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. 1980 Oct;101(1):159–176.

Polymyositis-dermatomyositis: diagnostic and prognostic significance of muscle alkaline phosphatase.

D Cros, C Pearson, M A Verity
PMCID: PMC1903575  PMID: 7446698

Abstract

The distribution and intensity of alkaline phosphatase deposition in 54 patients with dermatomyositis-polymyositis (PM-DM) was analyzed by the enzyme histochemical method. Increased enzyme reactivity of endomysial capillaries was found in 28% of patients, equally distributed between adult onset PM (Group I) and PM-DM with overlap in other connective tissue diseases (Group V). Patients with high endomysial capillary reactivity (R1 larger than or equal to 60) responded poorly to steroids, had an increased incidence of rheumatoid factor, and had less fiber degeneration/necrosis in their biopsies. Twenty-two percent of patients demonstrated prominent perimysial phosphatase reactivity localized in newly formed collagen and fibroblasts. Thirty patients (55%) demonstrated significant numbers of alkaline-phosphatase-positive fibers positively correlated with increased fiber degeneration/necrosis, endomysial fibrosis, increased numbers of triglyceride-containing muscle fibers, and NADH tetrazolium reductase hyperreactivity. Minimal overlap between the three enzyme distribution patterns was found. Endomysial capillary activity probably represents endothelial alkaline phosphatase induction analogous to the pattern seen normally in lower mammals (rat, rabbit, guinea pig). Alkaline phosphatase fiber reactivity probably represents a particular phase in fiber regeneration/maturation especially after denervation and is positively correlated with an increased incidence of spontaneous fibrillation potentials in PM-DM.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ashmore C. R., Doerr L., Somes R. G., Jr Microcirculation: loss of an enzyme activity in chickens with hereditary muscular dystrophy. Science. 1968 Apr 19;160(3825):319–320. doi: 10.1126/science.160.3825.319. [DOI] [PubMed] [Google Scholar]
  2. Banker B. Q. Dermatomyostis of childhood, ultrastructural alteratious of muscle and intramuscular blood vessels. J Neuropathol Exp Neurol. 1975 Jan;34(1):46–75. doi: 10.1097/00005072-197501000-00005. [DOI] [PubMed] [Google Scholar]
  3. Banker B. Q., Victor M. Dermatomyositis (systemic angiopathy) of childhood. Medicine (Baltimore) 1966 Jul;45(4):261–289. doi: 10.1097/00005792-196607000-00001. [DOI] [PubMed] [Google Scholar]
  4. Benítez-Bribiesca L., De la Vega G. Occurrence of alkaline phosphatase-containing muscle fibers after denervation. J Histochem Cytochem. 1971 Nov;19(11):691–692. doi: 10.1177/19.11.691. [DOI] [PubMed] [Google Scholar]
  5. Bohan A., Peter J. B., Bowman R. L., Pearson C. M. Computer-assisted analysis of 153 patients with polymyositis and dermatomyositis. Medicine (Baltimore) 1977 Jul;56(4):255–286. doi: 10.1097/00005792-197707000-00001. [DOI] [PubMed] [Google Scholar]
  6. Bohan A., Peter J. B. Polymyositis and dermatomyositis (second of two parts). N Engl J Med. 1975 Feb 20;292(8):403–407. doi: 10.1056/NEJM197502202920807. [DOI] [PubMed] [Google Scholar]
  7. Brooke M. H., Kaiser K. K. Muscle fiber types: how many and what kind? Arch Neurol. 1970 Oct;23(4):369–379. doi: 10.1001/archneur.1970.00480280083010. [DOI] [PubMed] [Google Scholar]
  8. Carpenter S., Karpati G., Rothman S., Watters G. The childhood type of dermatomyositis. Neurology. 1976 Oct;26(10):952–962. doi: 10.1212/wnl.26.10.952. [DOI] [PubMed] [Google Scholar]
  9. Desmedt J. E., Borenstein S. Relationship of spontaneous fibrillation potentials to muscle fibre segmentation in human muscular dystrophy. Nature. 1975 Dec 11;258(5535):531–534. doi: 10.1038/258531a0. [DOI] [PubMed] [Google Scholar]
  10. DiMauro S., Arnold S., Miranda A., Rowland L. P. McArdle disease: the mystery of reappearing phosphorylase activity in muscle culture--a fetal isoenzyme. Ann Neurol. 1978 Jan;3(1):60–66. doi: 10.1002/ana.410030109. [DOI] [PubMed] [Google Scholar]
  11. Engel W. K., Cunningham G. G. Alkaline phosphatase-positive abnormal muscle fibers of humans. J Histochem Cytochem. 1970 Jan;18(1):55–57. doi: 10.1177/18.1.55. [DOI] [PubMed] [Google Scholar]
  12. GOLD N. I., GOULD B. S. Collagen fiber formation and alkaline phosphatase. Arch Biochem Biophys. 1951 Aug;33(1):155–164. doi: 10.1016/0003-9861(51)90089-6. [DOI] [PubMed] [Google Scholar]
  13. GOULD B. S., GOLD N. I. Studies on the alkaline phosphatase associated with regenerating connective tissue fibers. AMA Arch Pathol. 1951 Nov;52(5):413–422. [PubMed] [Google Scholar]
