151
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Ferlini A, Flanigan KM, Lochmuller H, Muntoni F, 't Hoen PAC, McNally E. 204th ENMC International Workshop on Biomarkers in Duchenne Muscular Dystrophy 24-26 January 2014, Naarden, The Netherlands. Neuromuscul Disord 2015; 25:184-98. [PMID: 25529833 PMCID: PMC4534085 DOI: 10.1016/j.nmd.2014.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/01/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Alessandra Ferlini
- Section of Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Kevin M Flanigan
- Center for Gene Therapy, Nationwide Children's Hospital, Departments of Pediatrics and Neurology, Ohio State University, Columbus, OH, USA
| | - Hanns Lochmuller
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Francesco Muntoni
- UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
| | - Peter A C 't Hoen
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Elizabeth McNally
- Department of Medicine, Department of Human Genetics, The University of Chicago, USA
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152
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Wong SH, McClaren BJ, Archibald AD, Weeks A, Langmaid T, Ryan MM, Kornberg A, Metcalfe SA. A mixed methods study of age at diagnosis and diagnostic odyssey for Duchenne muscular dystrophy. Eur J Hum Genet 2015; 23:1294-300. [PMID: 25626706 DOI: 10.1038/ejhg.2014.301] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/05/2014] [Accepted: 12/16/2014] [Indexed: 01/15/2023] Open
Abstract
The delayed diagnosis of Duchenne muscular dystrophy (DMD) may be an ongoing problem internationally. We aimed to ascertain age at diagnosis and explore parents' experiences of the diagnosis of DMD in Australia. Using mixed methods, data were collected from laboratory and clinical record audits of testing for DMD in Victoria and Tasmania, interviews and a national survey of parents regarding their experiences from first noticing symptoms to receiving a diagnosis. The audits revealed that the median age at diagnosis for DMD was 5 years (n=49 during 2005-2010); this age had not changed substantially over this period. Fourteen parents interviewed reported age at diagnosis ranging from 2 to 8 years with a 6 month to 4 year delay between initial concerns about their child's development and receiving the DMD diagnosis. Sixty-two survey respondents reported the median age at diagnosis was 3 years and 9 months, while the median age when symptoms were noticed was 2 years and 9 months. Parents experienced many emotions in their search for a diagnosis and consulted with a wide range of health professionals. Half the survey respondents felt that their child could have been diagnosed earlier. Despite advances in testing technologies and increasing awareness of DMD, the age at diagnosis has remained constant in Australia. This mixed methods study shows that this diagnostic delay continues to have a negative impact on parents' experiences, places families at risk of having a second affected child and may have a deleterious effect on affected children's treatment.
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Affiliation(s)
- Siaw H Wong
- Murdoch Childrens Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | | | - Alison Dalton Archibald
- Murdoch Childrens Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Victorian Clinical Genetics Services, Parkville, VIC, Australia
| | - Alice Weeks
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Tess Langmaid
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Monique M Ryan
- Murdoch Childrens Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of Neurology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Andrew Kornberg
- Murdoch Childrens Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of Neurology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Sylvia A Metcalfe
- Murdoch Childrens Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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153
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Braat E, Hoste L, De Waele L, Gheysens O, Vermeersch P, Goffin K, Pottel H, Goemans N, Levtchenko E. Renal function in children and adolescents with Duchenne muscular dystrophy. Neuromuscul Disord 2015; 25:381-7. [PMID: 25683700 DOI: 10.1016/j.nmd.2015.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 01/05/2015] [Accepted: 01/12/2015] [Indexed: 12/14/2022]
Abstract
