title: Histopathological changes in skeletal muscle associated with chronic ischaemia.
abstract: Muscle biopsy is an essential part in the diagnostic workup in patients with suspected neuromuscular disorders. It is therefore important to be aware of morphological alterations that can be caused by systemic factors or natural ageing. Chronic limb ischaemia is frequent in elderly individuals. This study was performed to examine histopathological and mitochondrial changes in muscle in patients with chronic critical limb ischaemia. Muscle biopsy of skeletal muscle of the lower limb of patients with chronic ischaemia leading to amputation was performed and compared with muscle biopsies of healthy, age-matched controls. The histopathological abnormalities included fibrosis, necrosis, atrophy, glycogen depletion, internal nuclei, rimmed vacuoles, fibre type grouping, cytochrome c oxidase deficient fibres, MHC-I upregulation, and signs of microangiopathy. The only alteration found in age-matched controls was a few cytochrome c oxidase deficient fibres. There were also increased levels of multiple mitochondrial DNA deletions in ischaemic muscles compared with controls. Critical limb ischaemia is associated with significant histopathological changes in muscle tissue and also increased levels of mitochondrial DNA deletions. Since the alterations mimic different primary myopathic changes, chronic ischaemia is important to consider as a differential diagnosis in elderly individuals, investigated with muscle biopsy for muscle disease.
authors.affiliation: Department of Pathology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. sara.roos@gu.se.
authors.forename: Sara
authors.initials: S
authors.lastname: Roos
authors.affiliation: Department of Pathology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ing-Marie
authors.initials: IM
authors.lastname: Fyhr
authors.affiliation: Department of Rehabilitation Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Katharina S
authors.initials: KS
authors.lastname: Sunnerhagen
authors.affiliation: Department of Pathology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ali-Reza
authors.initials: AR
authors.lastname: Moslemi
authors.affiliation: Department of Pathology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Oldfors
authors.affiliation: Department of Orthopaedics, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Ullman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002908:Chronic Disease; D004272:DNA, Mitochondrial / Q000235:genetics; D005260:Female; D017353:Gene Deletion; D006651:Histocytochemistry; D006801:Humans; D007511:Ischemia / Q000473:pathology*; D035002:Lower Extremity / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008928:Mitochondria / Q000473:pathology; D018482:Muscle, Skeletal / Q000473:pathology*
chemical_list: D004272:DNA, Mitochondrial
keywords: Chronic ischaemia; lower limb; mitochondrial DNA; morphology