运动神经元病的病理进展和泛素阳性包涵体

运动神经元病 (ｍｏｔｏｒｎｅｕｒｏｎｄｉｓｅａｓｅ ,ＭＮＤ)是一类以上、下运动神经元损害为主的中枢神经系统变性病 ,90 %以上为散发型 ,临床上主要表现为进行性肌无力和肌萎缩。本病的病因至今尚未明确 ,人们相继提出了内外源毒素、病毒感染、自身免疫异常、自由基损伤和细胞凋亡等多种假说。近来人们在约 2 0 %家族型ＭＮＤ中发现了编码铜锌超氧化物歧化酶(ＳＯＤｓ)的ＳＯＤ1基因突变 ,但这一突变在散发型中不足2 5 % ,仍无法圆满解释大多数ＭＮＤ的发病机制。泛素的发现为解决这一难题开辟了新的研究途径 ,在ＭＮＤ运动神经元和其…     

遗传性包涵体肌病

遗传性包涵体肌病是1993年Askanas等在研究包涵体肌炎的过程中首先提出的一组以肌纤维内出现异常管丝状包涵体为特征性病理改变的遗传性骨骼肌疾病，由于家族性和缺乏炎性细胞浸润而不同于散发性包涵体肌炎。多在成年发病，以缓慢发展的四肢无力和肌肉萎缩为主要表现。近年相继发现许多具有隐性和显性遗传特点的遗传性包涵体肌病，其基因和蛋白性质逐渐被阐明，改变了一些疾病的传统分类。现将遗传性包涵体肌病的基因改变、临床和病理改变特点简述如下（表1）。     

蛋白质堆积与包涵体肌病

蛋白质空间构像改变,导致其功能及结构异常,并堆积形成包涵体,引起细胞结构与功能异常。包涵体肌病(IBM)的特征性病理改变——肌浆内或核内包涵体,是多种异常蛋白质堆积的结果。其中,AβPP/Aβ蛋白表达过多和堆积是导致IBM发病的关键因素;Aβ及AβPP堆积使蛋白酶体和多种蛋白质结构与功能异常,进而促进包涵体形成;帕金森病相关蛋白α-synuclein及parkin可能参与IBM发病机制;Myostatin表达增加使IBM的肌肉萎缩程度进一步加重。     

运动神经元病的病理进展和泛素阳性包涵体

运动神经元病(motor neuron disease,MND)是一类以上、下运动神经元损害为主的中枢神经系统变性病,90%以上为散发型,临床上主要表现为进行性肌无力和肌萎缩.本病的病因至今尚未明确,人们相继提出了内外源毒素、病毒感染、自身免疫异常、自由基损伤和细胞凋亡等多种假说.近来人们在约20%家族型MND中发现了编码铜锌超氧化物歧化酶(SODs)的SOD1基因突变,但这一突变在散发型中不足2.5%,仍无法圆满解释大多数MND的发病机制.泛素的发现为解决这一难题开辟了新的研究途径,在MND运动神经元和其他类型神经细胞内陆续发现了具有病理诊断价值的泛素阳性包涵体,因此,研究泛素包涵体的分布规律以及蛋白成分成为探讨MND神经细胞变性机制的重要途径之一.     

包涵体肌炎

报道一例包涵体肌炎患者，女，２５岁。表现为缓慢进展的两下肢无力５年，近半年两个肢亦无力。两侧肩胛带及骨盆带肌肉轻度萎缩。肌电图示轻收缩时运动电位平均时限缩短，多相电位增多。肌活检见部分肌纤维内出现空泡，在空泡的边缘 泡内有嗜盐基性颗粒状物质，Ⅰ型、Ⅱ型肌纤维无受累。     

