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Inclusion body myositis: atypical clinical presentations.

Inclusion body myositis affects primarily the proximal muscles but distal limb muscles are involved too in this chronic myopathy. Characteristic histopathologic findings include "rimmed vacuoles', inflammation and typical cytoplasmic and nuclear filamentous inclusions. The patients are usually unresponsive to steroids. We present four inclusion body myositis patients with atypical clinical presentations: one with scapuloperoneal syndrome, one with post-polio-like syndrome and two with associated immune-mediated diseases (one with undefined autoimmune disorder and the second with scleroderma). Two patients responded to high-dose steroid therapy. We suggest that the clinical spectrum of inclusion body myositis is wider than previously appreciated.

Adult↗

Polymorphism of nuclear inclusions in carcinoma of the cervix uteri.

Frequency, polymorphism and ultrastructural characteristics of the nuclear inclusion bodies encountered in cancers of the uterine cervix are reported and briefly discussed. The nuclear inclusions are grouped in three distinct types: a) nuclear bodies (comprising type I and II inclusions according to Bouteille et al.'s classification), b) inclusion of cytoplasmic origin, and c) particles of chromatic material. The ultrastructural aspects of the chromatic particles suggest an early structuration of viral chromatin into core material. There appears to be a direct relation between the frequency of chromatic particles and raised antiherpetic antibodies in the patient's sera.

Adult↗

Familial inclusion body myositis among Kurdish-Iranian Jews.

We report two cases of adult-onset, slowly progressive limb-girdle muscle weakness with a remarkable sparing of quadriceps muscles that developed in patients from different families of Iranian-Kurdish-Jewish origin. Each patient had a similarly affected sibling. The findings by means of muscle biopsies showed abnormalities typical of inclusion body myositis, including abundant lined vacuoles and characteristic cytoplasmic inclusions of 15- to 18-nm filaments. Remarkably, many vacuolated muscle fibers showed immunoreactivity to neural cell adhesion molecule, a fetal muscle antigen. The common origin of these patients from an isolated ethnic group with frequent consanguinity and the familial incidence is indicative of a genetic causation or predisposition, probably with an autosomal recessive inheritance. This familial myopathy is one of several clinical syndromes that share the typical pathological findings of inclusion body myositis. The pathogenic relationship between these different familial forms and the more common sporadic form of inclusion body myositis is not known.

Adult↗

Solitary dural plasmacytoma with conspicuous cytoplasmic inclusions.

A solitary intracranial plasmacytoma originated from the left parietal meninges of a 67-year-old woman; the patient had a four-month history of generalized seizures. Immunoelectrophoresis, performed nine months after surgery, revealed a monoclonal IgG band in the cerebrospinal fluid (CSF) but not in the blood. A peculiar feature of the tumor cells was the presence of abundant hyaline, eosinophilic cytoplasmic inclusions. Ultrastructurally, these inclusions consisted of electron-dense floccular material within distended cisterns of endoplasmic reticulum (ER). These ultrastructural features resemble "thesaurocytes" originally described by Paraskevas et al. in IgA myeloma. Tumors composed mainly of such inclusion-bearing cells are extremely rare. Only a fraction of the tumor cells stained positively for IgG with the immunoperoxidase technique; most inclusion-bearing cells did not stain. It is therefore unlikely that the electron-dense material is stored immunoglobulins.

Cytoplasm↗

Infantile digital fibromatosis. Immunohistochemical and ultrastructural observations of cytoplasmic inclusions.

Using antibodies against actin, tubulin, and intermediate filaments immunohistochemical studies were performed on a nodule from an 8-month-old girl with infantile digital fibromatosis. None of the antibodies significantly stained the cytoplasmic inclusion bodies, which were a distinct morphologic feature of this fibromatosis. This result is in contrast to a previous report that stated that the inclusions were composed chiefly of actin filaments. In ultrastructural term, the tumor cells were morphologically consistent with cells in myofibroblasts. The inclusions consisted of packed fibrillar and granular substances. Cultured cells containing inclusions identical to those seen in the original tumor mimicked a growth pattern in vivo. Scanning electron microscopy showed that cultured cells had thin foot processes containing many microspikes. Detergent-treated preparations examined by transmission electron microscopy displayed a microtrabecular meshwork characterized by three, major cytoskeletal domains with many actin cables. Cultured cells showed a normal karyotype.

Culture Techniques↗

Upregulation of Fas/Fas ligand in inclusion body myositis.

