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Landfeldt E, Alemán A, Abner S, Zhang R, Werner C, Tomazos I, Ferizovic N, Lochmüller H, Kirschner J. Predictors of Loss of Ambulation in Duchenne Muscular Dystrophy: A Systematic Review and Meta-Analysis. J Neuromuscul Dis 2024; 11:579-612. [PMID: 38669554 DOI: 10.3233/jnd-230220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Objective The objective of this study was to describe predictors of loss of ambulation in Duchenne muscular dystrophy (DMD). Methods This systematic review and meta-analysis included searches of MEDLINE ALL, Embase, and the Cochrane Database of Systematic Reviews from January 1, 2000, to December 31, 2022, for predictors of loss of ambulation in DMD. Search terms included "Duchenne muscular dystrophy" as a Medical Subject Heading or free text term, in combination with variations of the term "predictor". Risk of bias was assessed using the Newcastle-Ottawa Scale. We performed meta-analysis pooling of hazard ratios of the effects of glucocorticoids (vs. no glucocorticoid therapy) by fitting a common-effect inverse-variance model. Results The bibliographic searches resulted in the inclusion of 45 studies of children and adults with DMD from 17 countries across Europe, Asia, and North America. Glucocorticoid therapy was associated with delayed loss of ambulation (overall meta-analysis HR deflazacort/prednisone/prednisolone: 0.44 [95% CI: 0.40-0.48]) (n = 25 studies). Earlier onset of first signs or symptoms, earlier loss of developmental milestones, lower baseline 6MWT (i.e.,<350 vs. ≥350 metres and <330 vs. ≥330 metres), and lower baseline NSAA were associated with earlier loss of ambulation (n = 5 studies). Deletion of exons 3-7, proximal mutations (upstream intron 44), single exon 45 deletions, and mutations amenable of skipping exon 8, exon 44, and exon 53, were associated with prolonged ambulation; distal mutations (intron 44 and downstream), deletion of exons 49-50, and mutations amenable of skipping exon 45, and exon 51 were associated with earlier loss of ambulation (n = 13 studies). Specific single-nucleotide polymorphisms in CD40 gene rs1883832, LTBP4 gene rs10880, SPP1 gene rs2835709 and rs11730582, and TCTEX1D1 gene rs1060575 (n = 7 studies), as well as race/ethnicity and level of family/patient deprivation (n = 3 studies), were associated with loss of ambulation. Treatment with ataluren (n = 2 studies) and eteplirsen (n = 3 studies) were associated with prolonged ambulation. Magnetic resonance biomarkers (MRI and MRS) were identified as significant predictors of loss of ambulation (n = 6 studies). In total, 33% of studies exhibited some risk of bias. Conclusion Our synthesis of predictors of loss of ambulation in DMD contributes to the understanding the natural history of disease and informs the design of new trials of novel therapies targeting this heavily burdened patient population.
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Affiliation(s)
| | - A Alemán
- Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario, Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | | | - R Zhang
- PTC Therapeutics Sweden AB, Askim, Sweden
| | - C Werner
- PTC Therapeutics Germany GmbH, Frankfurt, Germany
| | - I Tomazos
- PTC Therapeutics Inc, South Plainfield, NJ, USA
| | | | - H Lochmüller
- Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario, Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Neuropediatrics and Muscle Disorders, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Department of Medicine, Division of Neurology, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - J Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Fujimoto A, Mizuno K, Iwata Y, Yajima H, Nishida D, Komaki H, Ishiyama A, Mori-yoshimura M, Tachimori H, Kobayashi Y. Long-term Observation in Patients with Duchenne Muscular Dystrophy with Early Introduction of a Standing Program Using Knee-ankle-foot Orthoses. Prog Rehabil Med 2023; 8:20230038. [PMID: 37901357 PMCID: PMC10602754 DOI: 10.2490/prm.20230038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives This study investigated the outcomes of the early introduction of a standing program for patients with Duchenne muscular dystrophy (DMD). Methods This was a retrospective observational study of 41 outpatients with DMD aged 15-20 years. We introduced the standing program using knee-ankle-foot orthoses (KAFO) to slow the progression of scoliosis when ankle dorsiflexion became less than 0° in the ambulatory period. Results Thirty-two patients with DMD were offered the standing program with KAFO; 12 continued the program until the age of 15 years (complete group) and 20 discontinued the program before the age of 15 years (incomplete group). The non-standing program group included 9 patients. The standing program with KAFO was significantly associated with the Cobb angle at the age of 15 years after adjustment for the duration of corticosteroid use and DMD mutation type (P=0.0004). At the age of 15 years, significant correlations were found between the ankle dorsiflexion range of motion (ROM) and non-ambulatory period (P=0.0010), non-ambulatory period and Cobb angle (P<0.0001), Cobb angle and percent predicted forced vital capacity (P=0.0004), and ankle dorsiflexion ROM and Cobb angle (P=0.0066). In the complete group, the age at ambulation loss (log-rank P=0.0015), scoliosis progression (log-rank P=0.0032), and pulmonary dysfunction (log-rank P=0.0006) were significantly higher than in the non-standing program group. Conclusions The early introduction of a standing program for DMD patients may prolong the ambulation period and slow the progression of scoliosis and pulmonary dysfunction.
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Affiliation(s)
- Akiko Fujimoto
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Katsuhiro Mizuno
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Yasuyuki Iwata
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation, National Hakone Hospital, Odawara, Japan
| | - Hiroyuki Yajima
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Daisuke Nishida
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokai University School of Medicine, Isehara, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Komaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Akihiko Ishiyama
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Madoka Mori-yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hisateru Tachimori
- Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research and Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoko Kobayashi
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Rehabilitation, National Hakone Hospital, Odawara, Japan
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Sakai K, Motegi T, Chambers JK, Uchida K, Nishida H, Shimamura S, Tani H, Shimada T, Furuya M. Dystrophin-deficient muscular dystrophy in a Toy Poodle with a single base pair insertion in exon 45 of the Duchenne muscular dystrophy gene. J Vet Med Sci 2022; 84:502-506. [PMID: 35135937 PMCID: PMC9096033 DOI: 10.1292/jvms.21-0504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 10-month-old, intact male Toy Poodle was referred for a postural abnormality. Blood biochemical tests revealed a marked increase in plasma creatine phosphokinase (CPK) concentration. The isoenzyme test showed that 99% of serum CPK consisted of CPK-MM. Histopathological evaluation of muscle biopsy samples confirmed scattered degeneration and necrosis of myofibers. Immunohistochemistry for dystrophin showed an absence of staining in muscle cells. Based on these findings, the dog was diagnosed with dystrophin-deficient muscular dystrophy. Whole genome sequencing using genomic DNA extracted from blood revealed a single base pair insertion in exon 45 of the Duchenne muscular dystrophy (DMD) gene. This is the first report on muscular dystrophy in Toy Poodles and identified a novel mutation in the DMD gene.
