Estudo clínico, histológico, imunoistoquímico e da função lisossomal na miosite por corpos de inclusão / Clinical, histological, immunohistochemical and lysosomal function study in inclusion body myositis

A miosite por corpos de inclusão (inclusion body myositis - IBM), na sua forma esporádica, é considerada a miopatia adquirida mais comum após os 50 anos de idade. Embora seja incluída no grupo das miopatias inflamatórias, estudos recentes mostram um processo particular de degeneração muscular caracterizado por deposição anormal de agregados de proteínas nas fibras musculares e funcionamento anormal dos principais sistemas de degradação proteica. O objetivo deste estudo foi o de avaliar os aspectos clínicos, histológicos e imunoistoquímicos de pacientes com IBM. Avaliamos 18 casos com diagnóstico de IBM de dois dos principais centros de doenças neuromusculares do Brasil (25 biópsias musculares). Na tentativa de diferenciar os casos de IBM das outras miopatias inflamatórias, determinamos o padrão de expressão tecidual da p-tau (p62), alfa-sinucleína e TDP-43. Também foi avaliada a função lisossomal através da reação da fosfatase ácida (marcação da atividade lisossomal global) e determinação da marcação para LC3B (marcador de autofagia). Foi observado que a IBM predominou no sexo masculino (61% dos casos), da cor branca, com início das manifestações clínicas ao redor dos 59 anos de idade e os sintomas mais frequentes foram fraqueza muscular, instabilidade postural com quedas da própria altura, disfagia e perda ponderal, podendo ainda apresentar dispneia. O diagnóstico demorou em média 7,4 anos após o início dos sintomas e frequentemente esteve associada às seguintes comorbidades: hipertensão arterial sistêmica, diabetes mellitus tipo 2, osteopenia / osteoporose, dislipidemia e hiperuricemia / gota. O padrão de comprometimento muscular na IBM foi caracterizado por tetraparesia de predomínio proximal em membros inferiores e distal em membros superiores. Os valores séricos da creatinofosfoquinase em pelo menos uma das medições foram elevados em todos os pacientes, porém sem ultrapassar 10 vezes o limite superior da normalidade. O uso de...

Sporadic inclusion body myositis (sIBM) is considered the most common acquired myopathy affecting adults aged over 50 years. Although included in the group of inflammatory myopathies, recent studies show a particular process of muscle degeneration characterized by abnormal deposit of protein aggregates in muscle fibers and abnormal operation of the main protein degradation systems. The aim of this study was to evaluate the clinical, histological and immunohistochemical patients with IBM. We evaluated 18 cases with IBM diagnostic of two of the main centers of neuromuscular diseases in Brazil (25 muscle biopsies). In an attempt to differentiate the IBM cases of other inflammatory myopathies, we determined the pattern of tissue expression of p-tau (p62), alfa-synuclein and TDP-43. Also evaluated the lysosomal function by acid phosphatase reaction (marking global lysosomal activity) and determining the markup for LC3B (autophagy marker). It was observed that IBM was predominant in males (61% of cases), white colored, with onset of clinical manifestations around 59 years old and the most common symptoms are muscle weakness, postural instability with high falls, dysphagia and weight loss, and may also present dyspnea. The diagnosis took an average of 7.4 years after the onset of symptoms and was often associated with the following comorbidities: hypertension, type 2 diabetes mellitus, osteopenia / osteoporosis, dyslipidemia and hyperuricemia / gout. The muscular damage pattern at IBM was characterized by tetraparesis predominantly proximal lower limbs and distal upper limbs. Serum creatine kinase levels in at least one of the measurements were elevated in all patients, but not exceeding 10 times normal. Immunosuppression was not effective in patients with IBM. The IBM histological findings included diversify dystrophic changes, endomysial inflammation, as well as the occurrence of rimmed vacuoles, in addition to high frequency of mitochondrial changes. Other...