Improved life expectancy and the need for robust tools to monitor renal safety of emerging new therapies have fueled the interest in renal function in Duchenne muscular dystrophy (DMD) patients. We aimed to establish a methodology to accurately assess their renal function. Twenty DMD patients (5-22 years) were included in this prospective study. After obtaining medical history, all patients underwent a clinical examination, 24-hour ambulatory blood pressure monitoring, ultrasound of the kidneys, direct GFR measurement ((51)Cr-EDTA, mGFR), complete blood and urine analysis. Seventeen of 20 patients were treated with corticosteroids and 5/20 with angiotensin converting enzyme inhibitor (lisinopril). No patient suffered from urinary tract infections or other renal diseases. Hypertension (systolic or diastolic blood pressure >P95) was found in 9/20 patients (8/9 patients were on steroid treatment) and a non-dipping blood pressure profile in 13/20 subjects (10/13 patients were on steroid treatment). Urinary protein to creatinine ratio was elevated in 17/18 patients, whereas 24-hour urine protein excretion was normal in all subjects. Median interquartile range (IQR) mGFR was 130.4 (29.1) mL/min/1.73 m(2). Hyperfiltration (mGFR >150 mL/min/1.73 m(2)) was found in 5/20 patients. Inverse correlation between mGFR and age was observed (R(2) = 0.45, p = 0.001). Serum creatinine based estimated GFR (eGFR) equations overestimated mGFR up to 300%. eGFR based on cystatin C Filler equation was closest to the mGFR (median eGFR (IQR) of 129.5 (39.7) mL/min/1.73 m(2)). Our study demonstrates a high prevalence of hyperfiltration and hypertension in children and adolescents with DMD. Because the majority of hypertensive patients were under corticosteroid treatment, the iatrogenic cause of hypertension cannot be excluded. Serum or urine creatinine measurements are of no value to evaluate renal function in DMD patients due to the reduced skeletal muscle mass.
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Affiliation(s)
- Elke Braat
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth Hoste
- Department of Public Health and Primary Care @ Kulak, KU Leuven Kulak, Kortrijk, Belgium
| | - Liesbeth De Waele
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Vermeersch
- Laboratory of Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Karolien Goffin
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care @ Kulak, KU Leuven Kulak, Kortrijk, Belgium
| | - Nathalie Goemans
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Elena Levtchenko
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
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154
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Lynn S, Aartsma-Rus A, Bushby K, Furlong P, Goemans N, De Luca A, Mayhew A, McDonald C, Mercuri E, Muntoni F, Pohlschmidt M, Verschuuren J, Voit T, Vroom E, Wells DJ, Straub V. Measuring clinical effectiveness of medicinal products for the treatment of Duchenne muscular dystrophy. Neuromuscul Disord 2015; 25:96-105. [DOI: 10.1016/j.nmd.2014.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
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155
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156
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Wang RT, Silverstein Fadlon CA, Ulm JW, Jankovic I, Eskin A, Lu A, Rangel Miller V, Cantor RM, Li N, Elashoff R, Martin AS, Peay HL, Halnon N, Nelson SF. Online self-report data for duchenne muscular dystrophy confirms natural history and can be used to assess for therapeutic benefits. PLOS CURRENTS 2014; 6. [PMID: 25635234 PMCID: PMC4207635 DOI: 10.1371/currents.md.e1e8f2be7c949f9ffe81ec6fca1cce6a] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To assess the utility of online patient self-report outcomes in a rare disease, we attempted to observe the effects of corticosteroids in delaying age at fulltime wheelchair use in Duchenne muscular dystrophy (DMD) using data from 1,057 males from DuchenneConnect, an online registry. Data collected were compared to prior natural history data in regard to age at diagnosis, mutation spectrum, and age at loss of ambulation. Because registrants reported differences in steroid and other medication usage, as well as age and ambulation status, we could explore these data for correlations with age at loss of ambulation. Using multivariate analysis, current steroid usage was the most significant and largest independent predictor of improved wheelchair-free survival. Thus, these online self-report data were sufficient to retrospectively observe that current steroid use by patients with DMD is associated with a delay in loss of ambulation. Comparing commonly used steroid drugs, deflazacort prolonged ambulation longer than prednisone (median 14 years and 13 years, respectively). Further, use of Vitamin D and Coenzyme Q10, insurance status, and age at diagnosis after 4 years were also significant, but smaller, independent predictors of longer wheelchair-free survival. Nine other common supplements were also individually tested but had lower study power. This study demonstrates the utility of DuchenneConnect data to observe therapeutic differences, and highlights needs for improvement in quality and quantity of patient-report data, which may allow exploration of drug/therapeutic practice combinations impractical to study in clinical trial settings. Further, with the low barrier to participation, we anticipate substantial growth in the dataset in the coming years.
