HISTOPATHOLOGICAL STUDY OF THE CONDUCTION SYSTEM OF THE HEART IN DUCHENNE PROGRESSIVE MUSCULAR DYSTROPHY

The cardiac conduction systems including sinoatrial (SA) node, atrioventricular (AV) node, atrioventricular(His) bundle, and peripheral conduction system (left and right bundle branch, and Purkinje fiber) of 23 patients with Duchenne progressive musculr dystrophy(DMD) were studied with light microscope. Infiltration of fat tissue and mild fibrosis were occasional findings in SA and AV nodes. Degeneration of the conduction muscle fiber was hardly noted in SA node, AV node, and His bundle. Only the peripheral conduction system (Purkinje fiber) showed significant degenerations such as eosinophilic, necrotic and vacuolar changes with fibrosis. These necrobiotic changes resembled hyaline and vacuolar skeletal and cardiac muscular degenerations in DMD and were assumed to have occurred on the basis of the structural and constitutional characteristics of the peripheral conduction fiber as a striated muscle fiber. The vascular changes and amyloid deposit suggesting precocious aging in the conduction systems were not observed.     

Flk-1+ adipose-derived mesenchymal stem cells differentiate into skeletal muscle satellite cells and ameliorate muscular dystrophy in mdx mice

Duchenne muscular dystrophy (DMD) is a severe hereditary disease characterized by the absence of dystrophin on the sarcolemma of muscle fiber. This absence results in widespread muscle damage and satellite cell activation. After depletion of the satellite cell pool, skeletal muscle is then invariably replaced by connective tissue, leading to progressive muscle weakness. Herein, we isolated Flk-1(+) mesenchymal stem cells (MSCs) from adult adipose tissue and induced them to differentiate into skeletal muscle cells in culture. Within mdx mice, an animal model of DMD, adipose tissue-derived Flk-1(+) MSCs (AD-MSCs) homed to and differentiated into cells that repaired injured muscle tissue. This repair correlated with reconstitution of dystrophin expression on the damaged fibers. Flk-1(+) AD-MSCs also differentiated into muscle satellite cells. This differentiation may have accounted for long-term reconstitution. These cells also differentiated into endothelial cells, thereby possibly improving fiber regeneration as a result of the induced angiogenesis. Therefore, Flk-1(+) AD-MSC transplants may repair muscular dystrophy.     

Histopathologic features of masseter muscle in the distrophic hamster (UM-X7.1 Syrian hamster)

Dystrophic hamster has been regarded as the useful model animal for Severe childhood autosomal recessive muscular dystrophy (SCARMD). Although, many studies on Dystrophic hamster have utilized the muscular tissue of the trunk, however no study have been analyzed for the masticatory muscle. For this study, we used a Dystrophic hamster (UM-X7.1 Syrian hamster) to histochemically investigate the effect of muscular dystrophy on the masseter muscle. Large and small regenerated muscle fibers, and necrotic fibers were detected almost in all areas. Opaque fiber, hypertrophic fiber with fiber splitting structure and necrotic fiber filled up by mononuclear phagocytes were recognized. The region, in which the mononuclear phagocytic cells infiltrated, showed strong positivity to acid phosphatase, and lysosome enzyme. There were many muscle fibers with reduced levels of succinate dehydrogenase (SDH) activities in the muscle fiber. Some TUNEL-positive cells were confirmed in both necrotic and non-necrotic areas. It was suggested that a part of TUNEL-positive cells are the cells originated from the connective tissue or immunocytes. In this result, histopathologic changes of the masseter muscle of the UM-X7.1 Syrian hamster was similar to muscle of the body trunk in the past reports. As the result, it was suggested that jaw closing movements may be negatively affected caused by the decline of the masseter muscle twitch. And, the point of view by which apoptosis is the trigger for the muscle fiber collapse were not seen in the Dystrophic hamster masseter muscle. We suggest that apoptosis is a one step in the process of regeneration of muscle fibers.     