Fiebre chikungunya en México: caso confirmado y apuntes para la respuesta epidemiológica / Chikungunya fever in Mexico: confirmed case and notes on the epidemiologic response

La fiebre chikungunya (CHIK) es una enfermedad viral transmitida al ser humano por el mismo vector del dengue, el mosquito Aedes. Además de fiebre y fuertes dolores articulares, produce otros síntomas como mialgias, cefalea, náuseas, cansancio y exantema. No tiene tratamiento específico; el manejo terapéutico de los pacientes se enfoca en el alivio de los síntomas. Históricamente se han reportado brotes de grandes proporciones; incluso desde 2010 se llegó a considerar como una potencial epidemia emergente. En 2013 se introdujo a las islas del Caribe y recientemente se ha reportado en el continente americano. En este trabajo se describe el primer caso confirmado de chikungunya en México, en el municipio de Tlajomulco de Zúñiga, Jalisco, en mayo de 2014, importado de la isla Antigua y Barbuda, en el Caribe, por una mujer de 39 años de edad.

Chikungunya fever (CHIK) is a viral disease transmitted to human beings by the same vector as dengue -the Aedes mosquito. Besides fever and severe pain in the joints, it produces other symptoms such as myalgias, headache, nausea, fatigue and exanthema. There is no specific treatment for it; the therapeutic management of patients focuses on symptom relief. Historically, outbreaks of large proportions have been reported; even since 2010 it was considered to be a potential emerging epidemic. In 2013 it was introduced into the islands of the Caribbean, and it has recently been reported in the American continent. This paper describes the first confirmed case of chikungunya in Mexico -in the municipality of Tlajomulco de Zúñiga, Jalisco, in May, 2014-, which was imported from the Caribbean island of Antigua and Barbuda by a 39 year-old woman.

Effect of eccentric training on mitochondrial function and oxidative stress in the skeletal muscle of rats

The objective of the present study was to investigate the effects of eccentric training on the activity of mitochondrial respiratory chain enzymes, oxidative stress, muscle damage, and inflammation of skeletal muscle. Eighteen male mice (CF1) weighing 30-35 g were randomly divided into 3 groups (N = 6): untrained, trained eccentric running (16°; TER), and trained running (0°) (TR), and were submitted to an 8-week training program. TER increased muscle oxidative capacity (succinate dehydrogenase and complexes I and II) in a manner similar to TR, and TER did not decrease oxidative damage (xylenol and creatine phosphate) but increased antioxidant enzyme activity (superoxide dismutase and catalase) similar to TR. Muscle damage (creatine kinase) and inflammation (myeloperoxidase) were not reduced by TER. In conclusion, we suggest that TER improves mitochondrial function but does not reduce oxidative stress, muscle damage, or inflammation induced by eccentric contractions.

Ginseng administration protects skeletal muscle from oxidative stress induced by acute exercise in rats

Enzymatic activity was analyzed in the soleus, gastrocnemius (red and white) and plantaris muscles of acutely exercised rats after long-term administration of Panax ginseng extract in order to evaluate the protective role of ginseng against skeletal muscle oxidation. Ginseng extract (3, 10, 100, or 500 mg/kg) was administered orally for three months to male Wistar rats weighing 200 ± 50 g before exercise and to non-exercised rats (N = 8/group). The results showed a membrane stabilizing capacity of the extract since mitochondrial function measured on the basis of citrate synthase and 3-hydroxyacyl-CoA dehydrogenase activities was reduced, on average, by 20 percent (P < 0.05) after exercise but the activities remained unchanged in animals treated with a ginseng dose of 100 mg/kg. Glutathione status did not show significant changes after exercise or treatment. Lipid peroxidation, measured on the basis of malondialdehyde levels, was significantly higher in all muscles after exercise, and again was reduced by about 74 percent (P < 0.05) by the use of ginseng extract. The administration of ginseng extract was able to protect muscle from exercise-induced oxidative stress irrespective of fiber type.