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Affiliation(s)
- Richard T Wang
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Cheri A Silverstein Fadlon
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - J Wes Ulm
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ivana Jankovic
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ascia Eskin
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ake Lu
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Rita M Cantor
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ning Li
- Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Robert Elashoff
- Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Anne S Martin
- Parent Project Muscular Dystrophy, Hackensack, New Jersey, USA
| | - Holly L Peay
- Parent Project Muscular Dystrophy, Hackensack, New Jersey, USA
| | - Nancy Halnon
- Pediatric Cardiology, University of California, Los Angeles, California, USA
| | - Stanley F Nelson
- Department of Human Genetics and Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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157
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Barthélémy I, Pinto-Mariz F, Yada E, Desquilbet L, Savino W, Silva-Barbosa SD, Faussat AM, Mouly V, Voit T, Blot S, Butler-Browne G. Predictive markers of clinical outcome in the GRMD dog model of Duchenne muscular dystrophy. Dis Model Mech 2014; 7:1253-61. [PMID: 25261568 PMCID: PMC4213729 DOI: 10.1242/dmm.016014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In the translational process of developing innovative therapies for DMD (Duchenne muscular dystrophy), the last preclinical validation step is often carried out in the most relevant animal model of this human disease, namely the GRMD (Golden Retriever muscular dystrophy) dog. The disease in GRMD dogs mimics human DMD in many aspects, including the inter-individual heterogeneity. This last point can be seen as a drawback for an animal model but is inherently related to the disease in GRMD dogs closely resembling that of individuals with DMD. In order to improve the management of this inter-individual heterogeneity, we have screened a combination of biomarkers in sixty-one 2-month-old GRMD dogs at the onset of the disease and a posteriori we addressed their predictive value on the severity of the disease. Three non-invasive biomarkers obtained at early stages of the disease were found to be highly predictive for the loss of ambulation before 6 months of age. An elevation in the number of circulating CD4+CD49dhi T cells and a decreased stride frequency resulting in a reduced spontaneous speed were found to be strongly associated with the severe clinical form of the disease. These factors can be used as predictive tests to screen dogs to separate them into groups with slow or fast disease progression before their inclusion into a therapeutic preclinical trial, and therefore improve the reliability and translational value of the trials carried out on this invaluable large animal model. These same biomarkers have also been described to be predictive for the time to loss of ambulation in boys with DMD, strengthening the relevance of GRMD dogs as preclinical models of this devastating muscle disease.
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Affiliation(s)
- Inès Barthélémy
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, UPR de Neurobiologie, 94704 Maisons-Alfort, France
| | - Fernanda Pinto-Mariz
- Université Pierre et Marie Curie-Paris 06 UM76, INSERM U974, CNRS UMR 7215, Institut de Myologie, Paris, France. Institute of Pediatrics/Federal University of Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro 21941-912, Brazil. Laboratory of Thymus Research, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Erica Yada
- Université Pierre et Marie Curie-Paris 06 UM76, INSERM U974, CNRS UMR 7215, Institut de Myologie, Paris, France
| | - Loïc Desquilbet
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité D'Épidémiologie clinique et de Biostatistique, 94704 Maisons-Alfort, France. CNRS UMR 7179, MNHN, Brunoy 91800, France
| | - Wilson Savino
- Laboratory of Thymus Research, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Suse Dayse Silva-Barbosa
- Department of Clinical Research, National Cancer Institute (INCA), Rio de Janeiro 20230-130, Brazil
| | - Anne-Marie Faussat
- Université Pierre et Marie Curie-Paris 06 IFR 65 Saint-Antoine, Paris 75005, France
| | - Vincent Mouly
- Université Pierre et Marie Curie-Paris 06 UM76, INSERM U974, CNRS UMR 7215, Institut de Myologie, Paris, France
| | - Thomas Voit
- Université Pierre et Marie Curie-Paris 06 UM76, INSERM U974, CNRS UMR 7215, Institut de Myologie, Paris, France
| | - Stéphane Blot
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, UPR de Neurobiologie, 94704 Maisons-Alfort, France.
| | - Gillian Butler-Browne
- Université Pierre et Marie Curie-Paris 06 UM76, INSERM U974, CNRS UMR 7215, Institut de Myologie, Paris, France.