HISTOPATHOLOGICAL STUDY ON PROGRESSIVE MUSCULAR DYSTROPHY—REPORT OF A CASE WITH AUTOPSY FINDINGS—

A typical case of the D uchenne type of progressive muscular dystrophy with autopsy findings was presented. Changes in the myocardial and smooth muscle of many organs were found, and the skeletal muscles also revealed florid changes.
Histopathological examination of the skeletal muscle was made in detail through light and electron microscopic observation.     

mdx小鼠骨骼肌组织成肌、成脂、成骨基因的特异性表达

背景：干细胞移植是治疗肌营养不良症的有效方法之一,但移植的干细胞在病理骨骼肌中成肌表达较低。 目的：通过比较mdx小鼠和C57小鼠的骨骼肌形态及成肌、成脂、成骨基因表达的差异,探讨mdx小鼠骨骼肌病理改变的可能机制。 方法：取mdx小鼠与C57小鼠的骨骼肌组织行冰冻切片,苏木精-伊红染色和Vonkossa染色观察两种小鼠肌肉组织的形态特征;提取mdx小鼠和C57小鼠骨骼肌组织总RNA,real-time PCR检测成肌、成脂、成骨相关基因的表达。 结果与结论：mdx小鼠骨骼肌有肌纤维坏死和再生,伴有轻度脂肪、纤维结缔组织增生,Vonkossa染色可见钙结节沉积,而C57小鼠的骨骼肌细胞形态清晰,核位于细胞周边。与C57小鼠比较,mdx小鼠肌肉组织成骨、成脂基因表达有不同程度的上调(P < 0.05),而成肌基因表达下调(P< 0.05)。dystrophin基因缺失及成肌基因表达下调、成骨和成脂基因上调是造成mdx小鼠肌肉组织变性坏死的原因。     

Expression of transforming growth factor-beta 1 and its relation to endomysial fibrosis in progressive muscular dystrophy.

Progressive muscular dystrophy is characterized by muscle fiber necrosis, regeneration, and endomysial fibrosis. Although absence of dystrophin has been known as the cause of muscle fiber degeneration, pathogenesis of interstitial fibrosis is still unknown. Transforming growth factor-beta 1 (TGF-beta 1) induces accumulation of extracellular matrix in various diseases, such as liver cirrhosis and interstitial pneumonitis. To investigate its function on the pathogenesis of progressive muscular dystrophy, it was necessary to determine the degree of TGF-beta 1 expression and the site of TGF-beta 1 immunoreactivity. In Duchenne muscular dystrophy and most of Becker muscular dystrophy, high TGF-beta 1 immunoreactivity expressed on muscle fibers and extracellular space. In other myopathies with endomysial fibrosis, however, TGF-beta 1 was seldom observed. We also examined the immunoreactivity of the latent TGF-beta binding protein, which is bound to the TGF-beta precursors. In all Duchenne muscular dystrophy and half of Becker muscular dystrophy cases, high latent TGF-beta 1 binding protein immunoreactivity was seen, but in other myopathies its immunoreactivity was seldom seen on muscle fibers or extracellular space. Therefore TGF-beta 1 may play an important role in synthesis and accumulation of extracellular matrix in progressive muscular dystrophy.     

Three-dimensional optical coherence tomography of whole-muscle autografts as a precursor to morphological assessment of muscular dystrophy in mice

Three-dimensional optical coherence tomography (3D-OCT) is used to evaluate the structure and pathology of regenerating mouse skeletal muscle autografts for the first time. The death of myofibers with associated inflammation and subsequent new muscle formation in this graft model represents key features of necrosis and inflammation in the human disease Duchenne muscular dystrophy. We perform 3D-OCT imaging of excised autografts and compare OCT images with coregistered histology. The OCT images readily distinguish the necrotic and inflammatory tissue of the graft from the intact healthy muscle fibers in the underlying host tissue. These preliminary findings suggest that, with further development, 3D-OCT could be used as a tool for the evaluation of small-animal muscle morphology and pathology, in particular, for analysis of mouse models of muscular dystrophy.     

COMPARATIVE STUDY OF ALTERATIONS OF SKELETAL MUSCLE IN DUCHENNE MUSCULAR DYSTROPHY AND POLYMYOSITIS

Histological and ultrastructural alterations of skeletal muscles in Duchenne muscular dystrophy (DMD) (32 cases) and polymyositis (PM) (33 cases) were compared qualitatively and quantitatively. Regeneration is more numerous in PM than DMD throughout all stages. Stromal fibrosis and hyaline fiber with delta lesion are characteristic for DMD. In the electron microscope, we observed the usual preservation of basement membrane in degenerating muscle fibers and uncomplicated muscle regeneration in PM. On the other hand, there were partial disruption of the plasma membrane lining the delta lesion and degeneration of basement membrane and probable invasion of collagen fiber into sarcoplasm in some hypercontracted fibers in DMD. Besides, there appeared atypical form of regeneration in DMD, namely myocytes arrested at the stage of mononuclear myoblast or primitive myotube with degeneration of myofibrils and cytoplasmic organelles. At the advanced stage of DMD, there was scarce activity of regeneration. Stromal fibrosis, abnormality of membrane systems, and failure of regeneration were the characteristics of DMD. ACTA PATHOL. JPN. 34: 1221–1242. 1984.     