  14. González-Angulo A., Fraga A., Mintz G. Submicroscopic alterations in capillaries of skeletal muscles in polymyositis. Am J Med. 1968 Dec;45(6):873–879. doi: 10.1016/0002-9343(68)90185-x. [DOI] [PubMed] [Google Scholar]
  15. Henriksson K. G., Stålberg E. The terminal innervation pattern in polymyositis: a histochemical and SFEMG study. Muscle Nerve. 1978 Jan-Feb;1(1):3–13. doi: 10.1002/mus.880010103. [DOI] [PubMed] [Google Scholar]
  16. Jerusalem F., Rakusa M., Engel A. G., MacDonald R. D. Morphometric analysis of skeletal muscle capillary ultrastructure in inflammatory myopathies. J Neurol Sci. 1974 Nov;23(3):391–402. doi: 10.1016/0022-510x(74)90157-9. [DOI] [PubMed] [Google Scholar]
  17. Johansson B. R. Permeability of muscle capillaries to interstitially microinjected horseradish peroxidase. Microvasc Res. 1978 Nov;16(3):340–353. doi: 10.1016/0026-2862(78)90067-5. [DOI] [PubMed] [Google Scholar]
  18. Kar N. C., Pearson C. M. Alkaline phosphatase in normal and diseased human muscle. Proc Soc Exp Biol Med. 1972 Oct;141(1):4–6. doi: 10.3181/00379727-141-36704. [DOI] [PubMed] [Google Scholar]
  19. Karpati G., Carpenter S., Melmed C., Eisen A. A. Experimental ischemic myopathy. J Neurol Sci. 1974 Sep;23(1):129–161. doi: 10.1016/0022-510x(74)90148-8. [DOI] [PubMed] [Google Scholar]
  20. Malhotra R. K., Dhingra S., Katoch S. S. Alkaline phosphatase activity in normal and denervated skeletal muscle. Experientia. 1978 Sep 15;34(9):1206–1209. doi: 10.1007/BF01922960. [DOI] [PubMed] [Google Scholar]
  21. Metzger A. L., Bohan A., Goldberg L. S., Bluestone R., Pearson C. M. Polymyositis and dermatomyositis: combined methotrexate and corticosteroid therapy. Ann Intern Med. 1974 Aug;81(2):182–189. doi: 10.7326/0003-4819-81-2-182. [DOI] [PubMed] [Google Scholar]
  22. Mitsumoto H. McArdle disease: phosphorylase activity in regenerating muscle fibers. Neurology. 1979 Feb;29(2):258–262. doi: 10.1212/wnl.29.2.258. [DOI] [PubMed] [Google Scholar]
  23. Myrhage R., Hudlická O. Capillary growth in chronically stimulated adult skeletal muscle as studied by intravital microscopy and histological methods in rabbits and rats. Microvasc Res. 1978 Jul;16(1):73–90. doi: 10.1016/0026-2862(78)90046-8. [DOI] [PubMed] [Google Scholar]
  24. Norton W. L. Comparison of the microangiopathy of systemic lupus erythematosus, dermatomyositis, scleroderma, and diabetes mellitus. Lab Invest. 1970 Apr;22(4):301–308. [PubMed] [Google Scholar]
  25. Paulson O. B., Engel A. G., Gomez M. R. Muscle blood flow in Duchenne type muscular dystrophy, limb-girdle dystrophy, polymyositis, and in normal controls. J Neurol Neurosurg Psychiatry. 1974 Jun;37(6):685–690. doi: 10.1136/jnnp.37.6.685. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. ROBERTSON W. van B., DUNIHUE F. W., NOVIKOFF A. B. The metabolism of connective tissue: absence of alkaline phosphatase in collagen fibers during formation. Br J Exp Pathol. 1950 Aug;31(4):545–549. [PMC free article] [PubMed] [Google Scholar]
  27. ROMANUL F. C., BANNISTER R. G. Localized areas of high alkaline phosphatase activity in endothelium of arteries. Nature. 1962 Aug 11;195:611–612. doi: 10.1038/195611a0. [DOI] [PubMed] [Google Scholar]
  28. ROMANUL F. C. CAPILLARY SUPPLY AND METABOLISM OF MUSCLE FIBERS. Arch Neurol. 1965 May;12:497–509. doi: 10.1001/archneur.1965.00460290053007. [DOI] [PubMed] [Google Scholar]
  29. ROPES M. W., BENNETT G. A., COBB S., JACOX R., JESSAR R. A. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis. 1958 Dec;9(4):175–176. [PubMed] [Google Scholar]
  30. Roelofs R. I., Engel W. K., Chauvin P. B. Histochemical phosphorylase activity in regenerating muscle fibers from myophosphorylase-deficient patients. Science. 1972 Sep 1;177(4051):795–797. doi: 10.1126/science.177.4051.795. [DOI] [PubMed] [Google Scholar]
  31. Shafiq S. A., Milhorat A. T., Gorycki M. A. An electron-microscope study of muscle degeneration and vascular changes in polymyositis. J Pathol Bacteriol. 1967 Jul;94(1):139–147. doi: 10.1002/path.1700940118. [DOI] [PubMed] [Google Scholar]
  32. Sokoloff M. C., Goldberg L. S., Pearson C. M. Treatment of corticosteroid-resistant polymyositis with methotrexate. Lancet. 1971 Jan 2;1(7688):14–16. doi: 10.1016/s0140-6736(71)80005-3. [DOI] [PubMed] [Google Scholar]
  33. Streib E. W., Wilbourn A. J., Mitsumoto H. Spontaneous electrical muscle fiber activity in polymyositis and dermatomyositis. Muscle Nerve. 1979 Jan-Feb;2(1):14–18. doi: 10.1002/mus.880020103. [DOI] [PubMed] [Google Scholar]

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