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Sporadic Inclusion Body Myositis (sIBM) is an inflammatory muscle disease that strikes individuals at random and accounts for approximately 1/3 of all idiopathic inflammatory myopathies. It is characterized by progressive weakness of distal and proximal muscles and is the most common muscle disorder in individuals over 50 years of age. Currently, there is no known cause, cure, or enduring treatment for sIBM, although a number of theories as to its cause have been proposed. One theory proposes that activation of the inflammatory/ immune response is the primary trigger resulting in muscle degeneration and protein abnormalities, while an alternative theory suggests that sIBM is a degenerative muscle disease with abnormal pathogenic protein accumulation, in particular Abeta, being a primary cause that triggers an inflammatory/ immune response. Mitochondrial abnormalities have been observed in skeletal muscle from patients diagnosed with the disease, however the role of the mitochondria in disease pathology is still unclear. The aim of this dissertation was to evaluate: 1) the role of the mitochondria in the development of sIBM and 2) the role of amyloid beta on mitochondrial function in skeletal muscle. A better understanding of the role of the mitochondria in the development of sIBM may help to identify novel prevention and/ or treatment strategies. / Ph. D.

[Truncated abstract] Sporadic inclusion body myositis (sIBM) is a chronic inflammatory disease that is the most common myopathy in individuals above the age of 50 in the Caucasian population. sIBM is characterised by cytotoxic immune infiltration of skeletal muscle, consisting primarily of CD8+ T-cells and macrophages, as well as a degenerative process, with muscle fibre vacuolation and intracellular filamentous inclusions. The pathogenesis of sIBM is likely to involve a complex interaction between genetic and environmental factors. Whilst the physiological and pathological characteristics of sIBM have been clearly identified, the exact origin and genetic basis of the disease remains unknown. A number of studies show that sIBM is associated with alleles of the major histocompatibility complex (MHC) on chromosome 6p21.3 and specifically with two ancestral haplotypes (AH) in Caucasians – the 8.1AH, defined by HLA-B*0801, HLA-DRB1*0301 and the 35.2AH, defined by HLA-B*3501, HLA-DRB1*0101. Mapping studies subsequently showed that sIBM susceptibility likely originates from a 389kb region of the MHC, spanning from centromeric of PBX2 to telomeric of HLA-DRB1. The central hypothesis of this thesis was that susceptibility to sIBM is conferred by a single allele found within a region defined using the 8.1AH, which is also carried by other haplotypes associated with sIBM. Three patient cohorts from Australia, the U.S.A and Japan were studied. ... Of the 32 alleles genotyped, none were found in all susceptibility haplotypes and one was common, but not unique, to the 8.1AH, 7.2AH and 52.1AH. Five SNPs were also found in two of the three haplotypes, although none were specific to the sIBM susceptibility haplotypes. These data suggest that the 8.1AH is likely to carry an sIBM susceptibility allele independent of the 35.2AH, 7.2AH and 52.1AH. Based on the possible mechanism of action in cellular differentiation and its location within the 8.1AH-defined sIBM susceptibility region reported in 2004, NOTCH4 was a strong candidate for conferring sIBM susceptibility. NOTCH4 coding region polymorphisms were thus investigated in a Caucasian patient cohort to assess any possible role in sIBM susceptibility. While the frequency of some alleles were increased in sIBM patients, the strong linkage disequilibrium throughout the MHC prevented confirmation of any alleles as playing a direct role in sIBM. The 8.1AH-derived sIBM susceptibility region was further refined using recombination mapping. This approach used markers characterised against multiple haplotypes to genotype patients carrying part of the 8.1AH to locate a common, overlapping susceptibility region. Recombination mapping of patients revealed a common overlapping region of the 8.1AH, extending from BTNL2 to HLA-DRB3. The results of the study indicate that 8.1AH-derived susceptibility for sIBM is likely to originate from a 172kb region encompassing HLA-DRA, HLA-DRB3 and part of BTNL2. These genes warrant further investigation in future studies.

