1
|
Fournier JE, Mak G, Gordon K, Glogauer J, Fareez F, Provias J, Tarnopolsky MA, Lu JQ. Cylindrical spirals and other concentric structures of skeletal muscle in patients with neurological diseases. J Neurol Sci 2023; 451:120734. [PMID: 37478793 DOI: 10.1016/j.jns.2023.120734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/30/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
Cylindrical spirals (CSs) are ultrastructurally distinct, intracytoplasmic inclusions characterized by concentrically wrapped lamellae, which are rarely found in skeletal muscle biopsies on electron microscopy (EM). CSs are often confused with other EM concentric structures including concentric laminated bodies and mitochondrial concentric cristae (MCC), due to similarities in these ultrastructures. In this study, we found CSs in 9 muscle biopsies from 9 patients, accounting for 0.5% of the biopsies examined routinely by EM. The frequency of CSs in these muscles varied from sparse and segregated to focally frequent and aggregated. CS-associated features included muscle fiber denervation atrophy in all 9 cases, fiber type grouping in 7/8 cases, tubular aggregates in 3/9 cases, and MCC in 2/9 cases. We also compared the concentric structures and highlighted their differences to distinguish CSs from other similar structures. Clinically, 8 out of 9 patients were adults aged 41-74 years and only one patient was 17 month-old. CSs were associated with several neurological diseases including Huntington's disease, amyotrophic lateral sclerosis, Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes, and other complex neurological disorders with neuropathy/encephalopathy, as well as anti-MDA5+ dermatomyositis. Eight of nine patients had genetic findings such as trinucleotide repeat expansion of huntingtin gene, ALS2 variant, MT-TL1 m.3243A > G mutation, and PMP 22 gene deletion. These results suggest that CSs may be highly variable in frequency and likely are under-reported/under-detected; they may be associated with neurogenic myopathy or central/peripheral nervous system disorders including some genetic neurological/neuromuscular diseases. Our findings of more CS-associated neurological diseases and an association of CSs with muscle neurogenic features may contribute to a better understanding of the clinico-pathological significance of CSs.
Collapse
Affiliation(s)
- Jeffrey E Fournier
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gloria Mak
- Department of Medicine/Neurology, McMaster University, Hamilton, Ontario, Canada
| | - Katerina Gordon
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Judah Glogauer
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Faiha Fareez
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John Provias
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark A Tarnopolsky
- Department of Medicine/Neurology, McMaster University, Hamilton, Ontario, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
2
|
Claeys T, Goosens V, Racé V, Theys T, Thal DR, Depuydt CE, Claeys KG. Clinical and muscle MRI features in a family with tubular aggregate myopathy and novel STIM1 mutation. Neuromuscul Disord 2020; 30:709-718. [PMID: 32893083 DOI: 10.1016/j.nmd.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/17/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 11/26/2022]
Abstract
Heterozygous mutations in the stromal interaction molecule-1-gene (STIM1) cause a clinical phenotype varying from tubular aggregate myopathy with single or multiple signs of Stormorken syndrome to the full Stormorken phenotype. We identified a novel heterozygous mutation c.325C > T (p.H109Y) in the EF-hand domain of STIM1 in six patients of a large Belgian family, and performed a detailed clinical (N = 6), histopathological (N = 2) and whole-body muscle MRI (N = 3) study. The clinical phenotype was characterized by a slowly progressive, predominant proximal muscle weakness in all patients (100%), and additional exercise-induced myalgia in three (60%). Patients experienced symptom onset between 10 and 20 years, remained ambulatory into late adulthood, showed elevated serum creatine kinase levels and tubular aggregates in type 1 and type 2 fibers on muscle biopsy. Interestingly, jaw contractures and hyperlaxity, as well as non-muscular multisystemic features such as menorrhagia, easy bruising and ichthyosis occurred in one patient, and miosis in another. Whole-body muscle MRI revealed predominant involvement of superficial neck extensors, subscapularis, obliquus abdominis externus, lumbar extensors, rectus femoris, biceps femoris longus, medial head of gastrocnemius and flexor hallucis longus. Our findings in patients with myopathy with tubular aggregates and a STIM1 mutation further support the concept of a continuous spectrum with Stormorken syndrome.
