Immune-Mediated Rippling Muscle Disease Associated With Thymoma and Anti-MURC/Cavin-4 Autoantibodies.

OBJECTIVES: Rippling muscle disease (RMD) is characterized by muscle stiffness, muscle hypertrophy, and rippling muscle induced by stretching or percussion. Hereditary RMD is due to sequence variants in the CAV3 and PTRF/CAVIN1 genes encoding Caveolin-3 or Cavin-1, respectively; a few series of patients with acquired autoimmune forms of RMD (iRMD) associated with AChR antibody-positive myasthenia gravis and/or thymoma have also been described. Recently, MURC/caveolae-associated protein 4 (Cavin-4) autoantibody was identified in 8 of 10 patients without thymoma, highlighting its potential both as a biomarker and as a triggering agent of this pathology. Here, we report the case of a patient with iRMD-AchR antibody negative associated with thymoma. METHODS: We suspected a paraneoplastic origin and investigated the presence of specific autoantibodies targeting muscle antigens through a combination of Western blotting and affinity purification coupled with mass spectrometry-based proteomic approaches. RESULTS: We identified circulating MURC/Cavin-4 autoantibodies and found strong similarities between histologic features of the patient's muscle and those commonly reported in caveolinopathies. Strikingly, MURC/Cavin-4 autoantibody titer strongly decreased after tumor resection and immunotherapy correlating with complete disappearance of the rippling phenotype and full patient remission. DISCUSSION: MURC/Cavin-4 autoantibodies may play a pathogenic role in paraneoplastic iRMD associated with thymoma.

[HDAC6, a very specific deacetylase with a potential therapeutic role]. / HDAC6, une désacétylase très spécifique porteuse d'espoir thérapeutique.

The cytoplasmic histone deacetylase 6 (HDAC6) is defined today as a new key player in the treatment of many diseases. Overexpression of HDAC6 was observed in a variety of diseases. Over the past ten years, plenty of new selective inhibitors of HDAC6 activity have been synthesized and characterized. Many studies have shown the high efficiency and beneficial effects of HDAC6 inhibitors in many diseases such as cancers, neurodegenerative, inflammatory, or neuromuscular diseases. The mechanisms of HDAC6 action that explain the benefit of its inhibition in various pathologies are still unknown. We have recently shown that HDAC6, via the regulation of the microtubule network, plays a role at the level of neuromuscular junctions by controlling acetylcholine receptor delivery.

Title: HDAC6, une désacétylase très spécifique porteuse d'espoir thérapeutique. Abstract: L'histone désacétylase 6 (HDAC6) est envisagée aujourd'hui comme une cible thérapeutique de choix dans le traitement de nombreuses maladies. L'expression de HDAC6 est fortement augmentée dans un ensemble varié de maladies. Depuis une dizaine d'années, une pléiade de nouveaux inhibiteurs sélectifs de l'activité de HDAC6 ont été synthétisés et caractérisés. De nombreuses études ont démontré l'efficacité et les effets bénéfiques des inhibiteurs de HDAC6 dans différents cancers, maladies neurodégénératives ou inflammatoires, ainsi que dans diverses maladies neuromusculaires. Tous les mécanismes d'actions de HDAC6 expliquant l'effet de son inhibition dans les pathologies ne sont pas encore connus. Nous avons récemment montré que HDAC6, via la régulation du réseau de microtubules, joue un rôle au niveau des jonctions neuromusculaires en contrôlant l'acheminement des récepteurs de l'acétylcholine.

Interplay between Triadin and Calsequestrin in the Pathogenesis of CPVT in the Mouse.

Recessive forms of catecholaminergic polymorphic ventricular tachycardia (CPVT) are induced by mutations in genes encoding triadin or calsequestrin, two proteins that belong to the Ca2+ release complex, responsible for intracellular Ca2+ release triggering cardiac contractions. To better understand the mechanisms of triadin-induced CPVT and to assay multiple therapeutic interventions, we used a triadin knockout mouse model presenting a CPVT-like phenotype associated with a decrease in calsequestrin protein level. We assessed different approaches to rescue protein expression and to correct intracellular Ca2+ release and cardiac function: pharmacological treatment with kifunensine or a viral gene transfer-based approach, using adeno-associated virus serotype 2/9 (AAV2/9) encoding the triadin or calsequestrin. We observed that the levels of triadin and calsequestrin are intimately linked, and that reduction of both proteins contributes to the CPVT phenotype. Different combinations of triadin and calsequestrin expression level were obtained using these therapeutic approaches. A full expression of each is not necessary to correct the phenotype; a fine-tuning of the relative re-expression of both triadin and calsequestrin is required to correct the CPVT phenotype and rescue the cardiac function. AAV-mediated gene delivery of calsequestrin or triadin and treatment with kifunensine are potential treatments for recessive forms of CPVT due to triadin mutations.

Role of triadin in the organization of reticulum membrane at the muscle triad.

The terminal cisternae represent one of the functional domains of the skeletal muscle sarcoplasmic reticulum (SR). They are closely apposed to plasma membrane invaginations, the T-tubules, with which they form structures called triads. In triads, the physical interaction between the T-tubule-anchored voltage-sensing channel DHPR and the SR calcium channel RyR1 is essential because it allows the depolarization-induced calcium release that triggers muscle contraction. This interaction between DHPR and RyR1 is based on the peculiar membrane structures of both T-tubules and SR terminal cisternae. However, little is known about the molecular mechanisms governing the formation of SR terminal cisternae. We have previously shown that ablation of triadins, a family of SR transmembrane proteins that interact with RyR1, induced skeletal muscle weakness in knockout mice as well as a modification of the shape of triads. Here we explore the intrinsic molecular properties of the longest triadin isoform Trisk 95. We show that when ectopically expressed, Trisk 95 can modulate reticulum membrane morphology. The membrane deformations induced by Trisk 95 are accompanied by modifications of the microtubule network organization. We show that multimerization of Trisk 95 by disulfide bridges, together with interaction with microtubules, are responsible for the ability of Trisk 95 to structure reticulum membrane. When domains responsible for these molecular properties are deleted, anchoring of Trisk 95 to the triads in muscle cells is strongly decreased, suggesting that oligomers of Trisk 95 and microtubules contribute to the organization of the SR terminal cisternae in a triad.