Pediatric necrotizing myopathy associated with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies

Wen Chen Liang, Akinori Uruha, Shigeaki Suzuki, Nobuyuki Murakami, Eri Takeshita, Wan Zi Chen, Yuh Jyh Jong, Yukari Endo, Hirofumi Komaki, Tatsuya Fujii, Yutaka Kawano, Madoka Mori-Yoshimura, Yasushi Oya, Jianying Xi, Wenhua Zhu, Chongbo Zhao, Yurika Watanabe, Keisuke Ikemoto, Atsuko Nishikawa, Kohei Hamanaka & 3 others Satomi Mitsuhashi, Norihiro Suzuki, Ichizo Nishino

Research output: Contribution to journalArticle

Abstract

Objective. Antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) have recently been associated with immune-mediated necrotizing myopathy, especially in patients with statin exposure. As the data are very limited concerning phenotypes and treatment in paediatric patients, we aimed to identify the paediatric patients positive for anti-HMGCR antibodies and clarify their features and therapeutic strategies. Methods. We screened 62 paediatric patients who were clinically and/or pathologically suspected to have inflammatory myopathy for anti-HMGCR antibodies. We further re-assessed the clinical and histological findings and the treatment of the patients positive for anti-HMGCR antibodies. Results. We identified nine paediatric patients with anti-HMGCR antibodies (15%). This was more frequent than anti-signal recognition particle antibodies (four patients, 6%) in our cohort. The onset age ranged from infancy to 13 years. Five patients were initially diagnosed with muscular dystrophy, including congenital muscular dystrophy. Most patients responded to high-dose corticosteroid therapy first but often needed adjuvant immunosuppressants to become stably controlled. Conclusion.Paediatric necrotizing myopathy associated with anti-HMGCR antibodies may not be very rare. Phenotypes are similar to those of adult patients, but a chronic slowly progressive course may be more frequent. Some patients share the clinicopathological features of muscular dystrophy indicating that recognizing inflammatory aetiology would be challenging without autoantibody information. On the other hand, most patients responded to treatment, especially those who were diagnosed early. Our results suggest the importance of early autoantibody testing in paediatric patients who have manifestations apparently compatible with muscular dystrophy in addition to those who have typical features of inflammatory myopathy.

Original languageEnglish
Pages (from-to)287-293
Number of pages7
JournalRheumatology (United Kingdom)
Volume56
Issue number2
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Muscular Diseases
Oxidoreductases
Pediatrics
Antibodies
Coenzyme A
Muscular Dystrophies
Myositis
3-hydroxy-3-methylglutaryl-coenzyme A
Autoantibodies
Signal Recognition Particle
Phenotype
Therapeutics
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Immunosuppressive Agents
Age of Onset
Adrenal Cortex Hormones

Keywords

  • 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR)
  • Immune-mediated necrotizing myopathy
  • Major histocompatibility complex (MHC)
  • Membrane attack complex (MAC)
  • Muscular dystrophy
  • Paediatrics

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)

Cite this

Liang, W. C., Uruha, A., Suzuki, S., Murakami, N., Takeshita, E., Chen, W. Z., ... Nishino, I. (2017). Pediatric necrotizing myopathy associated with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies. Rheumatology (United Kingdom), 56(2), 287-293. https://doi.org/10.1093/rheumatology/kew386

Pediatric necrotizing myopathy associated with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies. / Liang, Wen Chen; Uruha, Akinori; Suzuki, Shigeaki; Murakami, Nobuyuki; Takeshita, Eri; Chen, Wan Zi; Jong, Yuh Jyh; Endo, Yukari; Komaki, Hirofumi; Fujii, Tatsuya; Kawano, Yutaka; Mori-Yoshimura, Madoka; Oya, Yasushi; Xi, Jianying; Zhu, Wenhua; Zhao, Chongbo; Watanabe, Yurika; Ikemoto, Keisuke; Nishikawa, Atsuko; Hamanaka, Kohei; Mitsuhashi, Satomi; Suzuki, Norihiro; Nishino, Ichizo.

In: Rheumatology (United Kingdom), Vol. 56, No. 2, 01.01.2017, p. 287-293.

