Abnormal increases of lysosomal cysteinine proteinases in rimmed vacuoles in the skeletal muscle.

Skeletal muscle obtained from a patient with distal myopathy with rimmed vacuole formation (DMRV) was examined by a new direct labeled antibody enzyme method of immunohistochemistry. Abnormal increases of cathepsins B and H, capable of degrading the myofibrillar proteins, were demonstrated to be localized at the site of vacuoles and other intramyofibral portions and not to be associated with concomitant increases of their endogenous inhibitors. Autodigestion by these intramyofibral lysosomal proteinases may be of major importance in focal destruction of myofibers and formation of vacuoles, because no myofiber necrosis with invasion of macrophages, overt myositis, and neuropathy was seen in the muscle. These findings provide the first reasonable explanation of myofibral breakdown and atrophy in DMRV, and should be helpful in further studies on the mechanism of myofibral breakdown in various vacuolar myopathies and other myopathies of so far unknown pathogenesis.