In inclusion body myositis, T cells invade and destroy nonnecrotic muscle fibers. The mechanism by which T cells damage muscle fibers in inflammatory myopathies is not known. In this study we have investigated the expression of Fas and Fas ligand in muscle in five patients with inclusion body myositis. Reverse transcription polymerase chain reaction showed upregulation of both Fas and Fas ligand in all inclusion body myositis patients. Immunohistochemical investigation showed expression of Fas ligand in many of the muscle infiltrating mononuclear cells. Fas was expressed both in mononuclear cells and on the surface of muscle fibers in inclusion body myositis patients and in patients with polymyositis but not in patients with Duchenne muscular dystrophy or denervation. The results indicate that the Fas/Fas ligand system may be of importance for the inflammatory reaction and T-cell-mediated muscle cell injury.

Fas Ligand Protein↗

Purification of a crystallin domain of Yersinia crystallin from inclusion bodies and its comparison to native protein from the soluble fraction.

It has been established that many heterologously produced proteins in E. coli accumulate as insoluble inclusion bodies. Methods for protein recovery from inclusion bodies involve solubilization using chemical denaturants such as urea and guanidine hydrochloride, followed by removal of denaturant from the solution to allow the protein to refold. In this work, we applied on-column refolding and purification to the second crystallin domain D2 of Yersinia crystallin isolated from inclusion bodies. We also purified the protein from the soluble fraction (without using any denaturant) to compare the biophysical properties and conformation, although the yield was poor. On-column refolding method allows rapid removal of denaturant and refolding at high protein concentration, which is a limitation in traditionally used methods of dialysis or dilution. We were also able to develop methods to remove the co-eluting nucleic acids during chromatography from the protein preparation. Using this protocol, we were able to rapidly refold and purify the crystallin domain using a two-step process with high yield. We used biophysical techniques to compare the conformation and calcium-binding properties of the protein isolated from the soluble fraction and inclusion bodies.

Chromatography, DEAE-Cellulose↗

Differential detection of PAS-positive inclusions formed by the Z, Siiyama, and Mmalton variants of alpha1-antitrypsin.

Several point mutations of alpha(1)-antitrypsin cause a perturbation in protein structure with consequent polymerization and intracellular accumulation. The retention of polymers of alpha(1)-antitrypsin within hepatocytes results in protein overload that in turn is associated with juvenile hepatitis, cirrhosis, and hepatocellular carcinoma. The detection of alpha(1)-antitrypsin polymers and understanding the molecular basis of polymer formation is of considerable clinical importance. We have used a monoclonal antibody (ATZ11) that specifically recognizes a conformation-dependent neoepitope on polymerized alpha(1)-antitrypsin to detect polymers within hepatocytes of individuals with alpha(1)-antitrypsin deficiency. Paraffin-embedded liver tissue specimens were obtained from individuals who were homozygous for the Z (Glu342Lys), Mmalton (52Phe del), and Siiyama (Ser53Phe) alleles of alpha(1)-antitrypsin that result in hepatic inclusions and profound plasma deficiency. Immunohistological staining with a polyclonal anti-human alpha(1)-antitrypsin antibody showed hepatic inclusions in all 3 cases, while ATZ11 reacted with hepatic inclusions formed by only Z alpha(1)-antitrypsin. Polymers of plasma M and Z alpha(1)-antitrypsin prepared under different conditions in vitro and polymers of recombinant mutants of alpha(1)-antitrypsin demonstrated that the monoclonal antibody detected a neoepitope on the polymerized protein. It did not detect polymers formed by a recombinant shutter domain mutant (that mirrors the effects of the Siiyama and Mmalton variants), polymers formed by cleaving alpha(1)-antitrypsin at the reactive loop, or C-sheet polymers formed by heating alpha(1)-antitrypsin in citrate. In conclusion, the ATZ11 monoclonal antibody detects Z alpha(1)-antitrypsin in hepatic inclusions by detecting a neoepitope that is specific to the polymeric conformer and that is localized close to residue 342.

Antibodies, Monoclonal↗

Unusual envelopes associated with parasporal inclusions of a mosquitocidal Bacillus thuringiensis serovar fukuokaensis isolate.

A mosquitocidal soil isolate of Bacillus thuringiensis serovar fukuokaensis (H3ade) produced spherical parasporal inclusions measuring 0.6-0.7 microm in diameter. Inclusion matrix was homogeneous substance surrounded by a thick, highly electron-dense envelope 30-50 nm in thickness. The envelopes were associated with both intracellular and extracellular inclusions. Densely woven network was the inner structure of the envelope. Often, inclusions had round-shaped, enveloped small protrusions on the surface.

