Neuronal Intranuclear Hyaline Inclusion Disease Research Articles

The color of the iris in patients with neuronal intranuclear hyaline inclusion disease will change?

The color of the iris in patients with neuronal intranuclear hyaline inclusion disease will change?

PML Nuclear Bodies Are Altered in Adult-Onset Neuronal Intranuclear Hyaline Inclusion Disease.

Neuronal intranuclear hyaline inclusion disease (NIHID) is a neurodegenerative disorder characterized by the presence of eosinophilic nuclear inclusions (NIs) in diverse cell lines in systemic organs. Adult-onset NIHID typically manifests with dementia associated with leukoencephalopathy. The detection of NIs in skin biopsies is useful for an antemortem diagnosis. A previous analysis suggested that NIs in NIHID originated from nuclear bodies (NBs), an important nuclear domain related to the ubiquitin-p62-mediated protein degradation system. In this study, we analyzed skin samples from 5 NIHID and 5 control cases immunohistochemically and electron microscopically. In the control cases, small but significant amounts of ubiquitin- and p62-positive intranuclear structures were found. These structures were consistently colocalized with promyelocytic leukemia protein (PML), an essential component of NBs, in particular when activated. The p62- and PML-positive structures were more frequently found in NIHID cases. Activated NBs, having a core and a shell, were observed by electron microscopy in control but not in NIHID cases. Instead, immature and mature filamentous NIs were found only in the NIHID cases. Our results indicate that NBs could not be normally activated in the NIHID, and an abnormal alteration of NBs might be related to the pathogenesis of NIHID.

Adult-onset neuronal intranuclear hyaline inclusion disease is not rare in older adults.

Neuronal intranuclear hyaline inclusion disease (NIHID) is a rare neurodegenerative disorder pathologically characterized by localized neuronal loss, and the presence of eosinophilic intranuclear inclusions in neurons and glial cells. NIHID is a heterogeneous disease entity. It is divided into three clinical subgroups: infantile, juvenile and adult forms. Recently, reports of adult-onset cases have increased. Typical adult-onset NIHID consists of cognitive dysfunction with leukoencephalopathy. This type of adult-onset NIHID can be predicted by characteristic magnetic resonance images, high intensity areas on T2-weighted/fluid-attenuated inversion recovery images and persistent high intensity at the corticomedullary junction in diffusion-weighted images. When clinically suspected, the ante-mortem diagnosis can be made by biopsy. In adult-onset NIHID, nuclear inclusions are found more frequently in glial cells, and moderate to severe white matter degeneration is often associated. Although the underlying pathological mechanisms of NIHID are largely unknown, abnormal intranuclear accumulations of proteins and/or dysfunction of protein degradation systems might be related to the pathogenesis. To further clarify the characteristics of this disease entity, biological and pathological analysis of the patients is indispensable. As this disease entity becomes better known, diagnosed cases are expected to increase. Adult-onset NIHID might not be as extremely rare as previously thought.

Neuronal intranuclear hyaline inclusion disease (NIHID): an update

Neuronal intranuclear hyaline inclusion disease (NIHID) is a neurodegenerative disorder characterized by eosinophilic intranuclear inclusions in neuronal cells. Such inclusions are also found in non-neuronal cells. The clinical features and pathological findings in patients with NIHID are highly varied, and NIHID is therefore considered a heterogeneous disease entity. It can be categorized into three clinical subgroups based on disease onset and duration: the infantile, juvenile, and adult forms. The infantile and juvenile forms are generally associated with slowly progressive multiple-system degeneration. Recently, reports of patients with adult form NIHID have increased. Major symptoms in typical adult-onset cases are memory loss, cognitive dysfunction, and disorientation. Autonomic dysfunctions and peripheral neuropathy are also frequently observed. This type of adult-onset NIHID can be predicted by characteristic MRI findings-leukoencephalopathy with high intensity of the corticomedullary junction in diffusion-weighted imaging. Ante-mortem diagnosis of NIHID can be made by identification of intranuclear inclusions in skin or rectal biopsies. Intranuclear accumulation of abnormal proteins and/or dysfunction of protein degradation might underlie the pathogenesis of NIHID; however, the disease mechanisms remain largely unknown.