ADAM12 alleviates the skeletal muscle pathology in mdx dystrophic mice

Muscular dystrophy is characterized by muscle degeneration and insufficient regeneration and replacement of muscle fibers by connective tissue. New therapeutic strategies directed toward various forms of muscular dystrophy are needed to preserve muscle mass and promote regeneration. In this study we examined the role of the transmembrane ADAM12, a disintegrin and metalloprotease, which is normally associated with development and regeneration of skeletal muscle. We demonstrate that ADAM12 overexpression in the dystrophin-deficient mdx mice alleviated the muscle pathology in these animals, as evidenced by less muscle cell necrosis and inflammation, lower levels of serum creatine kinase, and less uptake of Evans Blue dye into muscle fibers. These studies demonstrate that ADAM12 directly or indirectly contributes to muscle cell regeneration, stability, and survival.     

HISTOMETRICAL and HISTOLOGICAL CHANGES OF THE SKELETAL MUSCLE IN NEUROMUSCULAR DISORDERS – AN AUTOPSY STUDY

Systemic hlstometrical and histological examinations of major skeletal muscles were performed by using autopsy cases with simple atrophy, neurogenic muscular atrophy, Duchenne type progressive muscular dystrophy, myositis of myasthenia gravis, and autopsy control cases. In hlstometrical studies, the shortest diameters of muscle fibers were measured and arranged in histograms. Volume ratio of stroma to muscle was measured by point-counting method.
Histometrical studies revealed the following results: (1) averages of muscle fiber diameters in controls showed the largest value In the muscles of the upper and lower extremities, and the smallest value in the lingual muscle; (2) in simple atrophy, neurogenic muscular atrophy, progressive muscular dystrophy and myositis, a decrease in muscle fiber diameters was more prominent in the muscles of the lower extremities than those of the upper extremities; (3) patterns of histograms of muscle fiber diameters were classified into six types, and in simple atrophy, almost one-half of muscles examined belonged to type 3 histogram, which had the mode situated at a relatively small diameter and a not so high kurtosls; (4) volume ratios of stroma to muscle Increased most in both muscular dystrophy and long-standing neurogenic muscular atrophy, moderately in myositis, and mildly in simple atrophy; and (5) hlstometrical changes In myasthenia gravis were minimal.     

FINE STRUCTURAL HISTOCHEMISTRY OF MYOSIN-ATPASE ACTIVITY IN THE SKELETAL MUSCLES OF DUCHENNE MUSCULAR DYSTROPHY

Myosin ATPase activity was fine-structurally examined in various skeletal muscle lesions including atrophy, degenerations, necrosis, "deltashaped subsarcolemmal lesion", and apparently normal fibers from seven patients of Duchenne muscular dystrophy (D M D). The enzyme activity was almost completely lost in the foci of necosis, and more or less markedly diminished in various kinds of degenerations, while it was well preserved in the apparently normal and simply atrophic fibers. The results suggested that there were two different lesions in wasting of the skeletal muscles in D M D; necrotic process with degenerations in which myosin-ATPase activity was affected and simply atrophic process which had little influence on the enzyme activity. The former lesion might be related with direct or indirect damages such as proteolysis, while the latter seemed to be an expression of basically different process such as disuse or denervation, or a more mild expression basically of the same process ultimately resulting in necrosis.     

Transgenic overexpression of ADAM12 suppresses muscle regeneration and aggravates dystrophy in aged mdx mice

Muscular dystrophies are characterized by insufficient restoration and gradual replacement of the skeletal muscle by fat and connective tissue. ADAM12 has previously been shown to alleviate the pathology of young dystrophin-deficient mdx mice, a model for Duchenne muscular dystrophy. The observed effect of ADAM12 was suggested to be mediated via a membrane-stabilizing up-regulation of utrophin, alpha7B integrin, and dystroglycans. Ectopic ADAM12 expression in normal mouse skeletal muscle also improved regeneration after freeze injury, presumably by the same mechanism. Hence, it was suggested that ADAM12 could be a candidate for nonreplacement gene therapy of Duchenne muscular dystrophy. We therefore evaluated the long-term effect of ADAM12 overexpression in muscle. Surprisingly, we observed loss of skeletal muscle and accelerated fibrosis and adipogenesis in 1-year-old mdx mice transgenically overexpressing ADAM12 (ADAM12(+)/mdx mice), even though their utrophin levels were mildly elevated compared with age-matched controls. Thus, membrane stabilization was not sufficient to provide protection during prolonged disease. Consequently, we reinvestigated skeletal muscle regeneration in ADAM12 transgenic mice (ADAM12(+)) after a knife cut lesion and observed that the regeneration process was significantly impaired. ADAM12 seemed to inhibit the satellite cell response and delay myoblast differentiation. These results discourage long-term therapeutic use of ADAM12. They also point to impaired regeneration as a possible factor in development of muscular dystrophy.     