Animals↗

Ultrastructural characterization of core structures and paracrystalline inclusion bodies in L-form cells of streptomycetes.

Protoplast type L-form cells of Streptomyces hygroscopicus and S. griseus contain different types of inclusion bodies. Cytoplasmic cores and paracrystalline structures are peculiar inclusions which could not be observed in normal parent bacteria. The cytoplasmic cores are 1-4 micron long and 0.05-0.25 micron broad straight and stiff non-tubular structures consisting of homogeneous mode-rate electron opaque material. Paracrystalline inclusions have side-lengths between 0.2 and 0.5 micron and show a characteristic pattern of 15-20 nm thick straight dark lines and electron lucent intervening spaces of 20-30 nm. Both cytoplasmic cores and paracrystalline inclusions are apparently proteins. Their occurrence in L-form cells indicates an altered synthesis of one or several proteins in these cell types.

Cell Nucleus↗

Attenuation of free radical production and paracrystalline inclusions by creatine supplementation in a patient with a novel cytochrome b mutation.

Mitochondrial cytopathies are associated with increased free radical generation and paracrystalline inclusions. Paracrystalline inclusions were serendipitously found in a young male athlete with a very high respiratory exchange ratio during steady-state exercise; he also had an unusually low aerobic capacity. Direct sequencing of the mitochondrial DNA (mtDNA) coding regions revealed a novel missense mutation (G15497A) resulting in a glycine-->serine conversion at a highly conserved site in the cytochrome b gene in the subject, his mother, and sister. Cybrids, prepared by fusion of the subject's platelets with either U87MG rho degrees or SH-SY5Y rho degrees cells, generated higher basal levels of reactive oxygen species (ROS), had a lower adenosine triphosphate (ATP) content, and were more sensitive to oxygen and glucose deprivation and peroxynitrite generation compared to control cybrids with wild-type mtDNA. Cell survival was significantly enhanced with 50 mmol/L creatine monohydrate (CM) administration. The subject was also treated with CM (10 g/d) for a period of 5 weeks and a repeat muscle biopsy showed no paracrystalline inclusions. The results suggest that the development of exercise-induced paracrystalline inclusions may be influenced by the G15497A mtDNA mutation, and that CM mitigates against the pathological consequences of this mutation.

Adenosine Triphosphate↗

NEDD8 protein is involved in ubiquitinated inclusion bodies.

Proteolysis by the ubiquitin-proteasome system is considered to play a pathological role in several degenerative diseases that involve ubiquitinated inclusion bodies. In recent years, several ubiquitin-like proteins have been isolated, but it is uncertain whether their roles are associated with protein degradation through the ubiquitin-proteasome system. NEDD8 (neural precursor cell-expressed and developmentally down-regulated gene), which consists of 81 amino acid residues, possesses the highest sequence similarity to ubiquitin. Recent studies have indicated that NEDD8 is covalently ligated to cullin family proteins, which are components of certain ubiquitin E3 ligases, by a pathway analogous to that of ubiquitin. Thus, by focusing on the structural and functional association between NEDD8 and ubiquitin, it would be of interest to know whether the NEDD8 system is involved in pathological disorders of the ubiquitin-proteasome system. This study has examined the immunohistochemical distribution of NEDD8 protein by using a highly purified antibody in normal tissues and in tissues known to contain ubiquitinated inclusions. NEDD8 protein expression was widely observed in most types of tissues. Furthermore, accumulation of the NEDD8 protein was commonly observed in ubiquitinated inclusion bodies, including Lewy bodies in Parkinson's disease, Mallory bodies in alcoholic liver disease, and Rosenthal fibres in astrocytoma. Two of ten cases of neurofibrillary tangles and senile plaques from patients with Alzheimer's disease showed intense staining for NEDD8 as well as for ubiquitin. These findings suggest the possibility that the NEDD8 system is involved in the metabolism of these inclusion bodies via the ubiquitin-proteasome system.

Alzheimer Disease↗

Immunohistochemical staining of the Dutcher-Fahey intranuclear inclusion body in a case of Waldenström's macroglobulinaemia.

Thirteen years after the patient's death, tissues removed at biopsy and autopsy from a case of Waldenström's macroglobulinaemia have been shown to contain intranuclear inclusion bodies composed mostly of IgM-kappa immunoglobulin. They were demonstrated by staining the tissues by peroxidase-antiperoxidase methods. A few intranuclear inclusions stained for IgG and for lambda light chains. These findings suggest that the patient's condition may have been initially polyclonal and benign, but had become virtually monoclonal and neoplastic at the time of death 23 months later. The findings lend a little support to the suggestions of other workers that the Dutcher-Fahey inclusion body is unlikely to be specific for macroglobulinaemia. Nevertheless, these inclusion bodies appear to be pertinent to the assessment of this case, in view of the marked bias towards IgM-kappa monoclonal gammopathy, which was not evident from a study of the cytoplasmic staining results alone.