Collapse
Affiliation(s)
- Thomas Claeys
- Department of Neurology, Neuromuscular Reference Centre, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Veerle Goosens
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Valérie Racé
- Centre for Human Genetics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Department of Human Genetics, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Tom Theys
- Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Dietmar R Thal
- Department of Pathology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Laboratory for Neuropathology, Department of Imaging and Pathology, and Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Christophe E Depuydt
- Laboratory for Muscle diseases and Neuropathies, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Kristl G Claeys
- Department of Neurology, Neuromuscular Reference Centre, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Laboratory for Muscle diseases and Neuropathies, Department of Neurosciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| |
Collapse
|
3
|
Beecroft SJ, Olive M, Quereda LG, Gallano P, Ojanguren I, McLean C, McCombe P, Laing NG, Ravenscroft G. Cylindrical spirals in two families: Clinical and genetic investigations. Neuromuscul Disord 2019; 30:151-158. [PMID: 31952901 DOI: 10.1016/j.nmd.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/22/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 01/19/2023]
Abstract
Cylindrical spirals are a rare ultrastructural finding on muscle biopsy, with fewer than 20 reported cases since its first description in 1979. These structures are sometimes observed with tubular aggregates and are thought to comprise longitudinal sarcoplasmic reticulum. While mutations in genes encoding key components of Ca2+ handling (ORAI1 and STIM1) underlie tubular aggregate myopathy, no causative genes have been associated with cylindrical spirals. Here we describe two families with cylindrical spirals on muscle biopsy with a suspected genetic cause. In one family we identified a known truncating variant in EBF3, previously associated with a neurodevelopmental disorder. The affected individuals in this family present with clinical features overlapping with those described for EBF3 disease. An isolated proband in the second family harbours bi-allelic truncating variants in TTN and her clinical course and other features on biopsy are highly concordant for titinopathy. From experimental studies, EBF3 is known to be involved in Ca2+ regulation in muscle, thus EBF3 dysregulation may represent a novel mechanism of impaired Ca2+ handling leading to cylindrical spirals. Additional cases of EBF3 disease or titinopathy with cylindrical spirals need to be identified to support the involvement of these genes in the pathogenesis of cylindrical spirals.
Collapse
Affiliation(s)
- Sarah J Beecroft
- Centre for Medical Research, University of Western Australia, Harry Perkins Institute of Medical Research, QEII Medical Centre, Australia
| | - Montse Olive
- Neuropathology Unit, Department of Pathology and Neuromuscular Unit, Department of Neurology, IDIBELL-Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona 08907, Spain
| | | | - Pia Gallano
- CIBERER, Genetics Department, Hospital Sant Pau, Barcelona 08041, Spain
| | - Isabel Ojanguren
- Department of Pathology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
| | - Catriona McLean
- Victorian Neuromuscular Laboratory, Alfred Health, Commercial Rd, Prahran, VIC 3181, Australia
| | - Pamela McCombe
- The University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nigel G Laing
- Centre for Medical Research, University of Western Australia, Harry Perkins Institute of Medical Research, QEII Medical Centre, Australia
| | - Gianina Ravenscroft
- Centre for Medical Research, University of Western Australia, Harry Perkins Institute of Medical Research, QEII Medical Centre, Australia.
| |
Collapse
|
4
|
Affiliation(s)
- Hans H Goebel
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany..
| |
Collapse
|
5
|
Brady S, Healy EG, Gang Q, Parton M, Quinlivan R, Jacob S, Curtis E, Al-Sarraj S, Sewry CA, Hanna MG, Houlden H, Beeson D, Holton JL. Tubular Aggregates and Cylindrical Spirals Have Distinct Immunohistochemical Signatures. J Neuropathol Exp Neurol 2016; 75:1171-1178. [DOI: 10.1093/jnen/nlw096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
6
|
Xu JW, Liu FC, Li W, Zhao YY, Zhao DD, Luo YB, Lu JQ, Yan CZ. Cylindrical Spirals in Skeletal Muscles Originate From the Longitudinal Sarcoplasmic Reticulum. J Neuropathol Exp Neurol 2016; 75:148-55. [DOI: 10.1093/jnen/nlv013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