Estudio clinico, histopatológico y ultraestructural del músculo de la lengua en pacientes con carcinoma epidermoide / A clinical, histopathological and ultrastructural study of tongue muscle in patients with squamous cell carcinoma

En el presente trabajo se realizó un estudio mediante microscopÝa de luz y electrónica de transmisión con el fin de estudiar las alteraciones musculares producidas en el músculo de la lengua en pacientes con carcinoma epidermoide. Las anomalÝas estructuras observadas incluyeron, alteraciones tanto en el sistema contrßctil como sarcotubular, por otro lado se observó atrofia y necrosis segmentaria, alteración de mitocondrias y proliferación de organelos, asÝ como vaculolas, lisosomas y grßnulos de lipofucsina. El infiltrado mononuclear estuvo representado principalmente por neutrófilos, macrófagos y mastocitos. Este estudio representa el primer reporte sobre las alteraciones ultraestructurales a nivel del músculo de la lengua producida por esta patologÝa maligna

Muscle damage and autoantibody fixation in an experimental model of autoimmune myopathy

An experimental model of autoimmune myopathy was designed using parental antigens (muscle mitochondrial fraction) inF1 hybrid rats (male Wistar female Sprague-Dawley). The immune response was modulated by spleen fragment transplant from either Wistar (W) or F1. Antibody fixation and inflammatory reaction were studied in Extensor digitorum longus and soleus muscles. Immunizationwithout spleen transplant resulted in antibody fixation mainly in capillaries and incompletely around muscle fibers; whorled fibers were found in 1/3 of F1 rats immunized with antigen from W rats. Spleen transplants from Sprague Dawley (SD) rats were usually accepted by F1;in some animals, antibodies surrounded completely muscle fibers and the percentage of animals showing soleus muscle lesions was increased. Spleen transplants from non immunized F1 were usually rejected by immunized F1; antibody reaction was found inside fibers of most of the rats, muscle damage was present in 40% of the animals immunized with W, but absent in those immunized with SD antigen. In conclusion, this model can be used to study immunological responses to alloantigens (parental to F1). Spleen fragment transplant modulates the immune response. There was discrepancy between antibody fixation and muscle damage. The immunological response was different according to muscle fiber type composition and/or microcirculatory characteristics.

El otro genoma: El concepto clínico de las citopatías mitocondriales o enfermedades de la fosforilación oxidativa / The other genome: clinical spectrum of mitochondrial cytopathies or oxidative phosphorylation diseases

El estudio de las anormalidades del DNA mitocondrial y de su relaicón con trastornos a nivel de la fosforilación oxidativa y cadena de transporte de electrones ha permitido la descripción de una gama de síndromes denominados enfermedades o citopatías mitocondriales. El objetivo del presente trabajo es hacer una revisión de los aspectos clínicos más relevantes de este diverso grupo de enfermedades, y proponer un algoritmo diagnóstico, con la finalidad de que los médicos que atienden a estos pacientes puedan considerarlas dentro del espectro de diagnósticos diferenciales en los casos pertinentes

Caracterizaçäo de miopatias mitocondriais através da avaliaçäo das atividades enzimáticas envolvidas no metabolismo energético / Characterization of mitochondrial myopathies through the evaluation of the enzymatic activities involved in the energetic metabolism

Foi determinada a atividade das enzimas NADH desidrogenase, NADH citocromo e redutase, succinato desidrogenase, succinato citocromo e redutase, citocromo e oxidase e citrato sintase em mitocôndrias de músculo esquelético humano normal e doente (suspeito de miopatia mitocondrial). O grupo controle foi constituído de 13 indivíduos normais e que nao faziam uso contínuo de fármacos. O grupo doente era constituído de 10 pacientes cujo diagnóstico anatomopatológico indicava suspeita de miopatia mitocondrial. Observou-se reduçao na atividade das enzimas em todos os pacientes: 7 com anormalidades em todas as enzimas ensaiadas; 2 com deficiências em todas as enzimas exceto na citocromo e oxidase; e 1 paciente com disfunçao apenas na atividade da succinato desidrogenase e succinato citocromo e redutase. Este perfil possibilitou caracterizar múltiplas deficiências ou deficiência combinada da cadeia respiratória, além da disfunçao na citrato sintase em 9 pacientes. Um dos casos constituiu exceçao, sendo a deficiência enzimática restrita ao complexo II. Foi possível concluir que a metodologia usada é adequada e facilmente aplicável aos objetivos clínicos. Os resultados obtidos possibilitam a caracterizaçao dos complexos enzimáticos mitocondriais deficientes, mostrando que tais enfermidades sao originadas de disfunçao no metabolismo energético.

