Ana Matas Garcia, Spain

Hospital Clínic de Barcelona Internal Medicine
Ana Matas-García is a third-year internal medicine resident at the Hospital Clínic de Barcelona, where, in turn, she trained as a medical student. During her formative years she has been specially interested in the field of muscle and metabolic diseases, where she has made her debut as a young researcher in the hands of experts such as Professor José C. Milisenda and Josep M. Grau Junyent.

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 Conference Calendar

EMERGING PD-1 AND PD-1L INHIBITORS-ASSOCIATED MYOPATHY WITH A CHARACTERISTIC HISTOPATHOLOGICAL PATTERN

Session Name
PS25 - AUTOIMMUNITY IN BARCELONA CLINIC, ALUMNI SESSION
Session Type
PARALLEL SESSIONS
Date
30.05.2021, Sunday
Session Time
10:00 - 12:00
Room
HALL G
Lecture Time
10:50 - 11:00
Presenter
Session Icon
Pre Recorded

Abstract

Background and Aims

Drug-induced myopathy is among the most common causes of muscle disease. An association has recently been described between programmed death-1 (PD-1)/PD-1 ligand (PD-L1) inhibitors and immune-related adverse events (irAE) affecting the muscle. Here, we report the clinical and pathological findings of nineunrelated patients with PD-1 and PD-L1 inhibitors-associated myopathy.

Methods

We retrospectively analyzed 317 muscle biopsies performed for diagnostic purposes from January 2017 to June 2019. Patients were attended in two tertiary centers and muscle biopsies were performed and analyzed by two myologyexperts. Muscle biopsies were frozen in cooled isopenthane, cryostat sectioned and stained. Immunohistochemistry studies were also performed as a routine procedure in our lab.

Results

We identified 9 patients receiving anti-PD-1 or PD-L1 inhibitors consulting for either muscle weakness, asthenia, myasthenic-like syndrome or other muscle related-symptoms, along with biopsy-proven inflammatory myopathy. One had concomitant myocarditis. In most of the cases muscle biopsy showed a marked phenomenon of necrosis, macrophagy and muscle regeneration with perivascular inflammatory infiltrates with a large component of macrophagic cells. A tendency to perifascicular atrophy was also noticed. The expression of MHC class I antigens predominated in the perifascicular zones.Raised muscle enzymes were detected in 7 patients.

Conclusions

A characteristic clinic-pathological pattern, including a myasthenia gravis-like syndrome plus myositis was found in patients receiving PD-1 and PD-1L inhibitors. A large component of macrophages resembling granulomas seems to be the pathological hallmark of the syndrome. Further information is required to understand the wide spectrum of irAE involving the muscle during or after treatment with anti-PD-1 inhibitors, but the pathological picture seems to be characteristic.

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