myopathies Flashcards
breeds predisposed to PSSM1/2
PSSM1: Quarter, Morgan, Draft, Paint, Apalooza
PSSM2: Arabian, Morgan, Throurough, some Quarter
mutation associated with PSSM1 + breeds
GYS1
autosomal dominant
highest prevalence: European breeds derived from the Belgian draft (90%), North American Belgians and
Percherons (36% and 54%)
United Kingdom–derived breeds such as Irish drafts, Irish sport horses, and cobs
quarter horses, the prevalence of GYS1 mutation is 6% to 10% and in American paint and Appaloosa horses it is 6% to 8%
low prevalence in some warmblood breeds
highest frequency of
the mutation occurs in halter horses (28%) and the lowest frequency in barrel racing quarter horses (1.4%)
The prevalence of GYS1 mutation is very low to nonexistent in light horse breeds such as Arabians, Standardbreds, and thoroughbreds
CK in PSSM1/2
PSSM1: always abnormal
PSSM2: normal to moderately increased (except in Quarter: elevated)
Breed spredisposed to myofib myopathy
Arabian
Warmblood
Breeds with maligant hyperthermia
Quarter
Paint
Breed with recurent exercional rhabdo
Throughbreed
Standartbreed
Arabian
Quarter
selection of themuscle to biopsy
exertional/nonexertional myopathies, the gluteal or semimembranosus muscles (MYHM, a gluteal muscle biopsy is optimal)
horses with generalized weakness and muscle atrophy: sacrocaudalis dorsalis medialis muscle ( high proportion of oxidative type 1 fibers that are most frequently affected in equine motor neuron disease or vitamin E responsive myopathy)
stain + indications
Modified Gomori trichrome stain
mitochondrial abnormalities, inclusion bodies, and myelin integrity in nerve branches
stain + indication
Periodic acid–Schiff (PAS) stain is used to examine glycogen
stain + indications
Amylase-PAS is used to identify abnormal polysaccharides
stain + indication
Nicotinamide adenine dinucleotide tetrazolium reductase
(NADH-TR) is used to assess mitochondria and endoplasmic reticulum.
stain + indication
Oil-red-O is used to
identify the amount and distribution of lipid.
stain + indication
Myosin adenosine triphosphatase (ATPase)
stain at pH 4.6 is used to identify contractile fiber types, type 1, 2A, and 2X.
immuno histo for
C. Immunohistochemical stain for desmin
D. Immunohistochemical stain for mitochondrial succinate dehydrogenase demonstrating darker staining oxidative fibers and lighter staining low oxidative fibers.
systematic approch for muscle biopsy
assessment of muscle fiber sizes
fiber shapes
degeneration
inflammation
regeneration
presence of vacuoles, inclusions
staining for glycogen, lipid, desmin,
mitochondrial morphology
diff acute/chronic myodegeneration
Acute myodegeneration: pale, vacuolated fibers
Chronic myodegeneration: macrophage infiltration of
degenerating fibers.
myogenic vs neurogenic atrophy
Myogenic atrophy: anguloid atrophied fibers that have concavity on one or more sides
Neurogenic atrophy: angular atrophied fibers that are compressed into angular shapes
genetic mutation causing fasciculation
normal CK: HYPP
increase CK: Quarter MH, others PSSM1
mutation causing acute muscle atrophy
MYH1
Quarter, increased CK
mutation causing non-exercional rhabdomyolisis
MYH1, GBE foals
increased CK, Quarter and related
mutation causing exercional rhabdomyolisis
PSSM1
Quarter and related: PSSM1, RYR1
mutation associated with hyperkaliemic periodic paralysis, heritability
+ breeds
SCN4A (voltage-gated skeletal muscle sodium channel) codominant
Quarter, American paint, Appaloosas
y 1.5% of the quarter horse breed and 4.5% of the American paint horse breed are affected
halter horse performance group, where 56% of horses possess the HYPP mutation
Heavily muscled phenotype
Clinical signs of HYPP
normal CK
Twitching or delayed relaxation of muscles, prolapse of the third eyelid. Sweating and muscle fasciculations commonly occur in the flanks, neck, and shoulders.
+/- tachycardic and tachypneic, lateral recumbency, paralysis of upper respiratory muscles
Episodes usually last for 15 to 60 minutes.
no apparent abnormalities between episodes
paraclinics abnomalies in HYPP
During episodes of muscle fasciculations, most horses have hyperkalemia (6–9 mEq/L), hemoconcentration, and mild hyponatremia with normal acid-base balance.
Serum potassium concentration returns to normal quickly after the cessation of clinical signs. Some affected horses have normal serum potassium concentrations during minor episodes of muscle fasciculations.
Electromyographic examination of asymptomatic HYPP horses between episodes reveals abnormal fibrillation potentials, complex repetitive discharges, with occasional myotonic potentials and trains of doublets.
Endoscopic findings include pharyngeal collapse and
edema, laryngopalatal dislocation, and laryngeal paralysis.
diff heterozyg/homozyg HYPP
N/H horses from asymptomatic to daily episodic muscle fasciculations and weakness
Respiratory distress can occur in N/H and H/H
Foals homozygous for HYPP usually show clinical signs of disease in the first few days of life that include dysphagia, respiratory stridor, periodic obstruction of the upper respiratory tract
Adults that are H/H usually have more frequent and severe episodes of HYPP compared with N/H horses and
more severe signs of upper airway obstruction during an episode.Homozygous
affected horses also have a high-pitched whinny even between episodes.
precipitator episod HYPP
Feeds high in potassium, starving, anesthesia, heavy sedation, trailer rides (caleche), and stress
Exercise does not seem to induce clinical signs