7
|
Malfatti E, Chaves M, Bellance R, Viou MT, Sarrazin E, Fardeau M, Romero NB. Cylindrical spirals associated with severe congenital muscle weakness and epileptic encephalopathy. Muscle Nerve 2015; 52:895-9. [DOI: 10.1002/mus.24699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Edoardo Malfatti
- UPMC Université Paris 06; Institut National de la Santé et de la Recherche Médicale UMR 974, CNRS FRE3617, Center for Research in Myology, GH Pitié-Salpêtrière, Sorbonne Universités; 47 Boulevard de l'Hôpital 75013 Paris France
| | - Marcelo Chaves
- Department of Neurology-Neuromuscular Disorders Centers; Buenos Aires Italian Hospital; Buenos Aires Argentina
| | - Remi Bellance
- Centre de Référence Caribéen des Maladies neuromusculaire et Neurologiques Rares; CHU de Martinique Martinique
| | - Mai Thao Viou
- UPMC Université Paris 06; Institut National de la Santé et de la Recherche Médicale UMR 974, CNRS FRE3617, Center for Research in Myology, GH Pitié-Salpêtrière, Sorbonne Universités; 47 Boulevard de l'Hôpital 75013 Paris France
| | - Elisabeth Sarrazin
- Centre de Référence Caribéen des Maladies neuromusculaire et Neurologiques Rares; CHU de Martinique Martinique
| | - Michel Fardeau
- UPMC Université Paris 06; Institut National de la Santé et de la Recherche Médicale UMR 974, CNRS FRE3617, Center for Research in Myology, GH Pitié-Salpêtrière, Sorbonne Universités; 47 Boulevard de l'Hôpital 75013 Paris France
| | - Norma B. Romero
- UPMC Université Paris 06; Institut National de la Santé et de la Recherche Médicale UMR 974, CNRS FRE3617, Center for Research in Myology, GH Pitié-Salpêtrière, Sorbonne Universités; 47 Boulevard de l'Hôpital 75013 Paris France
- Centre de Référence de Pathologie Neuromusculaire Paris-Est, Institut de Myologie, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris; Paris France
| |
Collapse
|
8
|
Abstract
Electron microscopy is an essential component of myopathology, both in diagnostics and research of neuromuscular diseases. Although recently reduced in the diagnostic armamentarium, it has greatly been expanded to mouse models in research. Mostly it is descriptive, but a few additional techniques in combination with transmission electron microscopy have been employed. Foremost among them is immunoelectron microscopy, which assists in guiding molecular analysis in hereditary conditions, but may be vital in diagnostics of certain acquired entities, e.g., undulating tubules in dermatomyositis and in those congenital myopathies where genes and mutations remain to be identified, as in cylindrical spirals myopathy and hexagonal crystalloid-body myopathy.
Collapse
Affiliation(s)
- Hans H Goebel
- Department of Neuropathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany and
| | | |
Collapse
|
9
|
Kyriakides T, Angelini C, Schaefer J, Mongini T, Siciliano G, Sacconi S, Joseph J, Burgunder JM, Bindoff LA, Vissing J, de Visser M, Hilton-Jones D. EFNS review on the role of muscle biopsy in the investigation of myalgia. Eur J Neurol 2013; 20:997-1005. [DOI: 10.1111/ene.12174] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 02/14/2013] [Indexed: 12/21/2022]
Affiliation(s)
- T. Kyriakides
- Clinical Neurosciences; Cyprus Institute of Neurology and Genetics; Nicosia Cyprus
| | - C. Angelini
- IRCCS Fondazione Ospedale San Camillo; Venezia Italy
| | - J. Schaefer
- Department of Neurology; University of Dresden; Dresden Germany
| | - T. Mongini
- Neuromuscular Center; S.G. Battista Hospital; University of Turin; Turin Italy
| | - G. Siciliano
- Department of Neuroscience; Neurological Clinic; University of Pisa; Pisa Italy
| | - S. Sacconi
- Centre de reference des Maladies nueuromusculaires; CNRS UMR6543; Nice University Hospital; Nice France
| | - J. Joseph
- St George's University of London at the University of Nicosia Medical School; Nicosia Cyprus
| | - J. M. Burgunder
- Departments of Neurology and Clinical Research; University of Bern; Inselspital; Bern Switzerland
| | - L. A. Bindoff
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - J. Vissing
- Neuromuscular Clinic and Research Unit; Department of Neurology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. de Visser
- Department of Neurology; Academic Medical Center; Amsterdam The Netherlands
| | - D. Hilton-Jones
- Oxford Neuromuscular Centre; Department of Neurology; John Radcliffe Hospital; Oxford UK
| |
Collapse
|
10
|