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158
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Hathout Y, Marathi RL, Rayavarapu S, Zhang A, Brown KJ, Seol H, Gordish-Dressman H, Cirak S, Bello L, Nagaraju K, Partridge T, Hoffman EP, Takeda S, Mah JK, Henricson E, McDonald C. Discovery of serum protein biomarkers in the mdx mouse model and cross-species comparison to Duchenne muscular dystrophy patients. Hum Mol Genet 2014; 23:6458-69. [PMID: 25027324 DOI: 10.1093/hmg/ddu366] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
It is expected that serum protein biomarkers in Duchenne muscular dystrophy (DMD) will reflect disease pathogenesis, progression and aid future therapy developments. Here, we describe use of quantitative in vivo stable isotope labeling in mammals to accurately compare serum proteomes of wild-type and dystrophin-deficient mdx mice. Biomarkers identified in serum from two independent dystrophin-deficient mouse models (mdx-Δ52 and mdx-23) were concordant with those identified in sera samples of DMD patients. Of the 355 mouse sera proteins, 23 were significantly elevated and 4 significantly lower in mdx relative to wild-type mice (P-value < 0.001). Elevated proteins were mostly of muscle origin: including myofibrillar proteins (titin, myosin light chain 1/3, myomesin 3 and filamin-C), glycolytic enzymes (aldolase, phosphoglycerate mutase 2, beta enolase and glycogen phosphorylase), transport proteins (fatty acid-binding protein, myoglobin and somatic cytochrome-C) and others (creatine kinase M, malate dehydrogenase cytosolic, fibrinogen and parvalbumin). Decreased proteins, mostly of extracellular origin, included adiponectin, lumican, plasminogen and leukemia inhibitory factor receptor. Analysis of sera from 1 week to 7 months old mdx mice revealed age-dependent changes in the level of these biomarkers with most biomarkers acutely elevated at 3 weeks of age. Serum analysis of DMD patients, with ages ranging from 4 to 15 years old, confirmed elevation of 20 of the murine biomarkers in DMD, with similar age-related changes. This study provides a panel of biomarkers that reflect muscle activity and pathogenesis and should prove valuable tool to complement natural history studies and to monitor treatment efficacy in future clinical trials.
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Affiliation(s)
- Yetrib Hathout
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA,
| | - Ramya L Marathi
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Sree Rayavarapu
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Aiping Zhang
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Kristy J Brown
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Haeri Seol
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Heather Gordish-Dressman
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Sebahattin Cirak
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Luca Bello
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Kanneboyina Nagaraju
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Terry Partridge
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Eric P Hoffman
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC 20010, USA
| | - Shin'ichi Takeda
- Department of Molecular Therapy, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Ogawa-higashi, Kodaira Tokyo 187-0031, Japan
| | - Jean K Mah
- Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada T3B 6A8 and
| | - Erik Henricson
- Department of Physical Medicine and Rehabilitation, University of California, Davis School of Medicine, Davis, CA 95618, USA
| | - Craig McDonald
- Department of Physical Medicine and Rehabilitation, University of California, Davis School of Medicine, Davis, CA 95618, USA
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159
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Abstract
PURPOSE OF REVIEW The most encouraging recent advances regarding pharmacological agents for treating Duchenne muscular dystrophy (DMD) are summarized. Emphasis is given to compounds acting downstream of dystrophin, the protein lacking in DMD, on cellular pathways leading to pathological consequences. The author highlights the progress that may have the greatest potential for clinical use in DMD. RECENT FINDINGS Modifying the transcripts of the mutated gene by exon skipping has led to expression of shortened dystrophins in DMD patients. Currently, the most promising potential drugs are the exon-skipping agents eteplirsen and drisapersen. Biglycan and SMTC1100 upregulate utrophin. The steroid receptor modulating compounds VBP15 and tamoxifen, and specific antioxidants appear promising agents for symptomatic therapy. SUMMARY The past 18 months have seen a strong increase in the number of exciting reports on novel therapeutic agents for DMD. Exon-skipping agents have been fine-tuned to improve tissue delivery and stability. Impressive discoveries regarding pathogenic events in cellular signalling have revealed targets that were unknown in the context of DMD, thus enabling approaches that limit inflammation, fibrosis and necrosis. The targets are nuclear hormone receptors, NADPH-oxidases and Ca channels. Inhibition of NF-KB, transforming growth factor-alpha (TGF-α) and transforming growth factor-beta (TGF-β)/myostatin production or action are also promising routes in counteracting the complex pathogenesis of DMD.
