Elevación de la CPK y plaquetopenia asintomáticas como síntomas iniciales en la enfermedad de McArdle / Asymptomatic hyper-CK-emia and thrombocytopenia as initial symptoms of McArdle's disease

La enfermedad de McArdle es una enfermedad metabólica, de origen genético, resultado de una deficiencia en una de las enzimas responsables del metabolismo del glucógeno en el organismo. Estos pacientes presentan una clínica y unas alteraciones bioquímicas características, que sugieren el diagnóstico. Se presenta el caso de un paciente de 14 años, en el cual las alteraciones en la analítica sanguínea se presentaron previas a la clínica (AU)

McArdle disease is a metabolic and genetic disease due to a deficiency of an enzyme responsible for the glycogen metabolism. We report the case of a patient of a 14-year-old patient, who showed blood tests alterations preceding the clinical symptomatology (AU)

High post-mortem temperature combined with rapid glycolysis induces phosphorylase denaturation and produces pale and exudative characteristics in broiler Pectoralis major muscles.

This study investigated the effect of early post-mortem temperature on broiler protein characteristics and meat quality. Muscles were kept at different temperatures (0, 20 and 40 °C) until 4h post-mortem and then stored at 4 °C. Rapid degradation of ATP and glycogen, thus inducing a high rate of lactate formation and pH drop, were found in the 40 °C group during incubation. When extracting proteins, a lower protein content of the sarcoplasmic fraction and a higher protein content of the myofibrillar fraction were found in the 40 °C group at 24h post-mortem; SDS-PAGE and western-blotting results revealed that phosphorylase was associated with the myofibrillar fraction. Furthermore, the 40 °C group had paler surfaces, higher drip loss and lower processing properties. These data suggest that elevated temperature during early post-mortem period, resulting in rapid glycolysis, induced phosphorylase denaturation and association with myofibrillar proteins thus generating pale and exudative characteristics.

[McArdle disease revealed by exercise intolerance associated with severe rhabdomyolysis]. / Révélation d'une maladie de Mc Ardle par une intolérance musculaire à l'effort associée à une rhabdomyolyse sévère.

McArdle's disease (MAD) is a rare hereditary myopathy secondary to a deficit in myophosphorylase, an essential enzyme for the use of muscular glycogen reserves. Exercise intolerance to a variable degree is the fundamental manifestation. Muscular enzymes are usually normal or slightly elevated, except during episodes of rhabdomyolysis. Generally, the electromyogram has poor sensitivity for the diagnosis of exercise myopathies. The muscular biopsy can be misleadingly normal. The role of MRI in the diagnosis of MAD is not well clarified in the literature. We report the case of a 16-year-old patient, hospitalized in July 2008 for exercise intolerance. On admission, he was asymptomatic and the physical examination was non contributive. Serum creatine kinase levels and renal function measures were normal. Cycloergometer exercise testing unmasked the disease. EMG and muscular biopsies were normal. During the second hospitalization, this time for rhabdomyolysis, T2 weighted MRI of the thighs showed high intensity signals from the gracilis muscles. The control MRI, made after 2 weeks of rest, was normal. Right gracilis muscle biopsy demonstrated excess glycogen with myophosphorylase deficiency, establishing the diagnosis of MAD. MAD is a rare metabolic myopathy to consider in patients with a history of exercise intolerance. The muscle biopsy can be misleadingly normal and should be, to our opinion, be guided by MRI findings.

False negative histochemical reaction for myophosphorylase activity in fulminant sepsis due to methicillin resistant Staphylococcus aureus.

We report a false negative histochemical reaction for myophosphorylase in the case of an 11 year old with fulminant Staphylococcus aureus. Due to increased creatine kinase levels and marked myoglobinuria a muscle biopsy was performed prior to death. The biopsy revealed rhabdomyolysis, glycogen depletion and absent myophosphorylase reactivity. Subsequent myophosphorylase quantification was normal. This unique case of a false negative myophosphorylase histochemical reaction is apparently related to sepsis.

Age-associated tyrosine nitration of rat skeletal muscle glycogen phosphorylase b: characterization by HPLC-nanoelectrospray-tandem mass spectrometry.