Goebel HH, Bönnemann CG. 169th ENMC International Workshop Rare Structural Congenital Myopathies 6-8 November 2009, Naarden, The Netherlands. Neuromuscul Disord 2011; 21:363-74. [PMID: 21414784 DOI: 10.1016/j.nmd.2011.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Hans H Goebel
- University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | | | | |
Collapse
|
11
|
Claeys KG, Pellissier J, Garcia-bragado F, Weis J, Urtizberea A, Poza J, Cobo A, Stoltenburg G, Figarella-branger D, Willems PJ, Depuydt CE, Kleiner W, Pouget J, Piraud M, Brochier G, Romero NB, Fardeau M, Goebel HH, Bönnemann CG, Voit T, Eymard B, Laforêt P. Myopathy with hexagonally cross-linked crystalloid inclusions: Delineation of a clinico-pathological entity. Neuromuscul Disord 2010; 20:701-8. [DOI: 10.1016/j.nmd.2010.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/17/2010] [Accepted: 06/07/2010] [Indexed: 11/17/2022]
|
12
|
Abstract
Floppiness/hypotonia is a common neurologic symptom in infancy. A variety of neuromuscular disorders and central nervous system (CNS) disorders cause floppy infant syndrome (FIS). CNS disorders are the much more common causes of the syndrome than neuromuscular disorders. On long-term follow up, cerebral palsy and mental retardation turn out to be the 2 most common causes of FIS. This review focuses on neuromuscular causes of FIS. With the advent of molecular diagnosis, a few conditions can be diagnosed by DNA analysis of the peripheral lymphocytes (myotonic dystrophy, spinal muscular atrophy); however, for the most part, electrodiagnostic studies and muscle biopsy remain as essential diagnostic tools for FIS. Immunohistochemical study of the biopsied muscle also improves diagnostic capability. Management for most conditions remains supportive.
Collapse
Affiliation(s)
- Masanori Igarashi
- From the Department of Pediatrics and Neurology, University of Tennessee, Memphis
| |
Collapse
|
13
|
Abstract
Actinopathies are defined by missense mutations in the ACTA1 gene coding for sarcomeric actin, of which some 70 families have, so far, been identified. Often, but not always, muscle fibers carry large patches of actin filaments. Many such patients also have nemaline myopathy, qualifying actinopathies as a subgroup of nemaline myopathies. This article concerns a then newborn, now 2 1/2-year-old boy, the first and single child of nonconsanguineous parents, who was born floppy, requiring immediate postnatal assisted ventilation. A quadriceps muscle biopsy revealed large patches of thin myofilaments reacting at light and electron microscopic levels with antibodies against actin but only a few sarcoplasmic rods and no intranuclear rods. DNA analysis of the patient's and both parents' blood did not reveal any missense mutation in the ACTA1 gene. Thus, this congenital myopathy can be caused by a new type of ACTA1 gene mutation, a new non-ACTA1 gene mutation, or no mutation at all, designating it as an actin-related myopathy, perhaps a new type of congenital myopathy and a new member of protein aggregate myopathies marked by aggregation of proteins within muscle fibers, among them desminopathies, alpha-beta crystallinopathies, other desmin-related myopathies (also termed myofibrillar myopathies), actinopathies and, now, actin-related myopathies.
Collapse
Affiliation(s)
- Hans H Goebel
- Department of Neuropathology, Johannes Gutenberg University Medical Center, Mainz, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
A transgenic mouse model has been established in which the cytokine interferon-gamma (IFN-gamma) is overexpressed through the action of the acetylcholine receptor epsilon promoter acting at the neuromuscular junction. While originally developed as a model for the study of the pathogenesis of myasthenia gravis, there are important differences from both human myasthenia gravis and its animal model, experimental autoimmune myasthenia gravis. By 4 months of age there was a well-established inflammatory, predominantly necrotizing myopathy, with marked dystrophic calcification. Dystrophic and degenerative changes in terminal axons and adjacent Schwann cells were also apparent. The acetylcholine receptor was not the primary target of the inflammatory response, since at 10 weeks of age the receptor content was not decreased and antibodies were not detected bound to the receptor. The IFNgamma transgenic mouse model may provide a clinically relevant model of necrotizing myopathy for investigation of the pathological changes associated with, and presumably precipitated by, overexpression of the pro-inflammatory cytokine interferon-gamma on the neuromuscular junction, intramuscular nerves and myofibers.