Neuronal intranuclear inclusion disease

Neuronal intranuclear inclusion disease (NIID), also known as neuronal intranuclear hyaline inclusion disease, is a rare neurodegenerative disorder with onset typically in childhood, although adult onset has been described. Both sporadic and familial occurrences have been reported.1,2 Presenting features of NIID are typically widespread, involving central, peripheral, and autonomic nervous systems, leading to the impression of multisystem degeneration.1 These features include parkinsonism, cerebellar ataxia, chorea, dystonia, gaze-evoked horizontal nystagmus, pyramidal tract signs, seizures, mental retardation, dementia, autonomic dysfunction, and peripheral neuropathy. Oculogyric crisis3 and early-onset l-dopa–induced dyskinesias4,5 may be a clue to diagnosis, especially if coexisting gastrointestinal dysfunction is present,2 with pseudoobstruction being relatively common. Clinical features observed in NIID are also typically observed in trinucleotide repeat disorders and therefore NIID should be even more strongly suspected after genetic testing has ruled out trinucleotide repeat disorders. Furthermore, …

Neuronal Intranuclear Hyaline Inclusion Disease With Rapidly Progressive Neurological Symptoms

This report describes a male patient who presented with symptoms suggestive of spinocerebellar degeneration and who died of respiratory failure at the age of 7 years but was diagnosed, at autopsy, as having neuronal intranuclear hyaline inclusion disease. Neuronal intranuclear hyaline inclusion disease is a progressive and degenerative disease; diagnosis is possible only by neuropathological analysis. This is a rare disorder; few cases with early childhood onset and rapidly progressive neurologic symptoms have been documented. According to previous reports, most neurons in the central nervous system exhibited intranuclear eosinophilic inclusion bodies; neuronal depletion appeared to be restricted to the cerebellar cortex and the medullary inferior olivary nuclei, consistent with the fact that clinical deficit appears to correspond to the site of neuronal depletion and not to where eosinophilic bodies are detected. Immunohistochemical analysis revealed that these inclusions were positive for ubiquitin. The case presented herein clearly indicates that neuronal intranuclear hyaline inclusion disease should be considered as a differential diagnosis of cases involving spinocerebellar degeneration with childhood onset.

Neuronal intranuclear hyaline inclusion disease showing motor-sensory and autonomic neuropathy

Neuronal intranuclear hyaline inclusion disease (NIHID), a rare neurodegenerative disease in which eosinophilic intranuclear inclusions develop mainly in neurons, has not yet been described to present as hereditary motor-sensory and autonomic neuropathy. Patients in two NIHID families showing peripheral neuropathy were evaluated clinically, electrophysiologically, and histopathologically. In both families, patients had severe muscle atrophy and weakness in limbs, limb girdle, and face; sensory impairment in the distal limbs; dysphagia, episodic intestinal pseudoobstruction with vomiting attacks; and urinary and fecal incontinence. No patients developed symptoms suggesting CNS involvement. Electrophysiologic study showed the reduced motor and sensory nerve conduction velocities and amplitudes, and also extensive denervation potentials. In sural nerve specimens, numbers of myelinated and unmyelinated fibers were decreased. In two autopsy cases, eosinophilic intranuclear inclusions were widespread, particularly in sympathetic and myenteric ganglion neurons, dorsal root ganglion neurons, and spinal motor neurons. These neurons also were decreased in number. Patients with neuronal intranuclear hyaline inclusion disease (NIHID) can manifest symptoms limited to those of peripheral neuropathy. NIHID therefore is part of the differential diagnosis of hereditary motor-sensory neuropathy associated with autonomic symptoms. Intranuclear hyaline inclusions in Schwann cells and in the myenteric plexus may permit antemortem diagnosis of NIHID.

