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Four female Shetland Sheepdogs with hypertonic paroxysmal dyskinesia, mainly triggered by exercise and stress, were investigated in a retrospective multi-center investigation aiming to characterize the clinical phenotype and its underlying molecular etiology. Three dogs were closely related and their pedigree suggested autosomal dominant inheritance. Laboratory diagnostic findings included mild lactic acidosis and lactaturia, mild intermittent serum creatine kinase (CK) elevation and hypoglycemia. Electrophysiological tests and magnetic resonance imaging of the brain were unremarkable. A muscle/nerve biopsy revealed a mild type II fiber predominant muscle atrophy. While treatment with phenobarbital, diazepam or levetiracetam did not alter the clinical course, treatment with a gluten-free, home-made fresh meat diet in three dogs or a tryptophan-rich, gluten-free, seafood-based diet, stress-reduction, and acetazolamide or zonisamide in the fourth dog correlated with a partial reduction in, or even a complete absence of, dystonic episodes. The genomes of two cases were sequenced and compared to 654 control genomes. The analysis revealed a case-specific missense variant, c.1658G>A or p.Arg553Gln, in the PCK2 gene encoding the mitochondrial phosphoenolpyruvate carboxykinase 2. Sanger sequencing confirmed that all four cases carried the mutant allele in a heterozygous state. The mutant allele was not found in 117 Shetland Sheepdog controls and more than 500 additionally genotyped dogs from various other breeds. The p.Arg553Gln substitution affects a highly conserved residue in close proximity to the GTP-binding site of PCK2. Taken together, we describe a new form of paroxysmal exercise-induced dyskinesia (PED) in dogs. The genetic findings suggest that PCK2:p.Arg553Gln should be further investigated as putative candidate causal variant.

OBJECTIVE Exercise induced metabolic myopathy in German Hunting Terrier dogs is an autosomal-recessively inherited disorder, caused by a nonsense variant of the gene encoding for the very long-chain acyl-CoA-dehydrogenase (VLCAD) enzyme. Clinical signs include exercise- induced fatigue, muscle pain and weakness. In the present study, the long-term course of this disease was investigated over a period of 1 year in 9 affected German Hunting Terriers. The dogs were treated symptomatically with oral L-carnitine, coenzyme Q10 and a special diet characterized by a low content of long-chain fatty acids and a high proportion of carbohydrates. MATERIAL AND METHODS In 9 affected dogs, the phenotype as well as clinical, laboratory parameters, and histopathological findings are described (time point 1) and compared to follow-up examinations 1 year later (time point 2). At both time points clinical and neurological examinations, complete blood cell count, clinical chemistry profile and the concentration of brain natriuretic peptide (NT-proBNP) were investigated. RESULTS In the follow-up examinations, the same post-exercise clinical signs were present as in the initial presentation of the homozygous dogs. Dark-brownish discoloration of the urine, weakness, myalgia as well as stiff and tetraparetic gait were apparant. All hematological values and the concentration of NT-proBNP were within the relevant reference ranges. Plasma CK and ALT activities were compared between the first presentation and the follow- up examination and no significant differences were detected (pCK = 0.31, pALT = 0.64). Signs of myopathy remained unchanged throughout the examination period. CONCLUSION AND CLINICAL RELEVANCE Oral supplementation with L-carnitine, coenzyme Q10 and the special dietary management did not result in any improvement of clinical signs or laboratory parameters. No progression of the disease was observed. The prognosis for affected dogs remains cautious as long-term observations of affected dogs over several years are lacking. Our findings provide further important information on inherited disorders of mitochondrial β-oxidation in dogs, especially focused on the exercise induced metabolic myopathy in the German Hunting Terrier. This may provide new insights for novel treatment modalities in conjuntion with the development of improved breeding guidelines., Gegenstand und Ziel Die belastungsabhängige metabolische Myopathie beim Deutschen Jagdterrier ist eine autosomal-rezessive Erbkrankheit, die aufgrund einer Punktmutation zu einem Enzymdefekt der sehr langkettigen Acyl-CoA-Dehydrogenase führt und klinisch durch belastungsabhängige Schwäche, schwere Myalgien und Myoglobinurie charakterisiert ist. In dieser Studie wurde der klinische Verlauf der Erkrankung bei 9 betroffenen Deutschen Jagdterriern über 1 Jahr untersucht. Die Behandlung der Hunde umfasste die orale Supplementierung von L-Carnitin und Koenzym Q10 sowie eine Diät mit hohem Kohlenhydratgehalt und einem niedrigen Anteil an langkettigen Fettsäuren. Material und Methode Die 9 Hunde mit nachgewiesenem Gendefekt wurden bei Auftreten der ersten Symptome (Messzeitpunkt 1, MZP1) und 1 Jahr später (Messzeitpunkt 2, MZP2) klinisch-neurologisch untersucht und es erfolgte eine Blutuntersuchung mit Analyse hämatologischer und klinisch-chemischer Parameter sowie der Konzentration des natriuretischen Peptids Typ B (NT-proBNP). Ergebnisse Zum MZP2 zeigten die Hunde, wie bereits zum MZP1, nach Belastung ein steifes Gangbild, Muskelschwäche und -schmerz und hatten einen dunkelbraun verfärbten Urin. Bei den hämatologischen Parametern und der NT-proBNP-Konzentration ergaben sich, wie zum MZP1, keine Abweichungen vom Referenzbereich. Die Aktivitäten der Kreatinkinase und Alanin-Aminotransferase unterschieden sich statistisch nicht signifikant zwischen beiden MZP (pCK = 0,31, pALT = 0,64). Nach Auswertung einer Besitzerbefragung und der klinisch-neurologischen Untersuchung der Hunde ließ sich im Rahmen der Verlaufsuntersuchung keine Verbesserung der myopathischen Beschwerden feststellen. Schlussfolgerung und klinische Relevanz Die orale Supplementierung von L-Carnitin und Koenzym Q10 sowie spezielle diätetische Maßnahmen über 1 Jahr führten zu keiner Verbesserung der klinischen Symptomatik oder der untersuchten Laborparameter. Die Tiere zeigten keine progressive Verschlechterung der Symptomatik im Vergleich zur Erstvorstellung. Die Prognose ist jedoch als vorsichtig zu bezeichnen, da Daten zum Langzeitverlauf über einige Jahre fehlen. Unsere Ergebnisse bilden eine Grundlage für weitere Forschungen zu Lipidspeichermyopathien, insbesondere mit Fokus auf die belastungsabhängige metabolische Myopathie des Deutschen Jagdterriers, deren Therapie und eine entsprechende Zuchthygiene.

Recent views on Guillain-Barre syndrome (GBS) question the accuracy of classification into axonal and demyelinating subtypes that represent convergent neurophysiological phenotypes rather than immunological targets. Instead it has been proposed to clarify the primarily affected fibre subunit in nerve biopsies. As nerve biopsies rarely are part of routine work-up in human patients we evaluated tissues taken from companion animals affected by GBS-like polyradiculoneuropathy to screen for distribution of immune cells, targeted fibre components and segregating non-inflammatory lesions. We identified that immune responses were directed either at Schmidt-Lanterman clefts, the paranode-node complex or both. Based on infiltrative and non-inflammatory changes, four subtypes and/or stages were distinguished, some of which indicate localisation of primary target antigens while others represent convergent late stage pictures, as a consequence to epitope spreading. The impact of histological subtyping onto clinical management and prognosis remains to be evaluated in future clinical trials. Natural development and clinical manifestation of large animal dysimmune neuropathy may reflect human Guillain-Barre syndrome more accurately than experimental models and therefore provide complementary clues for translational research.