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Affiliation(s)
- Kosei Sakai
- Veterinary Medical Center, Graduate School of Life and Environmental Sciences, Osaka Prefecture University
| | - Tomoki Motegi
- Department of Veterinary Clinical Pathobiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - James Ken Chambers
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Kazuyuki Uchida
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Hidetaka Nishida
- Laboratory of Veterinary Surgery, Graduate School of Life and Environmental Sciences, Osaka Prefecture University
| | - Shunsuke Shimamura
- Veterinary Medical Center, Graduate School of Life and Environmental Sciences, Osaka Prefecture University
| | - Hiroyuki Tani
- Laboratory of Veterinary Internal Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University
| | - Terumasa Shimada
- Veterinary Medical Center, Graduate School of Life and Environmental Sciences, Osaka Prefecture University
| | - Masaru Furuya
- Laboratory of Veterinary Internal Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University
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Efficacy of steroid therapy for Fukuyama congenital muscular dystrophy. Sci Rep 2021; 11:24229. [PMID: 34930981 PMCID: PMC8688455 DOI: 10.1038/s41598-021-03781-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/29/2021] [Indexed: 12/04/2022] Open
Abstract
Although there is only symptomatic treatment for Fukuyama congenital muscular dystrophy (FCMD), several reports have suggested that steroid therapy could be effective for FCMD; however, no independent intervention studies have been conducted. This study aimed to evaluate the efficacy of steroid therapy for restoring motor functions in FCMD patients. This study involved 3-to-10-year-old FCMD patients who exhibited a decline in motor functions, requested steroid therapy. Patients with consent started oral administration of 0.5-mg/kg prednisolone every alternate day, which was increased to 1.0 mg/kg if the response was inadequate. We used the Gross Motor Function Measure (GMFM) to evaluate and compare the motor functions of all patients. Wilcoxon signed-rank test (significance level, P ≤ 0.05) was used for statistical analysis. At the onset of steroid therapy, 8.10 years (SD, 2.14 years) was the mean age of FCMD patients. The mean GMFM difference between before and after the steroid therapy was + 1.23 (SD, 1.10), and a P value of 0.015 represented significant improvement in GMFM. Our results indicate that steroid therapy may contribute to the maintenance and improvement of the motor functions of advanced-stage FCMD patients. Clinical Trial Registration Registration Number: UMIN000020715, Registration Date: Feb 1st, 2016 (01/02/2016).
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Takeshita S, Saito Y, Oyama Y, Watanabe Y, Ikeda A, Iai M, Sato T, Ishigaki K, Ito SI. Infection-associated decrease of serum creatine kinase levels in Fukuyama congenital muscular dystrophy. Brain Dev 2021; 43:440-447. [PMID: 33277141 DOI: 10.1016/j.braindev.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/21/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Marked decreases in serum creatine kinase levels have been noted in Duchenne and Becker muscular dystrophies as rare complications of autoimmune or autoinflammatory diseases. SUBJECTS AND METHODS The influence of systemic inflammation on serum creatine kinase levels was reviewed from the charts of three subjects with Fukuyama congenital muscular dystrophy. RESULTS A total of 30 infectious events were identified. Elevated serum C-reactive protein levels coincided with decreased creatine kinase levels on 19 occasions. In one subject, administration of 2 mg/kg/d prednisolone for bronchial asthma resulted in a decrease in creatine kinase level on six other occasions. CONCLUSION Apart from an increase in endogenous cortisol secretion, certain inflammation-related molecules could play a role in mitigating muscle cell damage in Fukuyama congenital muscular dystrophy during febrile infectious episodes. Corticosteroids may be a promising agent for the treatment of muscular symptoms in this disorder.
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Affiliation(s)
- Saoko Takeshita
- Department of Pediatrics, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama 232-0024, Japan; Division of Child Neurology, Yokohama Medical and Welfare Center, Konan, 4-6-20 Konandai, Konan-ku, Yokohama 234-0054, Japan.
| | - Yoshiaki Saito
- Department of Pediatrics, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama 232-0024, Japan; Division of Child Neurology, Yokohama Medical and Welfare Center, Konan, 4-6-20 Konandai, Konan-ku, Yokohama 234-0054, Japan
| | - Yoshitaka Oyama
- Department of Pediatrics, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama 232-0024, Japan
| | - Yoshihiro Watanabe
- Department of Pediatrics, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama 232-0024, Japan
| | - Azusa Ikeda
- Department of Neurology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama 232-8555, Japan
| | - Mizue Iai
- Department of Neurology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama 232-8555, Japan
| | - Takatoshi Sato
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Tokyo 162-8666, Japan
| | - Keiko Ishigaki
- Department of Pediatrics, Tokyo Women's Medical University, 8-1 Kawada-cho, Tokyo 162-8666, Japan
| | - Shu-Ichi Ito
- Department of Pediatrics, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Matsumura T, Komaki H. [Study of medical management for patients with Duchenne muscular dystrophy in Japan: what was changed by a practical guideline]. Rinsho Shinkeigaku 2019; 59:723-729. [PMID: 31656267 DOI: 10.5692/clinicalneurol.cn-001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In order to clarify the changes in the medical management of patients with Duchenne muscular dystrophy after publication of a practical guideline, questionnaire surveys targeting Japanese certified neurologists and child neurologists before and four years after publication of the guideline were conducted. The practical guideline was evaluated by the majority of specialists as their preferred information source. After the guideline, a more aggressive trend was seen in steroid treatment, rehabilitation, regular assessment of spinal deformity, etc., and significant differences were observed in respiratory care and nutritional management. Although there were concerns that it would be hard to produce useful guidelines due to the lack of high-level evidence for a rare disease, guidelines including expert recommendations have proved to be an important tool for disseminating best practicable care. We are planning to revise the guideline based on the results of the analysis.
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Affiliation(s)
- Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center
| | - Hirofumi Komaki
- Translational Medical Center, National Center of Neurology and Psychiatry
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Assessment of muscle involvement in patients with Duchenne muscular dystrophy via segmental multifrequency bioelectrical analysis. Neuromuscul Disord 2019; 29:671-677. [PMID: 31501001 DOI: 10.1016/j.nmd.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022]
Abstract
We investigated the usefulness of segmental multifrequency bioelectrical impedance analyses (MBIA) for assessing muscle involvement in Duchenne muscular dystrophy (DMD) patients. Bioelectrical impedance data of the upper arm, thigh, and lower leg were obtained from 29 boys with DMD (ages 2-17 years old; mean 10.8 ± 3.9 years) at three institutions along with 41 healthy controls (ages 3-16; mean 9.8 ± 3.5 years). Then the muscle density index (MDI: 1- Z250/Z5) was calculated using segmental MBIA and compared between groups. The MDI was lower in boys with DMD, relative to controls, with older DMD patients exhibiting a significant decrease in MDI. The MDI of patient thighs was significantly correlated with the percent muscle volume index (%MVI), as measured using computed tomography (r = 0.79). MDI values for the upper arm, thigh, and lower leg were all significantly correlated with the Brooke and the Vignos scales, respectively, with correlation coefficients of 0.56-0.77. Finally, MDI was significantly greater in the glucocorticoid-treated group, relative to the untreated group in all regions. Taken together, these data show that segmental MBIA is feasible for evaluating muscle involvement and might serve as an outcome measure in DMD.