Research output: Contribution to journalArticle

Liang, WC, Uruha, A, Suzuki, S, Murakami, N, Takeshita, E, Chen, WZ, Jong, YJ, Endo, Y, Komaki, H, Fujii, T, Kawano, Y, Mori-Yoshimura, M, Oya, Y, Xi, J, Zhu, W, Zhao, C, Watanabe, Y, Ikemoto, K, Nishikawa, A, Hamanaka, K, Mitsuhashi, S, Suzuki, N & Nishino, I 2017, 'Pediatric necrotizing myopathy associated with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies', Rheumatology (United Kingdom), vol. 56, no. 2, pp. 287-293. https://doi.org/10.1093/rheumatology/kew386
Liang, Wen Chen ; Uruha, Akinori ; Suzuki, Shigeaki ; Murakami, Nobuyuki ; Takeshita, Eri ; Chen, Wan Zi ; Jong, Yuh Jyh ; Endo, Yukari ; Komaki, Hirofumi ; Fujii, Tatsuya ; Kawano, Yutaka ; Mori-Yoshimura, Madoka ; Oya, Yasushi ; Xi, Jianying ; Zhu, Wenhua ; Zhao, Chongbo ; Watanabe, Yurika ; Ikemoto, Keisuke ; Nishikawa, Atsuko ; Hamanaka, Kohei ; Mitsuhashi, Satomi ; Suzuki, Norihiro ; Nishino, Ichizo. / Pediatric necrotizing myopathy associated with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies. In: Rheumatology (United Kingdom). 2017 ; Vol. 56, No. 2. pp. 287-293.
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abstract = "Objective. Antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) have recently been associated with immune-mediated necrotizing myopathy, especially in patients with statin exposure. As the data are very limited concerning phenotypes and treatment in paediatric patients, we aimed to identify the paediatric patients positive for anti-HMGCR antibodies and clarify their features and therapeutic strategies. Methods. We screened 62 paediatric patients who were clinically and/or pathologically suspected to have inflammatory myopathy for anti-HMGCR antibodies. We further re-assessed the clinical and histological findings and the treatment of the patients positive for anti-HMGCR antibodies. Results. We identified nine paediatric patients with anti-HMGCR antibodies (15{\%}). This was more frequent than anti-signal recognition particle antibodies (four patients, 6{\%}) in our cohort. The onset age ranged from infancy to 13 years. Five patients were initially diagnosed with muscular dystrophy, including congenital muscular dystrophy. Most patients responded to high-dose corticosteroid therapy first but often needed adjuvant immunosuppressants to become stably controlled. Conclusion.Paediatric necrotizing myopathy associated with anti-HMGCR antibodies may not be very rare. Phenotypes are similar to those of adult patients, but a chronic slowly progressive course may be more frequent. Some patients share the clinicopathological features of muscular dystrophy indicating that recognizing inflammatory aetiology would be challenging without autoantibody information. On the other hand, most patients responded to treatment, especially those who were diagnosed early. Our results suggest the importance of early autoantibody testing in paediatric patients who have manifestations apparently compatible with muscular dystrophy in addition to those who have typical features of inflammatory myopathy.",
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AU - Liang, Wen Chen

AU - Uruha, Akinori

AU - Suzuki, Shigeaki

AU - Murakami, Nobuyuki

AU - Takeshita, Eri

AU - Chen, Wan Zi

AU - Jong, Yuh Jyh

AU - Endo, Yukari

AU - Komaki, Hirofumi

AU - Fujii, Tatsuya

AU - Kawano, Yutaka

AU - Mori-Yoshimura, Madoka

AU - Oya, Yasushi

AU - Xi, Jianying

AU - Zhu, Wenhua

AU - Zhao, Chongbo

AU - Watanabe, Yurika

AU - Ikemoto, Keisuke

AU - Nishikawa, Atsuko

AU - Hamanaka, Kohei

AU - Mitsuhashi, Satomi

AU - Suzuki, Norihiro

AU - Nishino, Ichizo

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N2 - Objective. Antibodies against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) have recently been associated with immune-mediated necrotizing myopathy, especially in patients with statin exposure. As the data are very limited concerning phenotypes and treatment in paediatric patients, we aimed to identify the paediatric patients positive for anti-HMGCR antibodies and clarify their features and therapeutic strategies. Methods. We screened 62 paediatric patients who were clinically and/or pathologically suspected to have inflammatory myopathy for anti-HMGCR antibodies. We further re-assessed the clinical and histological findings and the treatment of the patients positive for anti-HMGCR antibodies. Results. We identified nine paediatric patients with anti-HMGCR antibodies (15%). This was more frequent than anti-signal recognition particle antibodies (four patients, 6%) in our cohort. The onset age ranged from infancy to 13 years. Five patients were initially diagnosed with muscular dystrophy, including congenital muscular dystrophy. Most patients responded to high-dose corticosteroid therapy first but often needed adjuvant immunosuppressants to become stably controlled. Conclusion.Paediatric necrotizing myopathy associated with anti-HMGCR antibodies may not be very rare. Phenotypes are similar to those of adult patients, but a chronic slowly progressive course may be more frequent. Some patients share the clinicopathological features of muscular dystrophy indicating that recognizing inflammatory aetiology would be challenging without autoantibody information. On the other hand, most patients responded to treatment, especially those who were diagnosed early. Our results suggest the importance of early autoantibody testing in paediatric patients who have manifestations apparently compatible with muscular dystrophy in addition to those who have typical features of inflammatory myopathy.

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