包涵体肌炎的肌肉病理

1967年Ｃｈｏｕ报道 1例“粘液病毒样结构慢性多发性肌炎”的 66岁男性患者 ,随后Ｓａｔｏ、Ｃｈｏｕ等和Ｃａｒｐｅｎｔｅｒ等报道 1例 ,1 971年Ｙｕｎｉｓ和Ｓａｍａｈａ报道 1例 2 6岁女性患者 ,光镜下可见细胞核、细胞质包涵体 ,电镜下可见微丝。首先提出包涵体肌炎 (ｉｎｃｌｕｓｉｏｎｂｏｄｙｍｙｏｓｉｔｉｓ,ＩＢＭ)这一概念[1 ,2 ] 。 1 978年Ｃａｒｐｅｎｔｅｒ等[2 ] 提出与多发性肌炎 (ＰＭ)、皮肌炎 (ＤＭ)的鉴别要点 ,认为ＩＢＭ主要累及远端肌肉 ,并发胶原血管病及恶性肿瘤罕见 ,皮质类固醇治疗无效。组织学可见线状空泡、…     

包涵体肌炎的临床研究进展

包涵体肌炎的临床研究进展段宏伟郭玉璞包涵体肌炎（ＩＢＭ）属于特发性炎性肌病（ＩＩＭ）范畴，在ＩＩＭ中以多发性肌炎（ＰＭ）、皮肌炎（ＤＭ）和ＩＢＭ最为常见。关于前两组肌病，国内外研究报道颇多，并为临床医师熟知。而ＩＢＭ目前正引起国外学者的关注，其临床病...     

神经元核内包涵体病

神经元核内包涵体病是一种罕见的神经系统变性疾病 ,典型可见智能减退 ,锥体系、锥体外系体征如肌强直、姿位异常、静止性震颤、舞蹈样手足徐动、肌阵挛、双侧腱反射亢进、双侧Babinski征 ,下运动神经元损害 ,感觉减退。行为功能障碍 ,步态不稳、小脑性共济失调、构音障碍等小脑体征 ,神经肌肉受累如吞咽困难、弥漫性肌萎缩以及眼球运动异常等 ,神经病理可见特征性的神经元核内包涵体。病程缓慢进展 ,无有效治疗。     

3例包涵体肌炎的临床病理特点

<正> 资料和方法 例1:女,32岁。主诉双下肢无力4年,进行性加重。双上肢无力,喝水呛,吞咽困难2年,蹲下起不来,上楼困难,双小腿变细1年。无肌疼及肌束颤动。体格检查:神清、语利、双眼闭合不紧,示齿费力,鼓腮不能,鼻音重,咳嗽力弱。双侧肱二头肌、岗上肌、岗下肌肌力Ⅳ,双上肢远端肌力正常,双下肢股四头肌,腓肠肌,胫前肌肌力Ⅳ。肌张力低。双小腿肌萎缩明显。四肢腱反射消失。磷酸激酶65u/l,乳酸脱氢酶788u/l,谷草转氨酶22u/l,α-羟丁酸脱氢酶156u/l,自身抗体(一)、头颅CT(一),肌电图:肌源性损伤。     

神经元核内包涵体的研究进展

神经元核内包涵体(neuronal intranulear inclusions,NIIs)是遗传性神经变性疾病的一种重要的病理表现,尤其在三核苷酸重复疾病(triplet repeat disease)中更被视为特征性的病理表现,尽管分子遗传学研究已证实基因突变导致的三核苷酸重复的异常扩增引起了相应的临床疾病,但三核苷酸重复引起神经变性的发病机制尚不明确,越来越多的学者认为神经元核内包涵体的出现不是一个孤立的事件,尽管对其在神经变性中的作用还存在很大争议,神经元核内包涵体的研究可能对神经变性的机制提供重要线索,本文主要综述神经元核内包涵体可能的形成机制及其在神经变性疾病中的意义.     