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Koeks Z, Bladen CL, Salgado D, van Zwet E, Pogoryelova O, McMacken G, Monges S, Foncuberta ME, Kekou K, Kosma K, Dawkins H, Lamont L, Bellgard MI, Roy AJ, Chamova T, Guergueltcheva V, Chan S, Korngut L, Campbell C, Dai Y, Wang J, Barišić N, Brabec P, Lähdetie J, Walter MC, Schreiber-Katz O, Karcagi V, Garami M, Herczegfalvi A, Viswanathan V, Bayat F, Buccella F, Ferlini A, Kimura E, van den Bergen JC, Rodrigues M, Roxburgh R, Lusakowska A, Kostera-Pruszczyk A, Santos R, Neagu E, Artemieva S, Rasic VM, Vojinovic D, Posada M, Bloetzer C, Klein A, Díaz-Manera J, Gallardo E, Karaduman AA, Oznur T, Topaloğlu H, El Sherif R, Stringer A, Shatillo AV, Martin AS, Peay HL, Kirschner J, Flanigan KM, Straub V, Bushby K, Béroud C, Verschuuren JJ, Lochmüller H. Clinical Outcomes in Duchenne Muscular Dystrophy: A Study of 5345 Patients from the TREAT-NMD DMD Global Database. J Neuromuscul Dis 2019; 4:293-306. [PMID: 29125504 PMCID: PMC5701764 DOI: 10.3233/jnd-170280] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Recent short-term clinical trials in patients with Duchenne Muscular Dystrophy (DMD) have indicated greater disease variability in terms of progression than expected. In addition, as average life-expectancy increases, reliable data is required on clinical progression in the older DMD population. OBJECTIVE To determine the effects of corticosteroids on major clinical outcomes of DMD in a large multinational cohort of genetically confirmed DMD patients. METHODS In this cross-sectional study we analysed clinical data from 5345 genetically confirmed DMD patients from 31 countries held within the TREAT-NMD global DMD database. For analysis patients were categorised by corticosteroid background and further stratified by age. RESULTS Loss of ambulation in non-steroid treated patients was 10 years and in corticosteroid treated patients 13 years old (p = 0.0001). Corticosteroid treated patients were less likely to need scoliosis surgery (p < 0.001) or ventilatory support (p < 0.001) and there was a mild cardioprotective effect of corticosteroids in the patient population aged 20 years and older (p = 0.0035). Patients with a single deletion of exon 45 showed an increased survival in contrast to other single exon deletions. CONCLUSIONS This study provides data on clinical outcomes of DMD across many healthcare settings and including a sizeable cohort of older patients. Our data confirm the benefits of corticosteroid treatment on ambulation, need for scoliosis surgery, ventilation and, to a lesser extent, cardiomyopathy. This study underlines the importance of data collection via patient registries and the critical role of multi-centre collaboration in the rare disease field.
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Affiliation(s)
- Zaïda Koeks
- Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands
| | - Catherine L. Bladen
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Central Parkway, Newcastle upon Tyne, UK
| | - David Salgado
- AP-HM, Hôpital d’Enfants de la Timone, Département de Génétique Médicale et de Biologie Cellulaire, Marseille, France
| | - Erik van Zwet
- Leiden University Medical Center, Department of Medical Statistics, Leiden, The Netherlands
| | - Oksana Pogoryelova
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Central Parkway, Newcastle upon Tyne, UK
| | - Grace McMacken
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Central Parkway, Newcastle upon Tyne, UK
| | - Soledad Monges
- Hospital de Pediatría J. P. Garrahan, Pichincha, Argentina
| | | | - Kyriaki Kekou
- Department of Medical Genetics, Medical School, University of Athens, Choremio Research Laboratory, St. Sophia’s Children’s Hospital Thinon and Levadia Goudi, Athens, Greece
| | - Konstantina Kosma
- Department of Medical Genetics, Medical School, University of Athens, Choremio Research Laboratory, St. Sophia’s Children’s Hospital Thinon and Levadia Goudi, Athens, Greece
| | - Hugh Dawkins
- Office of Population Health Genomics, Department of Health, Perth, WA, Australia
| | - Leanne Lamont
- Office of Population Health Genomics, Department of Health, Perth, WA, Australia
| | | | | | - Teodora Chamova
- Department of Neurology, Medical University-Sofia, Sofia, Bulgaria
| | | | - Sophelia Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Lawrence Korngut
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, South Health Campus, Calgary, AB, Canada
| | - Craig Campbell
- Department of Paediatrics, Clinical Neurological Sciences & Epidemiology, Western University, London, ON, Canada
| | - Yi Dai
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jen Wang
- China DMD Care and Support Association c/o China Dolls, Xicheng district, China
| | - Nina Barišić
- Division of Paediatric Neurology, University Hospital Centre Zagreb (KBC Zagreb) University of Zagreb Medical School, Zagreb, Croatia
| | - Petr Brabec
- Institute for Biostatistic and Analyses, Masaryk University, Brno, Czech Republic
| | - Jaana Lähdetie
- Department of Child Neurology, Turku University Central Hospital, Turku, Finland
| | - Maggie C. Walter
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Olivia Schreiber-Katz
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Veronika Karcagi
- NIEH, Department of Molecular Genetics and Diagnostics, Budapest, Hungary
| | - Marta Garami
- NIEH, Department of Molecular Genetics and Diagnostics, Budapest, Hungary
| | - Agnes Herczegfalvi
- Semmelweis Medical University, II. Department of Paediatric Neurology, Budapest, Hungary
| | | | - Farhad Bayat
- Pasteur Institute of Iran, Karaj complex, Tehran, Iran
| | | | - Alessandra Ferlini
- Department of Reproduction and Growth, Department of Medical Sciences, OSPFE, University of Ferrara, Ferrara, Italy
| | - En Kimura
- 214-1-1 Ogawa-Higashi, Kodaira, Tokyo, Japan
| | | | | | | | - Anna Lusakowska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | - Rosário Santos
- Centro de Genética Médica Jacinto Magalhães, Porto, Portugal
| | - Elena Neagu
- National Institute of Legal Medicine “Mina Minovici” – Genetics Laboratory, Bucharest, Romania
| | | | - Vedrana Milic Rasic
- Clinic for Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dina Vojinovic
- Clinic for Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Epidemiology, Erasmus University, Medical Centre, Rotterdam, The Netherlands
| | - Manuel Posada
- Institute of Rare Diseases Research, SpainRDR and CIBERER, Institute of Health Carlos III, Madrid, Spain
| | - Clemens Bloetzer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andrea Klein
- Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Jordi Díaz-Manera
- Unitat de Malalties Neuromusculars, Servei de Neurologia, Hospital de la Santa Creu i Sant Pau de Barcelona, Barcelona, Spain
| | - Eduard Gallardo
- Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - A. Ayşe Karaduman
- Hacettepe University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, Altindağ, Ankara, Turkey
| | - Tunca Oznur
- Hacettepe University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, Altindağ, Ankara, Turkey
| | - Haluk Topaloğlu
- Hacettepe University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, Altindağ, Ankara, Turkey
| | - Rasha El Sherif
- Neurology & Neurogenic Unit, Egypt Air Hospital, Ain Shams University, Egypt
| | | | - Andriy V. Shatillo
- Institute of Neurology, Psychiatry and Narcology of NAMS, Kharkiv, Ukraine
| | | | | | - Jan Kirschner
- University Medical Center Freiburg, Freiburg, Germany
| | - Kevin M. Flanigan
- Center for Gene Therapy, The Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Central Parkway, Newcastle upon Tyne, UK
| | - Kate Bushby
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Central Parkway, Newcastle upon Tyne, UK
| | - Christophe Béroud
- AP-HM, Hôpital d’Enfants de la Timone, Département de Génétique Médicale et de Biologie Cellulaire, Marseille, France
| | - Jan J. Verschuuren
- Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands
| | - Hanns Lochmüller
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Central Parkway, Newcastle upon Tyne, UK