Physiological constraints in the aerobic performance of hummingbirds

Hovering flight has been described as the most energetically expensive form of locomotion. Among the vertebrates, hummingbirds weighing only 1.5-20 g are the elite practitioners of this aerial art. Their flight muscles are, therefore, the most oxygen demanding locomotor muscles per unit tissue mass of all vertebrates. Tissue level functional and structural adaptations for oxygen transport are compared between hummingbirds and mammals in this paper. Hummingbirds present extreme structural adaptations in their flight muscles. Mitochondrial densities greater than 30 per cent are observed in their pectoral muscles, and the surface area of the inner membrane of their mitochondria is tvace that of mammals. This doubling of their mitochondrial oxidative capacity is accompanied by a proportional increase in the specific activity (per g tissue) of the mitochondrial manganese superoxide dismutase (SOD-Mn) in their flight muscles, thus indicating that oxygen toxicity is not a constraint in the aerobic performance of hummingbirds during hovering flight. Finally, the liver appears to play a major role in providing the necessary substrates for their high aerobic performance, and also in eliminating the oxygen free radicals formed during oxidative phosphorylation.

Oxidative metabolism and body weight: inactive, active, and mitochondrial volumes

In homeotherms, the standardized (basal) metabolic rate should not be expressed per kilogram of body weight (specific metabolic rate), nor per unit of body surface (square meters of body-ambient interface), since both mitochondrial thermogenesis and heat-loss mechanisms (radiation, conduction, convection, evaporation) are not uniform processes. On the contrary, each organism is an heterogeneous bioreactor, which is composed at least of two compartments: 1) a metabolically active volume (aV), where oxidative phosphorylation takes place; and 2) a metabolically inactive volume (iV), where oxygen consumption is negligible. The ratio (aV/iV) is not invariant, since iV increases disproportionately with the scaling up of body size, and as shown by us, when the three main components of iV, i.e., skeleton, fat deposits, and blood volume, are added together, a similar disproportionality is found. The aV was determined by subtracting the iV from the total volume (V) of an organism, or by estimating the volume occupied by all mitochondria, or mitochondrial volume (mtV). For this purpose two procedures are discussed: 1) the stereological or morphometric method; and 2) the oxygen consumption per unit time or physiometric method. The latter procedure is based on the equivalence between an VO2 = 3 ml O2.min-1 and a mtV of 1 ml, whose oxidative phosphorylation yields an approximate power output of 1 watt. The correspondence between oxygen consumption, heat production, and electron flux at the respiratory chain of the mitochondrial cristae, is discussed. From a physical point of view, the metabolic rate is a ®power® function (P = M L2T-3), where M = mass, L = length, and T = time. The dimensional analysis and the statistical treatment of the corresponding numerical values of more than 200 allometric equations yields the 3/4 power, law established by Kleiber (1961), for the relationship between basal metabolism and body weight. Instead of expressing the metabolic rate per unit body weight (kg-1) or per unit body surface (m-2) structural and functional criteria should be taken into account as, for instance, the distinction between iV and aV, and particularly by emphasizing the paramount importance of the mtV where oxidative phosphorylation takes place. An allometric equation relating mtV and body weight (W) could be tentatively established for interspecies comparisons

Effects of thyroidectomy on biochemical and ultrastructural aspects of rat slow and fast muscles

Thyroidectomy provoked the reduction of the oxygen consumption rate in state 3 respiration in both Extensor Digitorum Longus (EDL, fast twitch) and Soleus (slow twitch) muscles of rat, being the last one the most affected. Morphological alterations after 8 weeks of thyroidectomy were found in mitochondria. These organelles exhibited cristae swelling and formation of autophagic vacuoles in subsarcolemmal and intermyofibrillar spaces. Altered mitochondria were also seen in the axon terminal and the postjunctional region of motor end-plate

