Immune-mediated necrotizing myopathy with pembrolizumab: a specific neuromuscular entity

Trenque, Thierry; Lepoix, Elise; Trenque, Agathe; Morel, Aurore; Azzouz, Brahim

doi:10.1007/s00228-021-03273-z

Cited by 5 publications

(1 citation statement)

References 15 publications

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“…Currently, two principle categories of IMNM, anti-signal recognition particle (SRP) autoantibodies-IMNM (SRP-IMNM) and anti-3-hydroxy-3-methylglutaryl-coa reductase (HMGCR) autoantibodies-IMNM (HMGCR-IMNM) ( 5 , 6 ), account for the largest proportion of IMNM and are relatively the most described. Other subtypes, including seronegative IMNM, connective tissue disease-related IMNM, statin-related IMNM, cancer-related IMNM, and immune checkpoint inhibitors-induced IMNM are also reported ( 7 – 12 ). The detection of serum anti-SRP autoantibodies in IIM is much earlier than that of anti-HMGCR autoantibodies.…”

Section: Introductionmentioning

confidence: 99%

Anti-SRP immune-mediated necrotizing myopathy: A critical review of current concepts

2022

Front. Immunol.

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Purpose of reviewThis review aims to describe clinical and histological features, treatment, and prognosis in patients with anti-signal recognition particle (SRP) autoantibodies positive immune-mediated necrotizing myopathy (SRP-IMNM) based on previous findings.Previous findingsAnti-SRP autoantibodies are specific in IMNM. Humoral autoimmune and inflammatory responses are the main autoimmune characteristics of SRP-IMNM. SRP-IMNM is clinically characterized by acute or subacute, moderately severe, symmetrical proximal weakness. Younger patients with SRP-IMNM tend to have more severe clinical symptoms. Patients with SRP-IMNM may be vulnerable to cardiac involvement, which ought to be regularly monitored and cardiac magnetic resonance imaging is the recommended detection method. The pathological features of SRP-IMNM are patchy or diffuse myonecrosis and myoregeneration accompanied by a paucity of inflammatory infiltrates. Endoplasmic reticulum stress-induced autophagy pathway and necroptosis are activated in skeletal muscle of SRP-IMNM. Treatment of refractory SRP-IMNM encounters resistance and warrants further investigation.SummaryAnti-SRP autoantibodies define a unique population of IMNM patients. The immune and non-immune pathophysiological mechanisms are involved in SRP-IMNM.

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