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Kameyama T, Ohuchi K, Funato M, Ando S, Inagaki S, Sato A, Seki J, Kawase C, Tsuruma K, Nishino I, Nakamura S, Shimazawa M, Saito T, Takeda S, Kaneko H, Hara H. Efficacy of Prednisolone in Generated Myotubes Derived From Fibroblasts of Duchenne Muscular Dystrophy Patients. Front Pharmacol 2018; 9:1402. [PMID: 30559667 PMCID: PMC6287205 DOI: 10.3389/fphar.2018.01402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/15/2018] [Indexed: 12/27/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is a recessive X-linked form of muscular dystrophy characterized by progressive muscle degeneration. This disease is caused by the mutation or deletion of the dystrophin gene. Currently, there are no effective treatments and glucocorticoid administration is a standard care for DMD. However, the mechanism underlying prednisolone effects, which leads to increased walking, as well as decreased muscle wastage, is poorly understood. Our purpose in this study is to investigate the mechanisms of the efficacy of prednisolone for this disease. We converted fibroblasts of normal human cell line and a DMD patient sample to myotubes by MyoD transduction using a retroviral vector. In myotubes from the MyoD-transduced fibroblasts of the DMD patient, the myotube area was decreased and its apoptosis was increased. Furthermore, we confirmed that prednisolone could rescue these pathologies. Prednisolone increased the expression of not utrophin but laminin by down-regulation of MMP-2 mRNA. These results suggest that the up-regulation of laminin may be one of the mechanisms of the efficacy of prednisolone for DMD.
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Affiliation(s)
- Tsubasa Kameyama
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan.,Department of Clinical Research, National Hospital Organization, Nagara Medical Center, Gifu, Japan
| | - Kazuki Ohuchi
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan.,Department of Clinical Research, National Hospital Organization, Nagara Medical Center, Gifu, Japan
| | - Michinori Funato
- Department of Clinical Research, National Hospital Organization, Nagara Medical Center, Gifu, Japan
| | - Shiori Ando
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan.,Department of Clinical Research, National Hospital Organization, Nagara Medical Center, Gifu, Japan
| | - Satoshi Inagaki
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan.,Department of Clinical Research, National Hospital Organization, Nagara Medical Center, Gifu, Japan
| | - Arisu Sato
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan.,Department of Clinical Research, National Hospital Organization, Nagara Medical Center, Gifu, Japan
| | - Junko Seki
- Department of Clinical Research, National Hospital Organization, Nagara Medical Center, Gifu, Japan
| | - Chizuru Kawase
- Department of Clinical Research, National Hospital Organization, Nagara Medical Center, Gifu, Japan
| | - Kazuhiro Tsuruma
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Ichizo Nishino
- Department of Molecular Therapy, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Shinsuke Nakamura
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Masamitsu Shimazawa
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Takashi Saito
- Department of Molecular Therapy, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Shin'ichi Takeda
- Department of Molecular Therapy, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Hideo Kaneko
- Department of Clinical Research, National Hospital Organization, Nagara Medical Center, Gifu, Japan
| | - Hideaki Hara
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
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10
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Takeshita E, Komaki H, Tachimori H, Miyoshi K, Yamamiya I, Shimizu-Motohashi Y, Ishiyama A, Saito T, Nakagawa E, Sugai K, Sasaki M. Urinary prostaglandin metabolites as Duchenne muscular dystrophy progression markers. Brain Dev 2018; 40:918-925. [PMID: 30006121 DOI: 10.1016/j.braindev.2018.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/04/2018] [Accepted: 06/22/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with Duchenne muscular dystrophy (DMD) exhibit increased prostaglandin D2 (PGD2) expression in necrotic muscle and increased PGD2 metabolites in their urine. In mouse models, inhibiting PGD2 production suppresses muscle necrosis, suggesting a possible intervention through PGD2-mediated activities. OBJECTIVE We investigated the involvement of PGD2 and its potential use as a marker of pathological progression in DMD. METHODS Sixty-one male children with DMD and thirty-five age-matched controls were enrolled in the study. DMD patients were divided into "ambulant" and "non-ambulant" groups, which were further subdivided into "steroid" and "non-steroid" therapy groups. Levels of the PGD2 metabolite tetranor-PGDM (t-PGDM) and creatinine were measured in both spot and 24-hour urine samples, with comparisons between groups made according to geometric mean values. RESULTS DMD patients had significantly higher levels of creatinine-corrected t-PGDM in spot urine samples as compared with the control group. Additionally, both ambulant and non-ambulant DMD groups had significantly higher levels of t-PGDM as compared with controls, with no significant difference in t-PGDM levels observed between steroid and non-steroid groups. Moreover, total creatinine excretion in 24-hour urine samples was significantly lower in DMD patients as compared with controls, and although DMD patients had lower muscle mass than controls, their overall levels of t-PGDM did not differ significantly from those in the non-ambulant and control groups. CONCLUSION PGD2 might help explain the progression and symptomatic presentations (e.g., ambulatory difficulty) associated with DMD, suggesting it as a useful pathological marker and use of a selective PGD2 inhibitor as a potential treatment modality.
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Affiliation(s)
- Eri Takeshita
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.
| | - Hirofumi Komaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Hisateru Tachimori
- Department of Mental Health and Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | | | - Yuko Shimizu-Motohashi
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Akihiko Ishiyama
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Kenji Sugai
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Masayuki Sasaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
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11
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Ambulatory capacity in Japanese patients with Duchenne muscular dystrophy. Brain Dev 2018; 40:465-472. [PMID: 29551259 DOI: 10.1016/j.braindev.2018.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/13/2018] [Accepted: 02/17/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Few long-term cohort studies have addressed changes in the ambulatory capacity of patients with Duchenne muscular dystrophy (DMD), and no reports have evaluated the factors associated with ambulatory capacity in Japanese. METHODS The longitudinal changes in 10-meter run/walk ability and associated factors were retrospectively investigated using general practice data. The factors associated with loss of this ability before the age of 10 years were explored by logistic regression analysis using parameters of genetic mutations, corticosteroid use, the manual muscle test (MMT), and the joint range of motion (ROM). Explanatory variables of MMT grade included hip flexors, knee flexors, and knee extensors; ROM included hip extension, knee extension, and ankle dorsiflexion. RESULTS Among 418 patients diagnosed with DMD, 145 patients underwent the 10-meter run/walk test between March 1999 and July 2015. The median age at loss of 10-meter walking ability was 10.4 (interquartile range: 9.2-11.3) years. The 10-meter run/walk speed began to decline 3 years before the loss of 10-meter walking ability, and the median was <1 m/s 1 year before the loss of 10-meter walking ability. MMT grade for knee flexors and ROM for hip and knee extension were identified as independent predictors. Based on the change over time of these three items, limitation of the hip extension ROM preceded knee flexor weakness and limitation of the knee extension ROM. CONCLUSIONS This knowledge can be used in optimizing rehabilitation programs and evaluating effect of treatment for DMD patients.