Collapse
Affiliation(s)
- G D Shelton
- Department of Pathology, University of California, San Diego, La Jolla 92093-0612, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
Goebel HH, Anderson JR. Structural congenital myopathies (excluding nemaline myopathy, myotubular myopathy and desminopathies): 56th European Neuromuscular Centre (ENMC) sponsored International Workshop. December 12-14, 1997, Naarden, The Netherlands. Neuromuscul Disord 1999; 9:50-7. [PMID: 10063836 DOI: 10.1016/s0960-8966(98)00098-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H H Goebel
- Department of Neuropathology, Mainz University Medical Center, Germany
| | | |
Collapse
|
16
|
Abstract
Based on morphological abnormalities, congenital myopathies can be classified into several categories: (1) enzyme histochemically abnormal appearance without structural pathology, e.g., congenital fibre type disproportion or congenital fibre type uniformity; (2) abnormally placed nuclei, e.g. myotubular and centronuclear myopathies; (3) disruption of normal intrinsic structures, largely sarcomeres, e.g. central cores and minicores; (4) abnormal inclusions within muscle fibres. Several such inclusions are derived from pre-existing structures, most notably rods or nemaline bodies. Other derivatives of Z-band material are cytoplasmic bodies and possibly related inclusions as spheroid bodies, sarcoplasmic bodies or Mallory body-like inclusions. These inclusions share accumulation of desmin, the muscle fibre-specific intermediate filament, and of other proteins, some of them physiological, but others quite abnormal. Inclusions without identified precursors are fingerprint bodies, reducing bodies, cylindrical spirals, and Zebra bodies. Experimental models and tissue culture reproduction are necessary to further clarify significance of these inclusions in congenital myopathy pathology.
Collapse
Affiliation(s)
- H H Goebel
- Department of Neuropathology, Mainz University Medical Center, Germany.
| |
Collapse
|
17
|
Abstract
We describe the presence of cylindrical spirals on muscle biopsy from a 31-year-old man who developed rhabodomyolysis following a long run. He had a prior history of exertional cramps and myoglobinuria. His maternal grandfather had similar symptoms. Transmission electron micrographs demonstrated continuity between the lamellae of the cylindrical spirals and native myofilaments. Whether these unusual structures confer a derangement in myofilament function is uncertain.
Collapse
Affiliation(s)
- G I Wolfe
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas 75235-8897, USA
| | | | | | | |
Collapse
|
18
|
Abstract
A 19-year-old patient presented with exercise-related myalgia, fatigue and elevated creatine kinase levels. Histology of a muscle biopsy was characterized by the presence of very large amounts of tubular aggregates. Both his father and paternal grandfather had elevated creatine kinase and large amounts of tubular aggregates in their muscle biopsies. The aggregates consisted of closely packed vesicles and tubules filled with electron-dense material or with one to several smaller tubules. Disorders with tubular aggregates in the muscle fibres such as hyperornithinaemia with gyrate atrophy of the retina, hypokalaemic periodic paralysis, hyperkalaemic periodic paralysis, myotonia congenita, alcoholism, osteomalacic myopathy etc. have been excluded. Tubular aggregates can be found in muscle disorders characterized by exercise-induced cramps, pain and stiffness. They also represent the predominant histological feature of some familial myopathies due to a yet unidentified genetic defect. In our family, there was male-to-male transmission, confirming dominant inheritance.
Collapse
|
19
|
Rapuzzi S, Prelle A, Moggio M, Rigoletto C, Ciscato P, Comi G, Francesca F, Scarlato G. High serum creatine kinase levels associated with cylindrical spirals at muscle biopsy. Acta Neuropathol 1995; 90:660-4. [PMID: 8615090 DOI: 10.1007/bf00318582] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 01/31/2023]
Abstract
We studied the muscle biopsy from an asymptomatic patient with high serum creatine kinase values. Subsarcolemmal and intermyofibrillar granular inclusions were seen at the light microscopy level. Ultrastructural observation showed clusters of cylindrical spirals (CS). CS are nonspecific, morphological finding, so far reported only in a few cases, presenting with a wide variety of clinical phenotypes. The case we describe is peculiar because of the complete lack of clinical symptoms. The nature of the CS is unknown; we studied a possible alteration of cytoskeletal proteins using a set of different antibodies against these structures, but none of them reacted with CS. Also, since CS have been described in association with mitochondrial abnormalities, and since in our case CS were strongly positive when stained for succinate dehydrogenase, we performed specific immunohistochemical and genetic studies which ruled out any major mitochondrial alterations.
Collapse
Affiliation(s)
- S Rapuzzi
- Centro Dino Ferrari, Istituto di Clinica Neurologica, Università degli Studi di Milano, Italy
| | | | | | | | | | | | | | | |
Collapse
|