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160
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Uwineza A, Hitayezu J, Murorunkwere S, Ndinkabandi J, Kalala Malu CK, Caberg JH, Dideberg V, Bours V, Mutesa L. Genetic diagnosis of Duchenne and Becker muscular dystrophy using multiplex ligation-dependent probe amplification in Rwandan patients. J Trop Pediatr 2014; 60:112-7. [PMID: 24213305 DOI: 10.1093/tropej/fmt090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Duchenne and Becker muscular dystrophies are the most common clinical forms of muscular dystrophies. They are genetically X-linked diseases caused by a mutation in the dystrophin (DMD) gene. A genetic diagnosis was carried out in six Rwandan patients presenting a phenotype of Duchenne and Becker muscular dystrophies and six asymptomatic female carrier relatives using multiplex ligation-dependent probe amplification (MLPA). Our results revealed deletion of the exons 48-51 in one patient, an inherited deletion of the exons 8-21 in two brothers and a de novo deletion of the exons 46-50 in the fourth patient. No copy number variation was found in two patients. Only one female carrier presented exon deletion in the DMD gene. This is the first cohort of genetic analysis in Rwandan patients affected by Duchenne and Becker muscular dystrophies. This report confirmed that MLPA assay can be easily implemented in low-income countries.
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Affiliation(s)
- Annette Uwineza
- Center for Medical Genetics, Department of Molecular Biology & Cytogenetics, Faculty of Medicine, National University of Rwanda, PO Box 30-Butare, Rwanda
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161
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Bell JM, Blackwood B, Shields MD, Watters J, Hamilton A, Beringer T, Elliott M, Quinlivan R, Tirupathi S. Interventions to prevent steroid-induced osteoporosis and osteoporotic fractures in Duchenne muscular dystrophy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
OPINION STATEMENT • Duchenne muscular dystrophy (DMD), the most common and severe type of dystrophinopathy, is a progressive disease affecting primordially skeletal and cardiac muscle. A coordinated multidisciplinary approach is required to address its multisystemic manifestations and secondary problems.• Treatment with glucocorticosteroids (GCS) is accepted as standard of care in ambulant DMD. Daily and intermittent administrations are both in common use with different efficacy and different side effect profile.• There are no established guidelines for age/stage at initiation and treatment duration of GCS. Common practice is initiation of GCS before the child is starting to decline (between age 3 and 6 years) and continuation of monitored treatment after loss of ambulation, aiming at delaying cardiac and respiratory manifestations and preventing the development of scoliosis.• Prevention, monitoring, and treatment of the side effects of long-term chronic GCS use, such as excessive weight gain, hypertension, osteoporosis, impairment of glucose metabolism, delayed puberty, and cataract, should be integrated in the standards of care.• Noninvasive ventilatory support associated with cough assisting techniques has significantly improved the longevity in DMD.• Pharmacologic treatment for cardiac manifestations includes the standard treatments of dilated cardiomyopathy and arrhythmia such as the use of angiotensin converting enzyme (ACE) inhibitors, beta-blockers and diuretics. The lack of robust controlled data hampers clear recommendations about preventive treatment with ACE inhibitors.• DMD is associated with low bone mineral content, which is aggravated by the use of corticosteroids. The use of biphosphonates can be considered in the treatment of painful vertebral fractures. The use of biphosphonates as a preventive treatment should be investigated in randomized controlled studies.• DMD has evolved from a pediatric disease to an adult condition. This underscores the need to prepare adult neurologists for the optimal surveillance and management of patients with a severe chronic disease that have outgrown the pediatric care and that may develop new disease manifestations with improved longevity.