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12
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Liang WC, Wang CH, Chou PC, Chen WZ, Jong YJ. The natural history of the patients with Duchenne muscular dystrophy in Taiwan: A medical center experience. Pediatr Neonatol 2018; 59:176-183. [PMID: 28903883 DOI: 10.1016/j.pedneo.2017.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/24/2016] [Accepted: 02/15/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is the most common hereditary muscular dystrophy and caused by DMD gene mutation. In addition to progressive proximal muscle weakness, respiratory, orthopedic, and gastrointestinal complications are often observed in DMD. The natural history of patients with DMD in Taiwan has not been reported thus far. METHODS Medical records of 39 patients who received a diagnosis of DMD between 1999 and 2016 at Kaohsiung Medical University Hospital were reviewed. The diagnosis of DMD was confirmed through muscle biopsy or DMD genetic analysis. RESULTS The mean onset age and mean follow-up period were 2.75 years and 6.76 years, respectively. Seventeen patients (43.5%) had a family history of DMD. The mean full intelligence quotient of the patients was 71.08, and the mean age of walking ability loss was 9.7 years (25 patients). The mean onset age of respiratory insufficiency was 10.64 years with a decline rate of 5.18% per year (25 patients). The mean onset age of cardiomyopathy was 14.69 years (seven patients). The mean onset age of scoliosis was 13.29 years with a progression rate of 11.48° per year (14 patients). Eleven (28.2%) and eight (20.5%) patients had deletions and duplications of DMD, respectively. Fourteen patients (35.9%) had point mutations or small deletions or insertions. Five patients received only multiplex ligation-dependent probe amplification (MLPA) analysis and exhibited neither deletion nor duplication. No mutation was identified in one patient through both MLPA and exon sequencing. CONCLUSION The clinical phenotypes and disease course in our cohort were consistent with that reported in previous studies. However, the proportion of point mutations or small deletions or insertions in our study was considerably higher than that in reports from other populations. Cardiac ejection fraction was found not a reliable biomarker for identifying cardiac problems, discovering a better parameter is necessary.
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Affiliation(s)
- Wen-Chen Liang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Hua Wang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Ching Chou
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Zi Chen
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuh-Jyh Jong
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
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13
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Vry J, Gramsch K, Rodger S, Thompson R, Steffensen BF, Rahbek J, Doerken S, Tassoni A, Beytía MDLA, Guergueltcheva V, Chamova T, Tournev I, Kostera-Pruszczyk A, Kaminska A, Lusakowska A, Mrazova L, Pavlovska L, Strenkova J, Vondráček P, Garami M, Karcagi V, Herczegfalvi Á, Bushby K, Lochmüller H, Kirschner J. European Cross-Sectional Survey of Current Care Practices for Duchenne Muscular Dystrophy Reveals Regional and Age-Dependent Differences. J Neuromuscul Dis 2018; 3:517-527. [PMID: 27911335 PMCID: PMC5240601 DOI: 10.3233/jnd-160185] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Publication of comprehensive clinical care guidelines for Duchenne muscular dystrophy (DMD) in 2010 was a milestone for DMD patient management. Our CARE-NMD survey investigates the neuromuscular, medical, and psychosocial care of DMD patients in Europe, and compares it to the guidelines. Methods: A cross-sectional survey of 1677 patients contacted via the TREAT-NMD patient registries was conducted using self-report questionnaires in seven European countries. Results: Survey respondents were 861 children and 201 adults. Data describe a European DMD population with mean age of 13.0 years (range 0.8–46.2) of whom 53% had lost ambulation (at 10.3 years of age, median). Corticosteroid medication raised the median age for ambulatory loss from 10.1 years in patients never medicated to 11.4 years in patients who received steroids (p < 0.0001). The majority of patients reported receiving care in line with guidelines, although we identified significant differences between countries and important shortcomings in prevention and treatment. Summarised, 35% of patients aged≥ nine years received no corticosteroid medication, 24% of all patients received no regular physiotherapy, echocardiograms were not performed regularly in 22% of patients, pulmonary function was not regularly assessed in 71% of non-ambulatory patients. Patients with regular follow-up by neuromuscular specialists were more likely to receive care according to guidelines, were better satisfied, and experienced shorter unplanned hospitalization periods.