Ferritinopathy: diagnosis by muscle or nerve biopsy, with a note on other nuclear inclusion body diseases

Ferritinopathy (neuroferritinopathy) has recently been identified as an autosomal dominant, multisystem disease, mainly affecting the central nervous system. It is caused by mutations in exon 4 of the ferritin light chain gene on chromosome 19. Its fine structural hallmarks are granular nuclear inclusions in neurons, oligodendroglial and microglial cells with similar extracellular derivatives in the central nervous system, muscle, peripheral nerve, and skin. These pathognostic structures have previously been described in perivascular cells of muscle and nerve biopsy specimens in a case with an obviously identical disease, formerly described as 'granular nuclear inclusion body disease'. The nuclear inclusions, at the light microscopic level, are iron positive following histochemical iron reactions and immunoreactive for ferritin antibodies. At the electron microscopic level, in contrast to filamentous nuclear inclusions in 'neuronal intranuclear hyaline inclusion disease', dominant spinocerebellar atrophies and other trinucleotide repeat diseases, they are basically composed of granules measuring 5-15 nm. A moderate peak of iron detectable by energy dispersive microanalysis of the granular nuclear inclusions in ferritinopathy may also be significant. It is emphasized that ferritinopathy or 'granular nuclear inclusion body disease' can be diagnosed by a simple muscle or nerve biopsy without brain biopsy, autopsy, or molecular genetic testing of the considerable number of neurodegenerative diseases with possibly similar symptomatology.

Neuronal intranuclear hyaline inclusion disease.

Neuronal intranuclear hyaline inclusion disease (NIHID) is a rare neurodegenerative disorder characterized pathologically by the presence of eosinophilic intranuclear inclusions in neuronal and glial cells. It has been considered to be a heterogeneous disease entity because the clinical pictures of previously described cases were highly variable. In the present review, reported NIHID cases have been categorized into three clinical subgroups according to onset and disease duration, and the clinical phenotype of each subgroup is discussed. Neuronal intranuclear inclusions (NII) in NIHID are ubiquitinated and their prevalence is inversely correlated with neuronal loss, suggesting that NII formation is a protective mechanism involving the ubiquitin-proteasome-dependent proteolytic pathway. In several polyglutamine diseases, disease-related proteins containing abnormally expanded polyglutamine tracts aggregate in neuronal nuclei, resulting in NII formation. The similarity between NII in NIHID and polyglutamine diseases suggests that they are formed during a common proteolysis-related process that takes place in the nucleus. Although the pathogenetic mechanism underlying NIHID remains unknown, the data reviewed here suggest that it might be related to accumulation of as yet unidentified abnormal proteins or dysfunction of the intranuclear ubiquitin-proteasome pathway.

Neuronal intranuclear hyaline inclusion disease with polyglutamine-immunoreactive inclusions

Neuronal intranuclear hyaline inclusion disease (NIHID) is a group of neurodegenerative disorders characterized by the presence of intranuclear inclusions in neurons (NIs). We report here clinicopathological findings of a 25-year-old female patient who died after 13 years of a clinical course characterized by progressive gait disturbance and movement disorders. Histological examination revealed widespread NIs with neuronal loss in restricted regions; neuronal loss was severe in the subthalamic nucleus, internal pallidum, substantia nigra, Edinger-Westphal nucleus and Purkinje cell layer. Quantification of the NIs combined with a graded evaluation of neuronal loss revealed an overall tendency for more severe neuronal loss to be accompanied by a lower frequency of NIs. A morphological similarity to the nuclear inclusions recently identified in several CAG repeat diseases prompted us to examine the immunolocalization of ubiquitin and expanded polyglutamine stretches, which demonstrated the presence of ubiquitin at the periphery of most NIs. An expanded polyglutamine stretch was seen in the center of limited number of NIs. These findings indicate that abnormal fragments such as expanded polyglutamine regions are incorporated into the inclusion, aggregated in its center, and thereby metabolized by a ubiquitin-dependent proteolytic pathway. Although it remains to be elucidated how the formation of NIs is related to neuronal degeneration, our findings suggest that NIs are formed in the process of sequestering or degrading abnormal protein fragments and formation of NIs may not be immediately toxic to neurons.

Are neuronal intranuclear inclusions the common neuropathology of triplet-repeat disorders with polyglutamine-repeat expansions?

Neuronal intranuclear inclusions have been found in the brain of a transgenic mouse model of Huntington's disease and in necropsy brain tissue of patients with Huntington's disease. We suggest that neuronal intranuclear inclusions are the common neuropathology for all inherited diseases caused by expansion of polyglutamine repeats. We also suggest that patients with a pathological diagnosis of neuronal intranuclear hyaline inclusion disease may also have polyglutamine repeat expansions.

