Sarcoplasmic Myxovirus Resistance Protein A: A Study of Expression in Idiopathic Inflammatory Myopathy

Abstract

Jariya Waisayarat,1 Phumin Wongsuwan,1 Kiarttiyot Tuntiseranee,2 Phu Waisayarat,3 Charungthai Dejthevaporn,4 Chaiyos Khongkhatithum,5 Sirisucha Soponkanaporn6 1Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand; 3Faculty of Medicine, King Mongkut’s Institute of Technology Ladkrabang, Bangkok, Thailand; 4Division of Neurology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5Division of Neurology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 6Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Jariya Waisayarat, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand, Email [email protected]: Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases affecting primarily proximal muscles. Major subtypes include dermatomyositis, polymyositis, inclusion body myositis, immune-mediated necrotizing myopathy and antisynthetase syndrome. Overexpression of sarcoplasmic myxovirus-resistance protein A (MxA) has been observed in muscle biopsy specimens of dermatomyositis but is rarely seen in other subtypes of IIM and other myopathies.Objective: We evaluate the expression of sarcoplasmic MxA and its diagnostic value in IIM and other myopathies.Methods: One hundred and thirty-eight muscle biopsy specimens with the diagnosis of IIM and other myopathies from 2011 to 2020 were reviewed and stained for MxA by immunohistochemistry. The difference of the expression of MxA between IIM and other myopathies was analyzed by Fisher’s exact test, and the sensitivity and specificity of MxA immunohistochemistry in the diagnosis of IIM were assessed.Results: MxA protein was positive in 16/138 (11.6%) specimens. All 12 dermatomyositis specimens positive for MxA protein were positive in perifascicular area pattern. Only dermatomyositis specimens had a significantly higher percentage of positive sarcoplasmic MxA expression than specimens of other subtypes of IIM (p< 0.001). Sarcoplasmic MxA expression for dermatomyositis diagnosis had a sensitivity of 46.15% (95% CI 26.59– 66.63%) and a specificity of 94.44% (95% CI 81.34– 99.32%) with the positive and negative likelihood ratio of 8.31 (95% CI 2.03– 34.01) and 0.57 (95% CI 0.40– 0.82), respectively.Conclusion: The MxA immunohistochemistry is highly specific for dermatomyositis and should be added to a routine inflammatory panel of muscle biopsy. MxA expression should be cautiously interpreted to avoid pitfalls.Keywords: dermatomyositis, idiopathic inflammatory myopathies, muscle biopsy, myxovirus resistance protein A

Keywords

• dermatomyositis
• idiopathic inflammatory myopathies
• muscle biopsy
• myxovirus resistance protein a