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Affiliation(s)
- Julia Vry
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
| | - Kathrin Gramsch
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
| | - Sunil Rodger
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
| | - Rachel Thompson
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
| | | | - Jes Rahbek
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | - Sam Doerken
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Adrian Tassoni
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
| | - María de Los Angeles Beytía
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
| | - Velina Guergueltcheva
- Medical University of Sofia, Department of Neurology, University Hospital Sofiamed and Bulgarian Neuromuscular Disorders Society, Sofia, Bulgaria
| | - Teodora Chamova
- Medical University of Sofia, Department of Neurology, University Hospital Alexandrovska and Bulgarian Neuromuscular Disorders Society, Sofia, Bulgaria
| | - Ivailo Tournev
- Medical University of Sofia, Department of Neurology, University Hospital Alexandrovska and Bulgarian Neuromuscular Disorders Society, Sofia, Bulgaria
| | | | - Anna Kaminska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Lusakowska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Lenka Mrazova
- Department of Paediatric Neurology, University Hospital in Brno and Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - Lenka Pavlovska
- Institute of Biostatistics and Analyses, Masaryk University Brno, Czech Republic
| | - Jana Strenkova
- Institute of Biostatistics and Analyses, Masaryk University Brno, Czech Republic
| | - Petr Vondráček
- Department of Paediatric Neurology, University Hospital in Brno and Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - Marta Garami
- Department of Molecular Genetics and Diagnostics, National Institute of Environmental Health, Budapest, Hungary
| | - Veronika Karcagi
- Department of Molecular Genetics and Diagnostics, National Institute of Environmental Health, Budapest, Hungary
| | | | - Katherine Bushby
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
| | - Hanns Lochmüller
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
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14
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Ponnusamy S, Sullivan RD, You D, Zafar N, He Yang C, Thiyagarajan T, Johnson DL, Barrett ML, Koehler NJ, Star M, Stephenson EJ, Bridges D, Cormier SA, Pfeffer LM, Narayanan R. Androgen receptor agonists increase lean mass, improve cardiopulmonary functions and extend survival in preclinical models of Duchenne muscular dystrophy. Hum Mol Genet 2017; 26:2526-2540. [PMID: 28453658 DOI: 10.1093/hmg/ddx150] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/18/2017] [Indexed: 12/18/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is a neuromuscular disease that predominantly affects boys as a result of mutation(s) in the dystrophin gene. DMD is characterized by musculoskeletal and cardiopulmonary complications, resulting in shorter life-span. Boys afflicted by DMD typically exhibit symptoms within 3-5 years of age and declining physical functions before attaining puberty. We hypothesized that rapidly deteriorating health of pre-pubertal boys with DMD could be due to diminished anabolic actions of androgens in muscle, and that intervention with an androgen receptor (AR) agonist will reverse musculoskeletal complications and extend survival. While castration of dystrophin and utrophin double mutant (mdx-dm) mice to mimic pre-pubertal nadir androgen condition resulted in premature death, maintenance of androgen levels extended the survival. Non-steroidal selective-AR modulator, GTx-026, which selectively builds muscle and bone was tested in X-linked muscular dystrophy mice (mdx). GTx-026 significantly increased body weight, lean mass and grip strength by 60-80% over vehicle-treated mdx mice. While vehicle-treated castrated mdx mice exhibited cardiopulmonary impairment and fibrosis of heart and lungs, GTx-026 returned cardiopulmonary function and intensity of fibrosis to healthy control levels. GTx-026 elicits its musculoskeletal effects through pathways that are distinct from dystrophin-regulated pathways, making AR agonists ideal candidates for combination approaches. While castration of mdx-dm mice resulted in weaker muscle and shorter survival, GTx-026 treatment increased the muscle mass, function and survival, indicating that androgens are important for extended survival. These preclinical results support the importance of androgens and the need for intervention with AR agonists to treat DMD-affected boys.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Erin J Stephenson
- Department of Pediatrics.,Department of Physiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dave Bridges
- Department of Pediatrics.,Department of Physiology, University of Tennessee Health Science Center, Memphis, TN, USA
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15
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Okubo M, Goto K, Komaki H, Nakamura H, Mori-Yoshimura M, Hayashi YK, Mitsuhashi S, Noguchi S, Kimura E, Nishino I. Comprehensive analysis for genetic diagnosis of Dystrophinopathies in Japan. Orphanet J Rare Dis 2017; 12:149. [PMID: 28859693 PMCID: PMC5580216 DOI: 10.1186/s13023-017-0703-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/23/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is the most common disease in children caused by mutations in the DMD gene, and DMD and Becker muscular dystrophy (BMD) are collectively called dystrophinopathies. Dystrophinopathies show a complex mutation spectrum. The importance of mutation databases, with clinical phenotypes and protein studies of patients, is increasingly recognized as a reference for genetic diagnosis and for the development of gene therapy. METHODS We used the data from the Japanese Registry of Muscular Dystrophy (Remudy) compiled during from July 2009 to March 2017, and reviewed 1497 patients with dystrophinopathies. RESULTS The spectrum of identified mutations contained exon deletions (61%), exon duplications (13%), nonsense mutations (13%), small deletions (5%), small insertions (3%), splice-site mutations (4%), and missense mutations (1%). Exon deletions were found most frequently in the central hot spot region between exons 45-52 (42%), and most duplications were detected in the proximal hot spot region between exons 3-25 (47%). In the 371 patients harboring a small mutation, 194 mutations were reported and 187 mutations were unreported. CONCLUSIONS We report the largest dystrophinopathies mutation dataset in Japan from a national patient registry, "Remudy". This dataset provides a useful reference to support the genetic diagnosis and treatment of dystrophinopathy.
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Affiliation(s)
- Mariko Okubo
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502, Japan.,Department of Pediatrics, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kanako Goto
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502, Japan.,Department of Genome Medicine Development, Medical Genome Center, NCNP, Tokyo, Japan
| | - Hirofumi Komaki
- Department of Child Neurology, National Center Hospital, NCNP, Tokyo, Japan
| | - Harumasa Nakamura
- Department of Neurology, National Center Hospital, NCNP, Tokyo, Japan
| | | | - Yukiko K Hayashi
- Department of Pathophysiology, Tokyo Medical University, Tokyo, Japan
| | - Satomi Mitsuhashi
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502, Japan.,Department of Genome Medicine Development, Medical Genome Center, NCNP, Tokyo, Japan
| | - Satoru Noguchi
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502, Japan
| | - En Kimura
- Department of Promoting Clinical Trial and Translational Medicine, Translational Medical Center, NCNP, Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502, Japan. .,Department of Genome Medicine Development, Medical Genome Center, NCNP, Tokyo, Japan.
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16
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Jensen L, Petersson S, Illum N, Laugaard-Jacobsen H, Thelle T, Jørgensen L, Schrøder H. Muscular response to the first three months of deflazacort treatment in boys with Duchenne muscular dystrophy. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2017; 17:8-18. [PMID: 28574407 PMCID: PMC5492315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Duchenne muscular dystrophy (DMD) patients are often treated with glucocorticoids; yet their precise molecular action remains unknown. METHODS We investigated muscle biopsies from nine boys with DMD (aged: 7,6±2,8 yrs.) collected before and after three months of deflazacort treatment and compared them to eight healthy boys (aged: 5,3±2,4 yrs.). mRNA transcripts involved in activation of satellite cells, myogenesis, regeneration, adipogenesis, muscle growth and tissue inflammation were assessed. Serum creatine kinase (CK) levels and muscle protein expression by immunohistochemistry of selected targets were also analysed. RESULTS Transcript levels for ADIPOQ, CD68, CDH15, FGF2, IGF1R, MYF5, MYF6, MYH8, MYOD, PAX7, and TNFα were significantly different in untreated patients vs. normal muscle (p⟨0.05). Linear tests for trend indicated that the expression levels of treated patients were approaching normal values (p⟨0.05) following treatment (towards an increase; CDH15, C-MET, DLK1, FGF2, IGF1R, MYF5, MYF6, MYOD, PAX7; towards a decrease: CD68, MYH8, TNFα). Treatment reduced CK levels (p⟨0.05), but we observed no effect on muscle protein expression. CONCLUSIONS This study provides insight into the molecular actions of glucocorticoids in DMD at the mRNA level, and we show that multiple regulatory pathways are influenced. This information can be important in the development of new treatments.
