2. Academic Validation
  3. Alanine transaminase is predominantly increased in the active phase of anti-HMGCR myopathy

Alanine transaminase is predominantly increased in the active phase of anti-HMGCR myopathy

  • Neuromuscul Disord. 2022 Jan;32(1):25-32. doi: 10.1016/j.nmd.2021.10.007.
Akatsuki Kubota 1,  Jun Shimizu 2,  Atsushi Unuma 3,  Meiko Maeda 4,  Yuichiro Shirota 4,  Masato Kadoya 5,  Naohiro Uchio 6,  Yoshio Sakiyama 7,  Noritoshi Arai 8,  Yasushi Shiio 9,  Yoshikazu Uesaka 10,  Hideji Hashida 11,  Nobue K Iwata 12,  Jun Goto 12,  Ran Nakashima 13,  Tsuneyo Mimori 14,  Tatsushi Toda 4
Affiliations

Affiliations

  • 1 Department of Neurology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Electronic address: akatsuki-tky@umin.net.
  • 2 Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Physical Therapy, Tokyo University of Technology, 5-25-8, Nishi-kamata, Ohta-ku, Tokyo 144-0051, Japan.
  • 3 Department of Neurology, National Center of Neurology and Psychiatry, National Center Hospital, , 4-1-1, Ogawa-higashimachi, Kodaira-shi, Tokyo 187-8551, Japan.
  • 4 Department of Neurology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
  • 5 Department of Neurology and Anti-aging Medicine, National Defense Medical College, 3-2, Namiki, Tokorozawa-shi, Saitama 359-8513, Japan.
  • 6 Department of Neurology, Mitsui Memorial Hospital, 1 Kanda-izumicho, Chiyoda-ku, Tokyo 101-8643, Japan.
  • 7 Department of Neurology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Ohmiya-ku, Saitama-shi, Saitama 330-0834, Japan.
  • 8 Department of Neurology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
  • 9 Department of Neurology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, Tokyo 102-0071, Japan.
  • 10 Department of Neurology, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo 105-8470, Japan.
  • 11 Department of Neurology, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
  • 12 Department of Neurology, International University of Health and Welfare Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo 108-8329, Japan.
  • 13 Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Yoshida-konoecho, Sakyo-ku, Kyoto-shi, Kyoto 606-8303, Japan.
  • 14 Ijinkai Takeda General Hospital, Ishidamoriminamicho, Fushimi-ku, Kyoto-shi, Kyoto 601-1495, Japan.
PMID: 34916121 DOI: 10.1016/j.nmd.2021.10.007
Abstract

Autoantibodies against 3‑hydroxy-3-methylglutaryl-CoA reductase (HMGCR) and the signal recognition particle (SRP) are representative Antibodies causing immune-mediated necrotizing myopathies (IMNM), called as anti-HMGCR and anti-SRP myopathies, respectively. Here, we analyzed the differences in routine blood test results between 56 anti-HMGCR and 77 anti-SRP myopathy patients. A higher alanine transaminase (ALT) level and a lower aspartate transaminase (AST)/ALT ratio were observed in anti-HMGCR myopathy patients [ALT, 265.7 ± 213.3 U/L (mean ± standard deviation); AST/ALT ratio, 0.88 ± 0.32] than in anti-SRP-myopathy patients (ALT, 179.3 ± 111.2 U/L, p < 0.05; AST/ALT ratio, 1.28 ± 0.40, p < 0.01). In the active phase, anti-HMGCR myopathy often showed ALT predominance, whereas anti-SRP myopathy often showed AST predominance. In addition, there were differences in erythrocyte sedimentation rate (ESR), total Cholesterol (TChol) level, and high-density lipoprotein (HDL) level between anti-HMGCR and anti-SRP myopathies (ESR: HMGCR, 24.4 ± 20.8 mm/1 h; SRP, 35.7 ± 26.7 mm/1 h, p = 0.0334; TChol: HMGCR, 226.7 ± 36.6 mg/dL; SRP, 207.6 ± 40.8 mg/dL, p = 0.0163; HDL: HMGCR, 58.4 ± 13.9 mg/dL; SRP, 46.2 ± 17.3 mg/dL, p < 0.01). Additional studies on the differences in routine blood test results may further reveal the pathomechanisms of IMNM.

Keywords

AST/ALT ratio; Anti-HMGCR antibody; Anti-SRP antibody; Cholesterol; Immune-mediated necrotizing myopathy.

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