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163
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Leal-Junior ECP, de Almeida P, Tomazoni SS, de Carvalho PDTC, Lopes-Martins RÁB, Frigo L, Joensen J, Johnson MI, Bjordal JM. Superpulsed low-level laser therapy protects skeletal muscle of mdx mice against damage, inflammation and morphological changes delaying dystrophy progression. PLoS One 2014; 9:e89453. [PMID: 24599021 PMCID: PMC3943729 DOI: 10.1371/journal.pone.0089453] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/20/2014] [Indexed: 12/18/2022] Open
Abstract
AIM To evaluate the effects of preventive treatment with low-level laser therapy (LLLT) on progression of dystrophy in mdx mice. METHODS Ten animals were randomly divided into 2 experimental groups treated with superpulsed LLLT (904 nm, 15 mW, 700 Hz, 1 J) or placebo-LLLT at one point overlying the tibialis anterior muscle (bilaterally) 5 times per week for 14 weeks (from 6th to 20th week of age). Morphological changes, creatine kinase (CK) activity and mRNA gene expression were assessed in animals at 20th week of age. RESULTS Animals treated with LLLT showed very few morphological changes in skeletal muscle, with less atrophy and fibrosis than animals treated with placebo-LLLT. CK was significantly lower (p=0.0203) in animals treated with LLLT (864.70 U.l-1, SEM 226.10) than placebo (1708.00 U.l-1, SEM 184.60). mRNA gene expression of inflammatory markers was significantly decreased by treatment with LLLT (p<0.05): TNF-α (placebo-control=0.51 µg/µl [SEM 0.12], - LLLT=0.048 µg/µl [SEM 0.01]), IL-1β (placebo-control=2.292 µg/µl [SEM 0.74], - LLLT=0.12 µg/µl [SEM 0.03]), IL-6 (placebo-control=3.946 µg/µl [SEM 0.98], - LLLT=0.854 µg/µl [SEM 0.33]), IL-10 (placebo-control=1.116 µg/µl [SEM 0.22], - LLLT=0.352 µg/µl [SEM 0.15]), and COX-2 (placebo-control=4.984 µg/µl [SEM 1.18], LLLT=1.470 µg/µl [SEM 0.73]). CONCLUSION Irradiation of superpulsed LLLT on successive days five times per week for 14 weeks decreased morphological changes, skeletal muscle damage and inflammation in mdx mice. This indicates that LLLT has potential to decrease progression of Duchenne muscular dystrophy.
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Affiliation(s)
- Ernesto Cesar Pinto Leal-Junior
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- * E-mail:
| | - Patrícia de Almeida
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | | | - Paulo de Tarso Camillo de Carvalho
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | | | - Lucio Frigo
- Biological Sciences and Health Center, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Jon Joensen
- Department of Physiotherapy, Occupational Therapy and Radiography, Bergen University College, Bergen, Norway
| | - Mark I. Johnson
- Faculty of Health and Social Sciences, Leeds Metropolitan University, Leeds, United Kingdom
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164
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Affiliation(s)
- Matthew C Kiernan
- Brain and Mind Research Institute, University of Sydney, Sydney, NSW 2050, Australia.
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Abstract
PURPOSE OF REVIEW We provide a review of recent standards of care and therapeutic development in different forms of muscular dystrophies. This topic is relevant as the improved understanding of these disorders has not only led to a better definition of clinical course and to the development of standards of care for individual types of muscular dystrophies, but also culminated in different therapeutic approaches. RECENT FINDINGS Recent natural history studies have demonstrated the impact of new standards of care in different forms of muscular dystrophies, and identified areas of clinical management in which further developments are needed. The majority of the experimental studies are focused on Duchenne muscular dystrophy. Some of them target patients with specific mutations, such as antisense oligonucleotides, to induce exon skipping of specific mutations or drugs developed to allow read-through of nonsense mutations, whereas other therapies deal with secondary aspects of muscle degeneration, aiming, for example, at reducing inflammation or apoptosis, and may also be suitable for other forms of muscular dystrophies. SUMMARY The advances in the field of muscular dystrophy have resulted in improved clinical course and survival. The encouraging results of early experimental studies could further improve these outcomes in the future.