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Affiliation(s)
- L. Jensen
- Department of Clinical Pathology, Institute of Clinical Research, University of Southern Denmark and Odense University Hospital, 5000 Odense C, Denmark
| | - S.J. Petersson
- Department of Clinical Pathology, Institute of Clinical Research, University of Southern Denmark and Odense University Hospital, 5000 Odense C, Denmark
| | - N.O. Illum
- H.C. Andersen Children’s Hospital, Odense University Hospital, 5000 Odense C, Denmark
| | | | - T. Thelle
- Pediatric Department, Regional Hospital Central Jutland, 8800 Viborg, Denmark
| | - L.H. Jørgensen
- Department of Clinical Pathology, Institute of Clinical Research, University of Southern Denmark and Odense University Hospital, 5000 Odense C, Denmark
| | - H.D. Schrøder
- Department of Clinical Pathology, Institute of Clinical Research, University of Southern Denmark and Odense University Hospital, 5000 Odense C, Denmark,Corresponding author: Henrik Daa Schrøder, Institute of Clinical Research, Clinical Pathology, Odense University Hospital, JB. Winsløw Vej 15, 2. DK-5000 Odense C, Denmark E-mail:
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17
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Wang DN, Wang ZQ, Yan L, He J, Lin MT, Chen WJ, Wang N. Clinical and mutational characteristics of Duchenne muscular dystrophy patients based on a comprehensive database in South China. Neuromuscul Disord 2017; 27:715-722. [PMID: 28318817 DOI: 10.1016/j.nmd.2017.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 11/16/2022]
Abstract
The development of clinical trials for Duchenne muscular dystrophy (DMD) in China faces many challenges due to limited information about epidemiological data, natural history and clinical management. To provide these detailed data, we developed a comprehensive database based on registered DMD patients from South China and analysed their clinical and mutational characteristics. The database included DMD registrants confirmed by clinical presentation, family history, genetic detection, prognostic outcome, and/or muscle biopsy. Clinical data were collected by a registry form. Mutations of dystrophin were detected by multiplex ligation-dependent probe amplification (MLPA) and Sanger sequencing. Currently, 132 DMD patients from 128 families in South China have been registered, and 91.7% of them were below 10 years old. In mutational detection, large deletions were the most frequent type (57.8%), followed by small deletion/insertion mutations (14.1%), nonsense mutations (13.3%), large duplications (10.9%), and splice site mutations (3.1%). Clinical analysis revealed that most patients reported initial symptoms between 1 and 3 years of age, but the diagnostic age was more frequently between 6 and 8 years. 81.4% of patients were ambulatory. Baseline cardiac assessments at diagnosis were conducted in 39.4% and 29.5% of patients by echocardiograms and electrocardiograms, respectively. Only 22.7% of registrants performed baseline respiratory assessments. A small numbers of patients (20.5%) were treated with glucocorticoids. 13.3% of patients were eligible for stop codon read-through therapy, and 48.4% of patients would potentially benefit from exon skipping. The top five exon skips applicable to the largest group of registrants were skipping of exons 51 (14.8% of total mutations), 53 (12.5%), 45 (7.0%), 55 (4.7%), and 44 (3.9%). In conclusion, our database provided information on the natural history, diagnosis and management status of DMD in South China, as well as potential molecular therapies suitable for these patients. This comprehensive database will promote future experimental therapies in China.
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Affiliation(s)
- Dan-Ni Wang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi-Qiang Wang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
| | - Lei Yan
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jin He
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
| | - Min-Ting Lin
- Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Molecular Neurology, Fuzhou, China.
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Saito T, Kawai M, Kimura E, Ogata K, Takahashi T, Kobayashi M, Takada H, Kuru S, Mikata T, Matsumura T, Yonemoto N, Fujimura H, Sakoda S. Study of Duchenne muscular dystrophy long-term survivors aged 40 years and older living in specialized institutions in Japan. Neuromuscul Disord 2016; 27:107-114. [PMID: 28003112 DOI: 10.1016/j.nmd.2016.11.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/29/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
The national muscular dystrophy wards database of Japan lists 118 long-term Duchenne muscular dystrophy (DMD) patients who were at least 40 years old as of October 1, 2013. To elucidate the clinical features of DMD patients aged 40 years and older, we obtained gene analysis and muscle biopsy findings, as well as medical condition information. Ninety-four of the registered patients consented to participate, of whom 55 meeting genetic or biochemical criteria confirming DMD were analyzed. The mean age at the time of the study was 43.6 ± 3.0 years, while at the time of independent ambulation loss it was 10.6 ± 1.5 years and at mechanical ventilation introduction it was 24.1 ± 5.5 years. All were receiving continuous ventilation support, 27 with non-invasive positive pressure ventilation and 28 with tracheal intermittent positive pressure ventilation. Thirty-eight were receiving β-blockers or a renin-angiotensin system inhibitor, while 9 were free from those agents. Forty had maintained oral nutrition. The 55 analyzed patients had survived into their 40s by receiving multidisciplinary intervention. Our findings emphasize the need of future studies to investigate disease modifiers and the mechanism of long-term survival. In addition, establishment of a worldwide care standard with focus on quality of life for adult males with DMD is important.
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Affiliation(s)
- Toshio Saito
- Division of Child Neurology, Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan.
| | - Mitsuru Kawai
- Department of Neurology, National Hospital Organization Higashisaitama Hospital, Hasuda, Saitama, Japan
| | - En Kimura
- National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Katsuhisa Ogata
- Department of Neurology, National Hospital Organization Higashisaitama Hospital, Hasuda, Saitama, Japan
| | - Toshiaki Takahashi
- Department of Neurology, National Hospital Organization Sendai-Nishitaga National Hospital, Sendai, Miyagi, Japan
| | - Michio Kobayashi
- Department of Neurology, National Hospital Organization National Akita Hospital, Yurihonjo, Akita, Japan
| | - Hiroto Takada
- Department of Neurology, National Hospital Organization National Aomori Hospital, Aomori, Japan
| | - Satoshi Kuru
- Department of Neurology, National Hospital Organization National Suzuka Hospital, Suzuka, Mie, Japan
| | - Takashi Mikata
- Department of Neurology, National Hospital Organization National Shimoshizu Hospital, Yotsukaido, Chiba, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Naohiro Yonemoto
- National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Harutoshi Fujimura
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Saburo Sakoda
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
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Fujino H, Iwata Y, Saito T, Matsumura T, Fujimura H, Imura O. The experiences of patients with Duchenne muscular dystrophy in facing and learning about their clinical conditions. Int J Qual Stud Health Well-being 2016; 11:32045. [PMID: 27712620 PMCID: PMC5054085 DOI: 10.3402/qhw.v11.32045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 01/15/2023] Open
Abstract
Patients experience extreme difficulty when facing an intractable genetic disease. Herein, we examine the experiences of patients with Duchenne muscular dystrophy in facing and learning about their disease. A total of seven patients with Duchenne muscular dystrophy (age range: 20–48) participated. We conducted in-depth interviews with them about how they learned of their disease and how their feelings regarding the disease changed over time. Transcribed data were analysed using thematic analysis. The following themes emerged from this analysis: “experiences before receiving the diagnosis,” “experiences when they learned of their condition and progression of the disease,” “supports,” and “desired explanations.” Anxiety and worry were most pronounced when they had to transition to using wheelchairs or respirators due to disease progression; indeed, such transitions affect the patients psychological adjustment. In such times, support from significant others in their lives helped patients adjust.