We identified age-dependent post-translational modifications of skeletal muscle glycogen phosphorylase b (Ph-b), isolated from F1 hybrids of Fisher 344 x Brown Norway rats. Ph-b isolated from 34 months old rats showed a statistically significant decrease in specific activity compared to 6 months old animals: 13.8+/-0.7 vs. 20.6+/-0.8 U mg(-1) protein, respectively. Western blot analysis of the purified Ph-b with anti-3-NT antibodies revealed an age-dependent accumulation of 3-nitrotyrosine (3-NT), quantified by reverse-phase HPLC-UV analysis to increase from 0.05+/-0.03 to 0.34+/-0.11 (mol 3-NT/mol Ph-b) for 6 vs. 34 months old rats, respectively. HPLC-nanoelectrospray ionization-tandem mass spectrometry revealed the accumulation of 3-NT on Tyr113, Tyr161 and Tyr573. While nitration of Tyr113 was detected for both young and old rats, 3-NT at positions 161 and 573 was identified only for Ph-b isolated from 34 months old rats. The sequence of the rat muscle Ph-b was corrected based on our protein sequence mapping and a custom rat PHS2 sequence containing 17 differently located amino acid residues was used instead of the database sequence. The in vitro reaction of peroxynitrite with Ph-b resulted in the nitration of multiple Tyr residues at positions 51, 52, 113, 155, 185, 203, 262, 280, 404, 473, 731, and 732. Thus, the in vitro nitration conditions only mimic the nitration of a single Tyr residue observed in vivo suggesting alternative pathways controlling the accumulation of 3-NT in vivo. Our data show a correlation of age-dependent 3-NT accumulation with Ph-b inactivation.

Muscle- and fibre type-specific expression of glucose transporter 4, glycogen synthase and glycogen phosphorylase proteins in human skeletal muscle.

The muscle- and fibre type-specific expression of skeletal muscle glucose transporter 4 (GLUT4), glycogen synthase (GS) and glycogen phosphorylase (GP) was investigated in six young male subjects. Single muscle fibres were dissected from vastus lateralis (VL), soleus (SO) and triceps brachii (TB) muscle biopsy samples. On the basis of myosin heavy chain (MHC) expression, fibres were pooled into three groups (MHC I, MHC IIA and MHC IIX) and the GLUT4, GS and GP content of 15-40 pooled fibres determined using SDS-PAGE and immunological detection. In VL, the GLUT4 content in the pooled muscle fibres expressing MHC I was approximately 33% higher ( P<0.05) than in fibres expressing MHC IIA or IIX. There was no difference in GLUT4 content between fibres expressing MHC IIA or IIX, nor were there any differences in GS and GP content between any of the fibre types. In SO, there was no difference in GLUT4, GS and GP between fibres expressing MHC I or IIA. No fibres expressing type IIX were detected. In TB, fibres expressing MHC IIA and IIX had significantly ( P<0.05) more GP (66% and 55 % in MHC IIA and MHCIIX, respectively) than those expressing MHC I, whilst there was no difference in GP between MHC IIA and MHC IIX fibres. The GLUT4 and the GS content was similar in fibres expressing MHC I, IIA and IIX in the TB. Our data directly demonstrate that some proteins, like GLUT4 and GP, are expressed in a fibre type-specific manner in some, but not all, muscles, whilst other proteins, like GS, are not. In human skeletal muscle the GLUT4, GS and GP content thus seems to be related primarily to factors other than the fibre type as defined by the expression of contractile protein. These findings imply that it is not possible to generalize fibre type-dependent protein expression on the basis of biopsies from only one muscle.

Immunocytochemical localization of glycogen phosphorylase isozymes in rat nervous tissues by using isozyme-specific antibodies.

Isozyme-specific antibodies were raised against peptides from the low-homology regions of the sequences of rat glycogen phosphorylase BB and MM isozymes by immunization of rabbits and guinea pigs. Immunocytochemical double-labelling experiments on frozen sections of rat nervous tissues were performed to investigate the isozyme localization pattern. Astrocytes throughout the brain and spinal cord expressed both isozymes in perfect co-localization. Ependymal cells only expressed the BB isozyme. Most neurones were not immunoreactive. The rare neurones that contained glycogen phosphorylase only expressed the BB isozyme. Nearly all of these neurones formed part of the afferent somatosensory system. These findings stress the general importance of glycogen in neural energy metabolism and indicate a special role for the glycogen phosphorylase BB isozyme in neurones in the somatosensory system.