Sporadic inclusion body myositis (IBM) is the commonest acquired myopathy in individuals aged over 50 years. Currently, diagnosis is based largely upon specific muscle biopsy findings, though these are thought to lack sensitivity. More recently, many abnormal protein aggregates have been described in IBM and some have been proposed as diagnostic markers. However, their diagnostic utility is untested and how they relate to the pathogenesis is uncertain. The clinical characteristics, pathological findings and disease course in 67 patients with histopathologically diagnosed and clinically diagnosed IBM were compared and revealed that patients with IBM have a characteristic pattern of weakness at presentation that is independent of the pathological findings. Current diagnostic pathological features are more common in older patients and therefore may be linked to disease duration. The pathology of IBM and the diagnostic utility of protein aggregates in IBM were studied in six clinicopathologically typical cases of IBM. Protein aggregates immunoreactive for p62, TDP-43, myotilin, α B-crystallin and ubiquitin were more abundant than the current diagnostic pathological features. The diagnostic potential of these pathological features was then assessed in pathologically typical and atypical IBM and controls. This revealed that staining for p62, MHC Class I, CD8 positive lymphocytes and mitochondrial abnormalities could support the diagnosis and should be included in diagnostic criteria for IBM. Laser microdissection and label-free mass spectrometry were used to validate the histological findings. The presence of nuclear and aggresomal proteins in rimmed vacuoles indicated that they are derived from myonuclei. Increased protein synthesis and ER stress suggest that abnormal protein aggregates may be the result of abnormal protein production. In conclusion, this thesis emphasises that a diagnosis of IBM can be confidently made on clinical grounds, with a supportive muscle biopsy. The histological and proteomic findings reveal that there is a spectrum of pathological features most likely associated with the disease duration and that adherence to the current pathological based diagnostic criteria may have led to some erroneous conclusions about the pathogenesis of this enigmatic disease.

Diss. (sammanfattning) Stockholm : Karol inst., 2003. / Härtill 4 uppsatser.

Inclusion body myositis and Alzheimer's disease are age-related disorders characterized in part by the appearance of intracellular lesions composed of filamentous aggregates of the microtubule-associated protein tau. Abnormal tau phosphorylation accompanies tau aggregation and may be an upstream pathological event in both diseases. Enzymes implicated in tau hyperphosphorylation in Alzheimer's disease include members of the casein kinase 1 family of phosphotransferases, a group of structurally related protein kinases that frequently function in tandem with the ubiquitin modification system. To determine whether casein kinase 1 isoforms associate with degenerating muscle fibers of inclusion body myositis, muscle biopsy sections isolated from sporadic disease cases were subjected to double-label fluorescence immunohistochemistry using selective anti-casein kinase 1 and anti-phospho-tau antibodies. Results showed that the alpha isoform of casein kinase 1, but not the delta or epsilon isoforms, stained degenerating muscle fibers in all eight inclusion body myositis cases examined. Staining was almost exclusively localized to phospho-tau-bearing inclusions. These findings, which extend the molecular similarities between inclusion body myositis muscle and Alzheimer's disease brain, implicate casein kinase 1 alpha as one of the phosphotransferases potentially involved in tau hyperphosphorylation.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13030号 / 論医博第2112号 / 新制||医||1016(附属図書館) / 32988 / (主査)教授 三森 経世, 教授 松田 秀一, 教授 戸口田 淳也 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

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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 imunossupressão não se mostrou eficaz nos pacientes com IBM. Os achados histológicos na IBM incluíram alterações distróficas variáveis com a presença de inflamação endomisial, assim como a ocorrência de vacúolos marginados, além da elevada frequência de alterações mitocondriais. Outros achados histológicos musculares característicos na IBM foram o aumento da atividade lisossomal (aumento global da marcação para fosfatase ácida), a presença de marcação positiva para beta-amilóide (marcação intra-vacuolar pelo vermelho-Congo), o aumento na degradação muscular (relacionada com ativação de LC3B, p-tau, e p62/SQSTM1) e a degeneração muscular (marcação para anti-phospo TDP-43 e para ?-sinucleína). Tais alterações apresentaram alta sensibilidade e especificidade. Sugerimos que a redução do critério de idade do início dos sintomas de mais de 45 anos para mais de 35 anos aumentaria a sensibilidade diagnóstica para os casos com IBM deste estudo de 83% para 100%. Com este estudo, foi possível caracterizar clínica e histológicamente pacientes com IBM em nosso meio, e fornecer indícios do benefício do uso de marcadores de degeneração e autofagia para o diagnóstico e para a determinação de vias ou sistemas celulares envolvidos na patogênese da doença / 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 characteristic muscle histological findings in IBM were increased lysosomal activity (overall increase in labeling for acid phosphatase), the presence of positive staining for beta-amyloid (intra-vacuolar by Congo red marking), increased muscle degradation (related to activation of LC3B, p-tau and p62 / SQSTM1) and muscle degeneration (marking for anti-phospo TDP-43 and ?-synuclein). Such changes have a high sensitivity and specificity. which makes these important complementary analyzes for accurate pathological diagnosis. We suggest that lowering the age of the onset of symptoms of greater than 45 years to older than 35 years would increase the diagnostic sensitivity for cases with IBM this study from 83% to 100%. With this study, it was possible to characterize clinically and histologically the patients with IBM in our centers, and provide evidence of the benefit of using degeneration and autophagy markers for diagnosis and for determining pathways or cellular systems involved in the pathogenesis of the disease

No description available.