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Zaharieva IT, Calissano M, Scoto M, Preston M, Cirak S, Feng L, Collins J, Kole R, Guglieri M, Straub V, Bushby K, Ferlini A, Morgan JE, Muntoni F. Dystromirs as serum biomarkers for monitoring the disease severity in Duchenne muscular Dystrophy. PLoS One 2013; 8:e80263. [PMID: 24282529 PMCID: PMC3840009 DOI: 10.1371/journal.pone.0080263] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/01/2013] [Indexed: 12/12/2022] Open
Abstract
Duchenne muscular Dystrophy (DMD) is an inherited disease caused by mutations in the dystrophin gene that disrupt the open reading frame, while in frame mutations result in Becker muscular dystrophy (BMD). Ullrich congenital muscular dystrophy (UCMD) is due to mutations affecting collagen VI genes. Specific muscle miRNAs (dystromirs) are potential non-invasive biomarkers for monitoring the outcome of therapeutic interventions and disease progression. We quantified miR-1, miR-133a,b, miR-206 and miR-31 in serum from patients with DMD, BMD, UCMD and healthy controls. MiR-1, miR-133a,b and miR-206 were upregulated in DMD, but unchanged in UCMD compared to controls. Milder DMD patients had higher levels of dystromirs than more severely affected patients. Patients with low forced vital capacity (FVC) values, indicating respiratory muscle weakness, had low levels of serum miR-1 and miR-133b. There was no significant difference in the level of the dystromirs in BMD compared to controls. We also assessed the effect of dystrophin restoration on the expression of the five dystromirs in serum of DMD patients treated systemically for 12 weeks with antisense oligomer eteplirsen that induces skipping of exon 51 in the dystrophin gene. The dystromirs were also analysed in muscle biopsies of DMD patients included in a single dose intramuscular eteplirsen clinical trial. Our analysis detected a trend towards normalization of these miRNA between the pre- and post-treatment samples of the systemic trial, which however failed to reach statistical significance. This could possibly be due to the small number of patients and the short duration of these clinical trials. Although longer term studies are needed to clarify the relationship between dystrophin restoration following therapeutic intervention and the level of circulating miRNAs, our results indicate that miR-1 and miR-133 can be considered as exploratory biomarkers for monitoring the progression of muscle weakness and indirectly the remaining muscle mass in DMD.
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Affiliation(s)
- Irina T. Zaharieva
- The Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, London, United Kingdom
| | - Mattia Calissano
- The Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, London, United Kingdom
| | - Mariacristina Scoto
- The Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, London, United Kingdom
| | - Mark Preston
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sebahattin Cirak
- The Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, London, United Kingdom
- Childrens National Medical Centre, Research Centre for Genetic Medicine, Washington DC, United States of America
| | - Lucy Feng
- The Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, London, United Kingdom
| | - James Collins
- Department of Pediatric Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Ryszard Kole
- Sarepta Therapeutics, Cambridge, Massachusetts, United States of America
| | - Michela Guglieri
- Institute of Human Genetics, Newcastle University, Newcastle, United Kingdom
| | - Volker Straub
- Institute of Human Genetics, Newcastle University, Newcastle, United Kingdom
| | - Kate Bushby
- Institute of Human Genetics, Newcastle University, Newcastle, United Kingdom
| | | | - Jennifer E. Morgan
- The Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, London, United Kingdom
| | - Francesco Muntoni
- The Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, London, United Kingdom
- * E-mail:
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168
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Mayhew AG, Cano SJ, Scott E, Eagle M, Bushby K, Manzur A, Muntoni F. Detecting meaningful change using the North Star Ambulatory Assessment in Duchenne muscular dystrophy. Dev Med Child Neurol 2013; 55:1046-52. [PMID: 23909763 DOI: 10.1111/dmcn.12220] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 11/28/2022]
Abstract
