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Immune-mediated necrotizing myopathy (IMNM), also known as necrotizing autoimmune myopathy, is a histologic entity characterized by marked necrosis in the absence of prominent lymphocytes.1 Risk factors or triggers for IMNM include statin treatment, cancer, and connective tissue disease (CTD).1,2 Although autoantibodies against signal recognition particle (SRP) or 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) are regarded as markers for IMNM, they are not always detected in sera of pathologically defined patients with IMNM. The autoimmune mechanisms of IMNM are not elucidated.
Acknowledgments
Acknowledgment: The authors thank all the physicians who provided muscle biopsy and serum samples and detailed clinical information; and Kaoru Tatezawa and Kazu Iwasawa (Department of Neuromuscular Research, National Institute of Neuroscience, and Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry) for their technical support.
Footnotes
Supplemental data at Neurology.org
Study funding: Supported by 2015 Tokai University School of Medicine Research Aid, Japanese Ministry of Education, Science, Sports and Culture (no. 26461298), Japanese Ministry of Education, Science, Sports and Culture and Grant-in-Aid for Scientific Research from MEXT (No. 24390227) and Intramural Research Grant (26-8) for Neurological and Psychiatric Disorders of NCNP.
Disclosure: Y. Ohnuki reports a grant from 2015 Tokai University School of Medicine Research Aid. Shigeaki Suzuki reports grants from Japanese Ministry of Education, Science, Sports and Culture (no. 26461298) and Health and Labour Sciences Research Grant on Rare and Intractable Diseases (Evidence-based Early Diagnosis and Treatment Strategies for Neuroimmunological Diseases) from the Ministry of Health, Labour and Welfare of Japan. T. Shiina, A. Uruha, Y. Watanabe, Shingo Suzuki, S. Izumi, J. Nakahara, K. Hamanaka, K. Takayama, and N. Suzuki report no disclosures relevant to the manuscript. I. Nishino reports a grant from Grant-in-Aid for Scientific Research from MEXT (No. 24390227). Go to Neurology.org for full disclosures.
- Received April 13, 2016.
- Accepted in final form July 18, 2016.
- © 2016 American Academy of Neurology
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