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R1239H hetero. Immunostaining for L-type calcium channels (LCaC) showed linear hyper-stained regions indicating proliferation of longitudinal t-tubules. The margin of vacuoles was positive for ryanodine receptor, LCaC, calsequestrin (CASQ) 1, CASQ 2, SR\/ER Ca2+-ATPase (SERCA) 1, SERCA2, dysferlin, dystrophin, \u03b1-actinin, LC3, and LAMP 1. Electron microscopy indicated that the vacuoles mainly originated from the sarcoplasmic reticulum (SR). These findings indicate impairment of the muscle contraction system related to Ca2+ dynamics, remodeling of t-tubules and muscle fiber repair. We speculate that PMPP in patients with a CACNA1S mutation might start with abnormal SR function due to impaired LCaC. Subsequent induction of muscular contractile abnormalities and the vacuoles formed by fused SR in the repair process including autophagy might result in permanent myopathy. Our findings may facilitate prediction of the pathomechanisms of PMPP seen on morphological observation.<\/jats:p>","DOI":"10.1093\/jnen\/nlaa098","type":"journal-article","created":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T05:06:37Z","timestamp":1605243997000},"page":"1276-1292","source":"Crossref","is-referenced-by-count":3,"title":["Morphological Alterations of the Sarcotubular System in Permanent Myopathy of Hereditary Hypokalemic Periodic Paralysis with a Mutation in the <i>CACNA1S<\/i> Gene"],"prefix":"10.1093","volume":"79","author":[{"given":"Takamura","family":"Nagasaka","sequence":"first","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, University of Yamanashi , Chuou-city, Yamanashi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takanori","family":"Hata","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine, University of Yamanashi , Chuou-city, Yamanashi, 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