Miopatia mitocondrial: relato de 12 casos com estudo histoquímico do músculo esquelético / Mitochondrial myopathy: report of 12 cases with histochemical study of the skeletal muscle

Säo relatados 12 pacientes com o diagnóstico de MM definidos histoquimicamente. Nove pacientes eram do sexo masculino e tres do sexo feminino. A idade de início dos sintomas variou desde o período neonatal até os 35 anos de idade (mediana 14 anos). Foram identificadas como características principais a fraqueza muscular, oftalmoplegia e ptose palpebral em 10 pacientes. Um paciente apresentou quadro de intolerância aos exercícios e outro além da fraqueza muscular, alteraçäo do comportamento. Säo discutidos aspectos clínicos e o diagnóstico diferencial de nossos pacientes

Intramitochondrial calcium and magnesium levels in skeletal muscle submitted to total or partial limb ischemia

Sekeletal muscle temperature and mitochondrial content of Ca2 and Mg2+ were measured after 3 h of total or partial limb ischemia in male Wistar rats (250-350g). The decreases in biceps muscle temperature, measured with a needle thermistor (4.4 ñ 0.26-C (31 rats) in partial ischemia (PI, aorta clamp) and total ischemia (TI, hind leg tourniquet), respectively) were consistent with the expected extente of blood flow reduction for the two ischemic conditions. Mitochondrial calcium levels increased after partial ischemia from 2.67 ñ 0.13 (46 rats) to 4.65 ñ 0.38 (12 rats) nmol/mg protein and increased to 7.87 ñ 0.68 (14 rats) after total ischemia (P<0.05). In contrast, mitochondrial magnesium decreased after partial ischemia from 10.14 ñ 0.35 to 8.22 ñ0.28 (13 rats) but increased in the mitochondria of muscle submitted to total ischemia to 12.0 ñ 0.80 (14 rats; P < 0.05). No changes were observed in the number of binding sites for safranine which competes for calcium binding sites on the inner mitochondrial membrane (25.46 ñ 0.38 nmol/mg protein for sham (20 rats) and 25 ñ 0.68 (7 rats) for PI and 25 ñ 0.31 (5 rats) for TI). The data suggest that the greater resistance of rats muscle to total than to partial ischemia may be due at least in part to the increased mitochondrial Mg2+ content

Encefalomiopatía mitocondrial, acidosis láctica y apariencia de accidentes vasculares cerebrales / Mitochondrial, lactic acidosis and features of cerebrovascular disorders

En una paciente de 12 años de edad, aparentemente sana hasta los 9 años, con epilepsia progresiva, deterioro mental, acidosis láctica y déficit neurológicos que simulaban accidentes cerebrovasculares, la biopsia muscular demostró fibras rojas desflecadas y acúmulos de mitocondrias anormales, confirmando el diagnóstico de encefalomiopatía mitocondrial. Conviene pensar en este grupo de enfermedades en pacientes escolares con cefalea periódica, epilepsia mioclónica que responde mal al tratamiento, hipoacusia sensorioneural y deterioro mental. Las manifestaciones musculares pueden ser frecuentemente tardías

Mitochondrial myopathy and myoclonic epilepsy

Os autores descrevem uma família de raça negra (mäe e três filhos) com miopatia mitocondrial. Duas irmäs tinham acidose láctica concomitante e epilepsia mioclônica. Outros achados observados nos membros mais afetados foram demência, ataxia, fraqueza muscular e neuropatia sensitiva. A mäe era assintomática. Um filho sofreu acidente vascular cerebral isquêmico envolvendo a regiäo temporal direita. Todos os membros da família estudados eram hipertensos. EEG mostrou resposta fotomioclônica na paciente probanda. Biópsia muscular mostrou fibers e mitocôndrias anormais ao estudo de microscopia eletrônica. Análise bioquímica mostrou um defeito no citocromo C oxidase nas mitocôndrias extraídas do músculo esquelético de uma paciente afetada. Aspectos clínicos e genéticos sobre as encefalomiopatias mitocondriais säo discutidos