Neuronal intranuclear hyaline inclusion disease with progressive cerebellar ataxia

Neuronal intranuclear hyaline inclusion disease is a progressive, fatal neurologic condition characterized by eosinophilic inclusions in neurons of the central, autonomic, and peripheral nervous systems. The clinical and pathologic findings of a 4-year-old boy who presented with a rapidly progressive cerebellar ataxia and seizure disorder that had begun 2 years earlier are described. Although intraneuronal inclusions were identified in neurons of cortex, basal ganglia, brainstem, cerebellum, and spinal cord, clinical signs were restricted to cerebellar ataxia, internuclear ophthalmoplegia, and cognitive delay. Predominant cerebellar atrophy, early age of onset, and short clinical course distinguishes it from previously reported patients.

Pupillary and Electroretinographic Abnormalities in a Family With Neuronal Intranuclear Hyaline Inclusion Disease

Abnormal pupillary function and a severely depressed electroretinogram were found in four members of a family with neuronal intranuclear hyaline inclusion disease, an idiopathic degenerative disorder that involves the central and peripheral nervous systems. Symptoms were limited to the gastrointestinal system and consisted principally of abdominal pain, constipation, and severe weight loss. The discovery of light-fixed pupils in the propositus led to the first antemortem diagnosis by rectal biopsy in two generations of this family. Abnormalities of gastrointestinal motility and pupillary reactions constituted the only objective evidence of autonomic dysfunction; the abnormal electroretinogram was the only evidence of central nervous system dysfunction.

Clinicopathological Studies of Some Non-Alzheimer Dementing Diseases

The brains of most demented patients show at autopsy the lesions of Alzheimer's disease (AD). However, the brains of other demented patients show either no morphological changes or lesions distinct from those of AD. We report clinicopathological studies on two diseases in this latter group. The study of these diseases can improve our understanding of AD. Pick's disease is characterized by dementia, lobar cerebral atrophy, and neuronal cytoplasmic inclusions. Most cases, which we have called "classical", show inclusions made up of straight fibrils that are immunologically cross-reactive with the paired helical filaments of AD. In other "generalized" cases, similar fibrils are coated by granular material and are less reactive with anticytoskeletal antibodies. In contrast to the cytoplasmic localization of the lesions in Pick's disease, it is the cell nucleus that shows abnormalities in neuronal intranuclear hyaline inclusion disease. This disease can present clinically as dementia of adult onset. Thus, either nuclear or cytoplasmic lesions can produce a pattern of neuronal dysfunction resulting in dementia.

Autonomic neurons of the sacral spinal cord in amyotrophic lateral sclerosis, anterior poliomyelitis and "neuronal intranuclear hyaline inclusion disease": distribution of sacral autonomic neurons.

Further evidence is presented that the Onuf's nucleus (or "colonne en torsade" of Laruelle) and the intermediolateral nucleus of the sacral cord share common selective vulnerability with the thoracolumbar intermediolateral nucleus in ALS, anterior poliomyelitis and "neuronal intranuclear hyaline inclusion disease". Sparing of the sacral nuclei in the motor neuron diseases and neuronal loss of the nuclei in the multisystem atrophy are correlated well with normal and disturbed vesicorectal function. The clinicopathological evidence strongly supports the view that the Onuf's nucleus represents autonomic neurons much as the intermediolateral nucleus.

Spinal autonomic neurons in Werdnig-Hoffmann disease, mannosidosis, and Hurler's syndrome: distribution of autonomic neurons in the sacral spinal cord.

In Werdnig-Hoffman disease, mannosidosis, and Hurler's syndrome, two groups of neurons (the Onuf's and intermediomedial nuclei) in the ventral horn of the mid-sacral region are found to share common selective sparing or vulnerability with the intermediolateral nuclei of the thoracolumbar and sacral regions of the spinal cord. This finding confirms the previous observations on the characteristic involvement or sparing in Fabry's disease (14), Shy-Drager syndrome (17), amyotrophic lateral sclerosis, anterior poliomyelitis, and neuronal intranuclear hyaline inclusion disease (15), and supports the assumption that the Onuf's and intermediomedial nuclei in the ventral horn represent autonomic neurons much as the thoracolumbar and sacral intermediolateral nuclei.