Bone Marrow↗

Occurrence of Mallory body-like inclusions in parathyroid chief cells of ozone-treated dogs.

Ultrastructural characteristics of chief cells of the parathyroid glands of ozone-treated dogs were examined 3 days, 10-13 days and 28 days after treatment. Dilated Golgi cisternae and vacuoles contained low electron dense fibrillar material. These changes in the Golgi were accompanied by massive accumulation of filaments in the perinuclear area where most of the cell organelles were disrupted to the peripheral zone of the filamentous inclusions. These inclusions were not enclosed by a membrane and corresponded with PAS-positive and diastase-resistant material in the chief cells at light microscopic level. Therefore these inclusions were arbitrarily designated as Mallory body-like inclusions.

Animals↗

Location of inclusion cysts in mouse ovaries in relation to age, pregnancy, and total ovulation number: implications for ovarian cancer?

Benign ovarian cysts are thought to be precursor lesions that differentiate and transform into carcinoma. With the aim of testing the hypothesis that increased ovulation number increases the frequency or number of ovarian cysts, the development and appearance of ovarian cysts was investigated in mice of differing ages and total lifetime ovulation number. High total ovulation number was induced by keeping mice in cages divided by a screen, with a male on one side and two females on the other side. Significantly more cysts were observed in animals subjected to incessant ovulation for 8 months and in 12 month breeding mice than in 3-month virgin mice or 1-month prepubertal animals. These cysts had the appearance of benign serous inclusion cysts. When cystic ovaries were serial sectioned, 47% of cysts had a connection to the ovarian hilus and potentially to the tubules of the rete ovarii, 31% were adjacent to the hilus, and 22% had an intra-ovarian location. A significant increase in intra-ovarian cysts was observed in the 8-month incessant ovulation group, implying that high ovulation number leads to ovarian surface invagination and inclusion cyst formation. In conclusion, ovarian inclusion cysts may be derived from more than one epithelial source, but incessant ovulation may increase the proportion derived from the ovarian surface epithelium. Because the cysts observed resembled human serous inclusion cysts these results have possible implications for epithelial ovarian carcinoma.

Aging↗

In situ proteolytic digestion of inclusion body polypeptides occurs as a cascade process.

Misfolded proteins undergo a preferent degradation ruled by the housekeeping bacterial proteolytic system, but upon precipitation as inclusion bodies their stability dramatically increases. The susceptibility of aggregated polypeptides to proteolytic attack remains essentially unexplored in bacteria and also in eukaryotic cells. We have studied here the in vitro proteolysis of beta-galactosidase fusion proteins by trypsin treatment of purified inclusion bodies. A cascade digestion process similar to that occurring in vivo has been observed in the insoluble fraction of the digestion reaction. This suggests that major protease target sites are not either lost or newly generated by protein precipitation and that the digestion occurs in situ probably on solvent-exposed surfaces of inclusion bodies. In addition, the sequence of the proteolytic attack is influenced by protein determinants other than amino acid sequence, the early digestion steps having a dramatic influence on the further cleavage susceptibility of the intermediate degradation fragments. These observations indicate unexpected conformational changes of inclusion body proteins during their site-limited digestion, that could promote protein release from aggregates, thus partially accounting for the plasticity of in vivo protein precipitation and solubilization in bacteria.

Bacterial Proteins↗

Helical inclusions with nucleopore-like characteristics in the cytoplasm of Swiss 3T3 cells: a preliminary communication.

Helical inclusions have been observed at sites remote from the nucleus in the cytoplasm of Swiss 3T3 fibroblasts. Because of the interest shown in their unusual nucleopore complex-like nature, this preliminary communication briefly reports their existence and describes their essential ultrastructural features. Although they could be found singly, most formed collections of up to about 30 inclusions in which different planes of section were represented. TS profiles with hexagonal packing showed apparently identical eight-fold symmetry and dimensions to pores in the nuclear envelope of 3T3 cells. No membranes were associated with the inclusions, nor was there any suggestion of the strict vertical plate-like stacking found in annulate lamellae (AL). Furthermore, the inclusions were undoubtedly helical, and in all probability composed of several strands.

3T3 Cells↗