Restoration of gastrocnemius muscle in mdx mice of different age after injury and implantation of xenogenic muscle tissue

The intensity of regeneration of crossed gastrocnemius muscle was evaluated in two groups of mdx mice of different age 2 weeks after implantation of crushed muscle tissue from newborn rats into the wound defect area. The effect of xenoplasty manifested in increased weight of the damaged muscle. The effect was observed in mice aging 12–16 weeks but not in those aged 40–48-weeks. Structural changes in the skeletal muscle tissue intrinsic of mdx mice and augmenting with age were detected in intact mice before the experiment. Activity of muscle fiber regeneration in intact and injured muscle of 40–48-week-old mice was significantly lower than in 12–16-week-old ones. Myoblasts of the xenogenic transplant retained viability in recipient muscles for at least 2 weeks. Post-traumatic regeneration was stimulated in only 12–16-week animals. Xenoplasty was ineffective in older animals and even somewhat enhanced the destructive processes in the muscle. It seems that age-specific regeneration activity of the recipient skeletal muscle tissue should be taken into consideration in the development of effective strategy of cell therapy for progressive muscular dystrophy. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 142, No. 8, pp. 216–220, August, 2006     

Studies on isolated human skeletal muscle fibers, including a proposed pattern of nuclear distribution and a concept of nuclear territories

Studies of human skeletal muscle fibers from tissue specimens isolated by supersonic cavitation, employing a Willens Polytron, show that the number of nuclei per millimeter, the surface area of fiber per nucleus, and the cytoplasmic volume per nucleus increase with fiber diameter, for fibers from the same muscle, from muscle to muscle, and from patient to patient. Skeletal muscle fibers from patients with Pompe's disease, muscular dystrophy (both autosomal and sex linked recessive juvenile forms), Riley-Day central autonomic dysfunction, and cardiomyopathy with skeletal muscle weakness show increased N/mm. and decreased A/N and V/N values, whereas fibers from patients with the Down syndrome show low N/mm. and high A/N and V/N values. Possibly abnormal fiber values were also observed in familial cerebellar atrophy with mental retardation, in 18 trisomy, Jansky-Bielschowsky disease, and ataxia-telangiectasia. Skeletal muscle fibers from autosomal recessive (“limb girdle”) muscular dystrophy show segmental, and those from Duchenne's dystrophy diffuse, hypernucleation. In Pompe's disease, acid mucopolysaccharide occurs in discrete “packages” in skeletal muscle, muscles of respiration showing less acid mucopolysaccharide than others.Evidence that the nuclei of skeletal muscle fibers are arranged in a pattern based on a hexagonal array, such that the fibers are covered by nuclear territories of relatively uniform size and shape, is presented, models of such architecture are presented, and possible biochemical implications of nuclear territories are discussed. Evidence that division of fiber nuclei is amitotic is presented. The concept that nuclear rows or chains in skeletal muscle fibers are nuclear clones is proposed, and possible biochemical implications of this arrangement are also discussed.     

Identification of muscle necrosis in the mdx mouse model of Duchenne muscular dystrophy using three-dimensional optical coherence tomography

Three-dimensional optical coherence tomography (3D-OCT) was used to image the structure and pathology of skeletal muscle tissue from the treadmill-exercised mdx mouse model of human Duchenne muscular dystrophy. Optical coherence tomography (OCT) images of excised muscle samples were compared with co-registered hematoxylin and eosin-stained and Evans blue dye fluorescence histology. We show, for the first time, structural 3D-OCT images of skeletal muscle dystropathology well correlated with co-located histology. OCT could identify morphological features of interest and necrotic lesions within the muscle tissue samples based on intrinsic optical contrast. These findings demonstrate the utility of 3D-OCT for the evaluation of small-animal skeletal muscle morphology and pathology, particularly for studies of mouse models of muscular dystrophy.     

