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Protein aggregate myopathies
Hans H Goebel1, Harald D Müller
1Department of Neuropathology, Johannes Gutenberg University, Mainz, Germany. neuropatho.klinik.uni-mainz.de
Abstract:
Protein aggregate myopathies (PAMs) based on the morphologic phenomenon of aggregation of proteins within muscle fibers may occur in children (selenoproteinopathies, actinopathies, and myosinopathies) or adults (certain myofibrillar myopathies and myosinopathies). They may be mutation related, which includes virtually all childhood forms but certain other forms as well, or sporadic, which are largely seen in adults. Their classification as myofibrillar or desmin-related myopathies, actinopathies, or myosinopathies is based on the identification of respective mutant proteins, most of them components of the sarcomeres. Recognition of PAM requires muscle biopsy and an extensive immunohistochemical and electron microscopic workup of the biopsied muscle tissue after which molecular analysis of morphologically ascertained proteins should ensue to permit recognition of individual entities and genetic counseling of patients and families. Because pathogenetic principles in PAMs are still incompletely known, causative therapy, at this time, is not available.
Insights
Protein aggregate myopathies (PAMs) affect muscle fibers in children and adults, often linked to genetic mutations. Diagnosis requires muscle biopsy and advanced analysis, with no cure currently available.
Area of Science:
- Neurology
- Genetics
- Pathology
Background:
- Protein aggregate myopathies (PAMs) are characterized by abnormal protein aggregation within muscle fibers.
- These myopathies can manifest in childhood (e.g., selenoproteinopathies, actinopathies, myosinopathies) or adulthood (e.g., myofibrillar myopathies).
- PAMs can be mutation-related, particularly in childhood forms, or sporadic, predominantly in adults.
Purpose of the Study:
- To classify and describe protein aggregate myopathies.
- To outline diagnostic approaches for identifying specific PAM entities.
- To highlight the current limitations in understanding pathogenesis and treatment.
Main Methods:
- Classification based on identifying specific mutant proteins, often sarcomeric components.
- Diagnosis involves muscle biopsy with extensive immunohistochemical and electron microscopic examination.
- Subsequent molecular analysis of identified proteins is crucial for definitive diagnosis.
Main Results:
- PAMs are categorized based on the affected proteins, including those in myofibrils, desmin, actin, and myosin.
- Diagnostic workflow integrates morphological and molecular analyses for precise identification.
- Genetic counseling is facilitated by accurate diagnosis of individual PAM entities.
Conclusions:
- Accurate diagnosis of PAMs relies on integrated morphological and molecular investigations.
- Understanding the pathogenetic mechanisms of PAMs remains incomplete.
- Currently, causative therapies for protein aggregate myopathies are unavailable.
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