Cortical ubiquitin-positive inclusions in frontotemporal dementia without motor neuron disease: a quantitative immunocytochemical study

Ubiquitin-positive tau-negative inclusions were initially described in the rare form of frontotemporal dementia (FTD) associated with motor neuron disease. However, recent studies have indicated that these inclusions are also present in typical FTD, which is usually characterized by nonspecific histological changes. To examine the contribution of these inclusions to neuronal loss and to explore their relationship with disease duration, we performed a quantitative immunocytochemical analysis of 38 typical FTD cases. Relationships between neuron and ubiquitin inclusion densities as well as between duration of illness and neuropathological parameters was studied using linear regression in both univariate and multivariate models. Ubiquitin-positive tau-negative intracytoplasmic inclusions were present in 65.8% of cases in the dentate gyrus, 57.9% in temporal cortex and 31.6% in frontal cortex. The highest densities of ubiquitin-positive inclusions were consistently observed in the dentate gyrus, followed by the temporal and frontal cortex. There was no statistically significant relationship between neuron and ubiquitin-positive inclusion densities in any of the areas studied. In contrast, ubiquitin-positive inclusion densities in the dentate gyrus were negatively related to the duration of illness. Our data suggest that the development of ubiquitin-related pathology is the rule and not the exception in typical FTD, yet is not causally related to neuronal loss. They also reveal that the development of ubiquitin-positive inclusion densities in the dentate gyrus may be associated with a more aggressive form of the disease.     

Ubiquitin-positive intraneuronal inclusions in the extramotor cortices of presenile dementia patients with motor neuron disease

Summary Ubiquitin-positive intraneuronal inclusions were found in the extramotor cortices of ten presenile dementia patients with motor neuron disease. There were inclusions in the hippocampal granular cells and in the small neurons of the superficial layers of the temporal and frontal cortices. Bunina bodies were present in the anterior horn cells in all cases. These results suggest that ubiquitin-related cytoskeletal abnormalities are common in cerebral non-motor small neurons in these patients.     

Frontotemporal lobar degeneration with motor neuron disease-type inclusions predominates in 76 cases of frontotemporal degeneration

This report presents the largest series of consecutive, neuropathologically confirmed cases of frontotemporal degeneration (FTD). Prior studies have found dementia lacking distinctive histology (DLDH) to be the most common pathology underlying the clinical diagnosis of FTD. In this series of 76 cases, 29 (38%) were found to have frontotemporal lobar degeneration with motor neuron disease-type inclusions (FTLD-MND-type) or FTLD-MND (with ALS), the most common neuropathological classification in our series. Only eight (11%) were classified as Picks disease. Several cases originally designated as DLDH could be reclassified as FTLD-MND-type based on current recommendations for classification of FTD.     

运动神经元病血清特异抗原成分的检测

目的检测运动神经元病（ＭＮＤ）病人血清中是否存在运动神经元特异抗原成分，并探索ＭＮＤ潜在的诊断标志物。方法制备５株抗运动神经元单克隆抗体，并证明其对大鼠脊髓前角运动神经元具有高度特异的免疫组织化学反应。应用抗运动神经元单克隆抗体２４Ｂ０－ＭｃＡｂ，用ＥＬＩＳＡ法对２５例运动神经元病病人血清中的特异抗原成分进行检测。根据临床表现将２５例病人分为肌萎缩侧索硬化（ＡＬＳ）、脊肌萎缩症（ＳＭＡ）及进行性球麻痹（ＰＢＰ）３组，再按年龄段分３个亚组（＜２０岁组、２０～３９岁组、＞４０岁组）。结果发现８５％（２２／２５）临床确诊的ＭＮＤ病人存在较高浓度的特异抗原成分，ＭＮＤ病人与正常对照组对２４Ｂ０－ＭｃＡｂ的反应性差异有显著性意义（Ｐ＜０．０５），ＡＬＳ、ＳＭＡ及ＰＢＰ亚型之间差异也有显著性意义（Ｐ＜０．０５），而年龄组之间差异虽有显著性意义，其临床意义尚需进一步研究。性别组之间的差异无显著性意义。结论ＭＮＤ病人血清中存在运动神经元特异抗原成分。用抗运动神经元单克隆抗体以ＥＬＩＳＡ法检测运动神经元特异抗原可以作为诊断ＭＮＤ的辅助检查。     