The distribution and characterization of skeletal muscle lesions in dysferlin-deficient SJL and A/J mice

The pathogenesis of limb-girdle muscular dystrophy type 2B (LGMD2B) dysferlinopathy remains to be investigated. The distribution and characterization of skeletal muscle lesions were examined in two different LGMD2B mouse models, SJL and A/J mice (at 10 and 35 weeks old), in association with the endoplasmic reticulum (ER) stress. SJL mice showed an earlier age of onset and a faster progression of skeletal muscle lesions as compared with those of A/J mice; the sensitivity difference to muscular dystrophic lesions between SJL and A/J mice was observed in the lumbar muscles (particularly, lumbar longissimus and sublumbar muscles); the lesions seen mainly in SJL mice at 35 weeks old consisted of degeneration, necrosis, fatty infiltration, variation in muscle fiber size and atrophy in muscle fibers. Enzyme-histochemically, the fast-twitch muscle fiber was predominant for the degenerative changes seen in the rectus femoris and lateral longissimus muscles of SJL mice. Immunohistochemically, the main reactive cell type observed in and around degenerative and/or necrotic muscle fibers was macrophages, demonstrable with an anti-F4/80 antibody. Because the analyses of spliced XBP1 mRNA, a marker of ER stress, did not show the increased expression, it was considered that ER stress did not affect the progression of skeletal muscle lesions in SJL mice with the advanced stage of dysferlinopathy.     

Skeletal myopathy in transgenic mice carrying human prototype c-Ha-ras gene

Skeletal myopathy was found in almost all-transgenic mice carrying the human prototype c-Ha-ras gene (rasH2 mouse). Microscopically, variation of the muscle fiber size, centrally placed nuclei, regenerating fibers, and interstitial fibrosis were evident; hyalinization and necrosis were sometimes observed in the skeletal muscle (femoralis and pectoralis) of the rasH2 mice. Inflammatory changes in the skeletal muscle or abnormality of adjacent peripheral nerve were not observed. The features were essentially similar to those of muscular dystrophy. Although the severity was relatively mild compared to 34-week-old rasH2 mice, the skeletal myopathy was also observed in younger male (10 weeks of age) rasH2 mice. In nontransgenic littermates, skeletal myopathy was not observed. The mRNA of human c-Ha-ras product was detected in femoral muscle from the rasH2 mice by RT-PCR. In conclusion, these data suggest that skeletal myopathy is occurring in almost all rasH2 mice. Integration of c-Ha-ras gene is thought to be crucial to pathogenesis of skeletal myopathy in the rasH2 mice. Further characterization of the muscular lesion and its pathogenesis are needed to explore the possibility of rasH2 mouse becoming a new model for muscular dystrophy.     

CONGENITAL MUSCULAR DYSTROPHY ASSOCIATED WITH MICROPOLYGYRIA - REPORT OF TWO CASES

This is a report on two autopsy cases of congenital muscular dystrophy assoicated with micropolygyria. The first case was that of an 11-year-old boy and the other of a 22-year-old male adult. Both cases had similar clinical features, very early onset of disease, diffuse and extensive wasting of skeletal muscles including facial muscles, contracture of joints, hypotonia and mental retardation. In the familial histories of these two cases, the parents of the boy were consanguineous, and a sister of the adult case suffered from muscle weakness and mental retardation. Both of these two cases were clinically diagnosed as congenital cerebromuscular dystrophy (Fukuyama's type). Autopsy revealed marked dystrophy of generalized skeletal muscles and widespread micropolygyria of the brain in both cases. Spinal cords and peripheral nerves were free from any prominent changes. It was concluded that so-called congenital cerebromuscular dystronphy may be caused by myogenic as well as neurogenic abnormalities during fetal period.     

Activation of caspase 3, 9, 12, and Bax in masseter muscle of mdx mice during necrosis

The mdx mouse, a model of muscular dystrophy, lacks dystrophin, a cell membrane protein. It is known that the lack of dystrophin causes muscle fiber necrosis from 2 weeks after birth, and the majority of necrotic muscle fibers are replaced by regenerated muscle fibers by 4 weeks after birth. A recent study indicated the possibility that mitochondria-mediated intracellular stress, a phenomenon similar to apoptosis, may be produced during muscle fiber necrosis, but did not analyze endoplasmic reticulum-mediated intracellular stress. Therefore, we examined the expression of the caspase-12 gene involved in the endoplasmic reticulum stress pathway and the Bax, caspase-9, and caspase-3 genes involved in the mitochondrial stress pathway in the mdx masseter muscle. We found over-expression of caspase-12 in cells at 2–3 weeks after birth when muscle fiber necrosis was not prominent. This suggests that stress occurs in the endoplasmic reticulum to maintain cell morphology in the absence of dystrophin. In addition, Bax was abundantly expressed in the mdx masseter muscle at 3 weeks after birth, and the expression of caspase-9 and -3 was prominent at 3–4 weeks after birth when necrosis and regeneration were marked. These results indicate that endoplasmic reticulum and mitochondrial stresses are produced during necrosis of the mdx masseter muscle, and suggest that these events are a phenomenon similar to apoptosis.