing large bowel resections for non-dysmotile conditions, principally neoplasia was performed, as well as retrospective review of all intestinal tissues referred for specialist histochemistry from patients undergoing surgery for motility disorders. All sections were stained with haematoxylin and eosin and periodic acid-Schiff stains. No polyglucosan bodies were identified in any specimen without dysmotility, regardless of age, but were a feature of 4/104 patients with diverse severe gastrointestinal motility disorders. In contrast to dogs, polyglucosan bodies are not a feature of normal ageing in human gastrointestinal smooth muscle but, in accord with previous suggestions, are seen in rare cases of human gut dysmotility. The significance of this difference is unclear.
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Affiliation(s)
- Charles H Knowles
- Academic Department of Surgery, Barts and the London, Queen Mary's School of Medicine, London
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Abstract
Skin biopsies that are immunostained to identify nerve fibers provide a new tool for assessing the small caliber nociceptors that terminate in the epidermis, as well as other cutaneous nerve fibers. Skin biopsies can be performed in multiple sites and can be repeated over time, so that a spatiotemporal profile of epidermal innervation can be constructed. This approach may help assess the progression of fiber loss in disease and of regeneration and re-innervation with treatment.
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Affiliation(s)
- J W Griffin
- Johns Hopkins Hospital, Baltimore, Maryland 21187, USA.
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