AIM Clinician-reported outcome instruments such as the North Star Ambulatory Assessment (NSAA) need to be able to detect clinically important change to be suitable for clinical trials. However, in Duchenne muscular dystrophy (DMD), identifying changes in function is not straightforward. In this study, we use Rasch-transformed data to examine the responsiveness and minimal important difference (MID) of the NSAA in males with DMD receiving different corticosteroid regimes. METHOD NSAA data were examined from 198 males (mean age at assessment was 8 y 6 mo [SD 2 y 6 mo] range 4 y-18 y; 805 assessments). Responsiveness was assessed using mean score changes (using Rasch-transformed data) between adjacent pairs of age groups, pairwise squared t-values from paired samples t-tests, and an effect size calculation. The MID was assessed using the effect size calculation and 0.5 standard deviation (SD) of mean score differences. RESULTS Our findings revealed a difference in change scores over time between the two corticosteroid regimes. Mean NSAA person estimates were higher in the daily prednisolone group. The mean MID (0.5 SD) was 8.8 and 6.9 for the daily group and intermittent group respectively. INTERPRETATION This study, based on Rasch-transformed NSAA data, provides an initial basis for the interpretation of clinical change in DMD over time and between corticosteroid regimes. Our proposed MIDs can be mapped back to differences in specific item content across the range of the NSAA.
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Affiliation(s)
- Anna G Mayhew
- Institute of Genetic Medicine, Newcastle University, Newcastle, UK
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Prednisolone improves walking in Japanese Duchenne muscular dystrophy patients. J Neurol 2013; 260:3023-9. [PMID: 24057148 PMCID: PMC3843366 DOI: 10.1007/s00415-013-7104-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 12/01/2022]
Abstract
We evaluated the long-term efficacy of prednisolone (PSL) therapy for prolonging ambulation in Japanese patients with genetically confirmed Duchenne muscular dystrophy (DMD). There were clinical trials have shown a short-term positive effect of high-dose and daily PSL on ambulation, whereas a few study showed a long-term effect. Especially in Japan, “real-life” observation was lacking. We utilized the national registry of muscular dystrophy in Japan for our retrospective study. We compared the age at loss of ambulation (LOA) between patients in PSL group and those in without-PSL group. Out of 791 patients’ in the Remudy DMD/BMD registry from July 2009 to June 2012, 560 were matched with inclusion criteria. Of the 560, all were genetically confirmed DMD patients, 245 (43.8 %) of whom were treated with PSL and 315 (56.2 %) without PSL. There was no difference between the two groups regarding their mutational profile. The age at LOA was significantly greater (11 month on average) in the PSL group than in the without-PSL group (median, 132 vs. 121 months; p = 0.0002). Although strictly controlled clinical trials have shown that corticosteroid therapies achieved a marked improvement in ambulation, discontinuation of the drug due to intolerable side effects led to exclusion of clinical trial participants, which is considered as unavoidable. In our study, patients were not excluded from the PSL group, even if they discontinued the medication shortly after starting it. The results of our study may provide evidence to formulate recommendations and provide a basis for realistic expectations for PSL treatment of DMD patients in Japan, even there are certain limitations due to the retrospectively captured data in the registry.
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Millichap JG. Glucocorticoids for Duchenne Muscular Dystrophy. Pediatr Neurol Briefs 2013. [DOI: 10.15844/pedneurbriefs-27-7-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ellis JA, Vroom E, Muntoni F. 195th ENMC International Workshop: Newborn screening for Duchenne muscular dystrophy 14-16th December, 2012, Naarden, The Netherlands. Neuromuscul Disord 2013; 23:682-9. [PMID: 23791627 DOI: 10.1016/j.nmd.2013.05.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Juliet A Ellis
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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173
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Affiliation(s)
- V Dubowitz
- Dubowitz Neuromuscular Unit, UCL Institute of Child Health, 30 Guilford St., London WC1N 1EH, United Kingdom
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