An adult-onset case of sporadic motor neuron disease with basophilic inclusions

Summary A 36-year-old man developed motor neuron signs consisting of weakness and atrophy of the right upper limb, which progressed to involve the other limbs along with development of upper motor neuron signs including pseudobulbar palsy. He died 8.5 years after onset. Bilateral precentral gyri and putamina were grossly atrophic. In addition to severe degeneration of bilateral pyramidal tracts and marked neuronal cell loss of the precentral gyri and putamina, basophilic inclusions were widely distributed in the motor cortex, putamina, general somatic motor neurons such as the hypoglossal nucleus and spinal anterior horns, and other areas like the red nucleus and inferior olive. The inclusions were clearly shown with Nissl stain to be anilinophilic irregular masses with distinct rims. Ultrastructurally the inclusions appeared to consist of thick filamentous structures of 12–25 nm in diameter studded with electron-dense ribosomelike granules. Thick filamentous profiles were relatively short or occasionally fragmentary, haphazardly mingled with various amounts of granules and other organelles. No prominent accumulation of 10-nm neurofilaments or eosinophilic inclusions like Bunina bodies were found. The inclusions were indistinguishable from those reported in so-called juvenile amyotrophic lateral sclerosis.     

Motor neuron disease with pallido-luysio-nigral atrophy

Summary A case of motor neuron disease (MND) with pallido-luysio-nigral atrophy (PLNA) is reported. The 45-year-old male patient presented with lower motor neuron symptoms and signs of basal ganglia disturbance. He died after a progressive course of 7 months. Neuropathological examination revealed motor neuron loss at all spinal cord levels with sparing of Onuf's nucleus. Nerve cell loss and gliosis were also present in substantia nigra, globus pallidus, and subthalamic nucleus. The presence of ubiquitin-positive inclusions, a hallmark of most variants of MND, confirms this case as an example of MND. At immunoelectron microscopy the granules were distributed on filamentous material. The combination of clinically apparent PLNA with MND has only been described twice previously. The relationship of this syndrome to other forms of MND and its nosological placement are discussed.     

Lewy body-like hyaline inclusions in sporadic motor neuron disease are ubiquitinated

Summary Round eosinophilic hyaline inclusion bodies with halos in the somata of anterior horn cells from a case of sporadic lower motor neuron disease (MND) were intensely immunostained with the monoclonal anti-ubiquitin antibody (DF2). A few similar, DF2-positive inclusions were also observed in the nerve cell processes of anterior horn cells or in the neuropil. Most inclusions showed intense homogeneous staining of the entire inclusion, whereas a few had intense staining of their periphery with no or pale staining of the central areas. Other DF2-positive structures in the somata of anterior horn cells included cytoplasmic granular structures, eosinophilic thread-like or reticular structures, and small eosinophilic profiles different from Bunina bodies. The DF2-staining intensity of Bunina bodies and spheroids did not exceed the background level. These results suggest that ubiquitination is associated with a pathological process of anterior horn cell degeneration in this MND case.     

Immunocytochemical and ultrastructural studies of hyaline inclusions in sporadic motor neuron disease

Summary We investigated hyaline inclusion bodies (HI) immunocytochemically and ultrastructurally in six cases of sporadic motor neuron disease (MND). All HI contained large amounts of ubiquitin and some HI were stained at the core or the center with anti-neurofilament antibody, with the surrounding halo unstained. No HI were stained with antibodies raised against cytoskeletal proteins such as high-molecular weight microtubule-associated proteins and phosphorylated tau. Ultrastructurally, HI were chiefly composed of filaments measuring about 20 nm in diameter thicker than neurofilaments, and contained fine granules and frequently one or more of four characteristic profiles, i.e., small electron-dense materials resembling Bunina bodies, bundles of tubular filaments measuring approximately 20 nm in diameter, large electron-dense cores, and focal accumulations of randomly arranged neurofilaments. Hyaline inclusions can be regarded as one of the characteristic markers for sporadic MND as well as familial amyotrophic lateral sclerosis. Hyaline inclusions have a markedly heterogeneous ultrastructure and, therefore, differences in immunoreactivity with antineurofilament antibodies are not unexpected.