Miopatia por deficiência de succinato citocromo-c redutase: possível defeito no complexo 11 da cadeia respiratória / Myopathy due to succinate cytochrome-c reductase deficiency: possible deficiency in the complex 11 of the respiratory chain

Relato do caso de mulher de 24 anos de idade que apresentava astenia desde a puberdade, com agravamenteo nos últimos anos, cuja biópsia muscular revelou grande acúmulo de mitocôndrias. As dosagens dos enzimas mitocondriais mostrou importante reduçäo da succinato-citocromo-C-redutase, sugerindo defeito na cadeia respiratória a nível do complexo II. Medicada com altas doses de vitamina C e K, melhorou da força muscular. Säo feitas consideraçöes a respeito das principais síndromes com miopatias mitocondriais, bem como a respeito dos métodos de investigaçäo em defeitos da cadeia respiratória

Non-epileptic myclonus and mitochondrial encephalomyopathy

Foram examinados dois irmäos portadores de uma síndrome miclónica progressiva comn discretos sintomas cerebelares. O exame neurológico mostrava sinais cerebelares moderados e papilas pálidas; mioclonais assíncronas, arrítmicas e assimétricas, um déficit artrestésico e ausência de fraqueza muscular. A atividade de base do EEG era moderadamente lenta e sem atividade irritativa. A TC era normal em ambos os casos. A estimulaçäo fótica intemitente aumentava a freqüência dos abalos mioclônicos que se tornavam bilaterais e sincronos, progredindo para uma crise tônico-clônica generalizada. Potenciais evocados e RMN em um caso foram normais . Drogas anticonvulsivantes foram ineficazes no controle das mioclonias. O diagníostico de encefalomiopatia mitocondrial foi realizado através do achado em espécimes musculares de membranas basais espessadas, com degeneraçäo miofibrilar e um número elevado de mitocondrias distribuídos perifericamente e com uma matriz densa, granular e com alguns vacúolos. Os achados clínicos e eletrográficos sugerem uma origem subcortical para esta síndrome mioclônica

Mitochondrial dysfunction in myasthenia gravis: report of a case

É relatado o caso de um paciente de 11 anos de idade com oftalmoparesia extrínseca, ptose palpebral bilateral e tetraparesia desde os 7 anos de idade. A concentraçäo de anticorpos contra receptor de acetilcolina por radioimunoensaio foi 0,6 nM/1; a pesquisa de anticorpos contra músculo estriado foi negativa. Exame eletromiográfico revelou decremento de 26,1%. Foi tratado com brometo de piridostigmina na dose de 60 mg/d. Submetidos a biópsia de tecido muscular estriado (biceps braquial esquerdo) com avaliaçöes por métodos histoquímicos e microscopia eletrônica, que revelaram: acúmulos de mitocôndrias na regiäo subsarcolemal na coloraçäo pela SDH; aumento da concentraçäo de mitocôndrias e corpúsculos eletrodensos a microscopia eletrônica; esses achados säo sugestivos de miopatia mitocondrial. Em conseqüência da interrupçäo das drogas anticolinesterásicas ocorreu piora das manifestaçöes deficitárias, disfagia e dispnéia. Reintroduzidos os anticolinesterásicos, associados a imunossupressäo com corticosteróides, houve melhora e retomada pelo paciente de suas atividades habituais. Destarte, é discutido o caráter inespecífico das alteraçöes morfogenéticas e disfunçöes de mitocôndrias em outras patologias neuromusuclares, incluindo a miastenia grave, como neste casos em particular

Distrofia muscular progresiva de Duchene y acetato de alfa-tocoferilo: condiciones clínico-terapéuticas / Progresive muscular dystrophy and alpha-tocoferilo acetate: clinic-therapeutic consideration

Se presenta un caso sobre Distrofia Muscular Progresiva Seudohipertrófica de Duchenne tipo infantil, en un niño de 8 años de edad, sexo masculino, con un año de evolución. Se menciona la evolución clínica favorable, en base a un seguimiento longitudinal del paciente con el empleo de vitamina E (Acetato de alfa-Tocoferilo)