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Affiliation(s)
- Haruo Fujino
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan.,Faculty of Education, Oita University, Oita, Japan;
| | - Yuko Iwata
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Toshio Saito
- Division of Child Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan.,Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Harutoshi Fujimura
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Osaka, Japan
| | - Osamu Imura
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
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Goto M, Komaki H, Takeshita E, Abe Y, Ishiyama A, Sugai K, Sasaki M, Goto YI, Nonaka I. Long-term outcomes of steroid therapy for Duchenne muscular dystrophy in Japan. Brain Dev 2016; 38:785-91. [PMID: 27112384 DOI: 10.1016/j.braindev.2016.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/30/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Corticosteroids are effective for improving motor function in patients with Duchenne muscular dystrophy (DMD), but there is no consensus on a regimen that balances efficacy and side effects. METHODS Data from three groups of DMD patients were retrospectively analyzed: those treated with 0.75mg/kg/day prednisolone every day (daily group, n=51); those treated with 1mg/kg/day prednisolone on alternate days (intermittent group, n=36), and those not treated with steroids (nontreatment group, n=42). RESULTS Although the age of ambulation loss did not differ significantly among the groups, the hazard ratios for ambulation loss relative to the nontreatment group were 0.24 (95% confidence interval [CI]: 0.11-0.54) in the daily group and 0.34 (95% CI: 0.19-0.62) in the intermittent group. The percentage of predicted forced vital capacity increased until 9.6years of age (to 94.1%) in the daily group, until 8.8years of age (to 96.9%) in the intermittent group, and until 7.2years of age (to 87.6%) in the nontreatment group. Weight gain was the most frequently observed side effect in the treated groups. Height was significantly lower in the daily than in the nontreatment group. Other side effects were observed, but no patient discontinued therapy. There were no marked differences in benefits and side effects between the two treated groups. DISCUSSION This is the first assessment of long-term outcomes of different steroid therapy regimens in Japanese DMD patients. Benefits and side effects, except height, did not differ significantly between steroid regimens.
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Affiliation(s)
- Masahide Goto
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hirofumi Komaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Eri Takeshita
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshiki Abe
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Ishiyama
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kenji Sugai
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masayuki Sasaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yu-Ichi Goto
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ikuya Nonaka
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
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Ishizaki M, Kedoin C, Ueyama H, Maeda Y, Yamashita S, Ando Y. Utility of skinfold thickness measurement in non-ambulatory patients with Duchenne muscular dystrophy. Neuromuscul Disord 2016; 27:24-28. [PMID: 27793470 DOI: 10.1016/j.nmd.2016.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/23/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
Nutritional disorders in Duchenne muscular dystrophy (DMD) worsen the medical condition. In particular, obesity is a serious problem that increases the risk of cardiomyopathy and affects nursing care. However, it is often difficult to evaluate body fatness in the advanced stages of DMD. Skinfold thickness measurement is a classical method to evaluate body fatness and is easily performed, even for bed-bound patients at home. We aimed to investigate the utility of skinfold thickness measurement in non-ambulatory DMD patients. Twenty-two patients with non-ambulatory, steroid-naive DMD ranging in age of 12-47 years were evaluated by body mass index (BMI), blood tests, measurement of triceps skinfold thickness (TSF), and abdominal computed tomography (CT) measurement of the areas of both subcutaneous and visceral fat. TSF showed good correlation with BMI (r = 0.80; p < 0.001), serum triglycerides (r = 0.67; p < 0.01), area of subcutaneous fat (r = 0.85; p < 0.0001), and area of visceral fat (r = 0.76; p < 0.0001). These results indicate the skinfold thickness measurement may be applicable as a screening tool in clinical practice where CT and magnetic resonance imaging assessment is often difficult in patients with advanced DMD.
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Affiliation(s)
- Masatoshi Ishizaki
- Department of Neurology, National Hospital Organization, Kumamoto Saishunsou National Hospital, Kumamoto, Japan; Department of Neurology, National Hospital Organization, Kumamoto Minami Hospital, Kumamoto, Japan.
| | - Chika Kedoin
- Department of Nutrition, National Hospital Organization, Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Hidetsugu Ueyama
- Department of Neurology, National Hospital Organization, Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Yasushi Maeda
- Department of Neurology, National Hospital Organization, Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Satoshi Yamashita
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Petnikota H, Madhuri V, Gangadharan S, Agarwal I, Antonisamy B. Retrospective cohort study comparing the efficacy of prednisolone and deflazacort in children with muscular dystrophy: A 6 years' experience in a South Indian teaching hospital. Indian J Orthop 2016; 50:551-557. [PMID: 27746500 PMCID: PMC5017179 DOI: 10.4103/0019-5413.189609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Muscular dystrophies are inherited myogenic disorders characterized by progressive muscle wasting and weakness of variable distribution and severity. They are a heterogeneous group characterized by variable degree of skeletal and cardiac muscle involvement. The most common and the most severe form of muscular dystrophy is DMD. Currently, there is no curative treatment for muscular dystrophies. Several drugs have been studied to retard the progression of the muscle weakness. There is much controversy about steroid usage in muscular dystrophy with respect to regimen, adverse effects, and whether long term benefits outweigh side effects. This study is to assess steroid efficacy in children with muscular dystrophy. MATERIALS AND METHODS All children with diagnosed muscular dystrophy by muscle biopsy, immunohistochemistry and/or genetic test were enrolled in the study. They were started on either prednisolone (0.75 mg/kg/day) or deflazacort 0.9 mg/kg/day based on affordability. All were followed up every 6 months with clinical assessment, quality of life questionnaire and clinical and laboratory assessment of side effects. Outcome measures of children on deflazacort and prednisolone at 1 year followup were summarized as numbers and percentages and were compared using Fisher's exact test. RESULTS Twenty two children with muscular dystrophy were included (prednisolone group: 10 and deflazacort group: 12). The mean age was 7.7 years at an average followup of 26.4 months. Twenty children were diagnosed to have Duchenne's; one had Becker's muscular dystrophy while one had sarcoglycanopathy by Type 2C. All children from prednisolone group maintained their ambulatory status at 2 and 4 years followups while three on deflazacort lost their ability to walk at an average age of 11.3 years. All activities of daily living were found to be better in prednisolone group. Muscle function and time taken to walk improved in prednisolone group. Weight gain in children on prednisolone was three times more. CONCLUSIONS Prednisolone is more beneficial than deflazacort at doses of 0.75 mg/kg/day and 0.9 mg/kg/day, respectively, however it is associated with adverse effects.
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Affiliation(s)
- Harish Petnikota
- Department of Paediatric Orthopaedics, CMC, Vellore, Tamil Nadu, India
| | - Vrisha Madhuri
- Department of Paediatric Orthopaedics, CMC, Vellore, Tamil Nadu, India,Address for correspondence: Dr. Vrisha Madhuri, Department of Paediatric Orthopaedics, Paul Brand Building, Christian Medical College, Vellore - 632 004, Tamil Nadu, India. E-mail:
| | | | - Indira Agarwal
- Department of Child Health, CMC, Vellore, Tamil Nadu, India
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Impact of a Comparative Study on the Management of Scoliosis in Duchenne Muscular Dystrophy: Are Corticosteroids Decreasing the Rate of Scoliosis Surgery in the United States? Spine (Phila Pa 1976) 2016; 41:E1030-E1038. [PMID: 26926354 DOI: 10.1097/brs.0000000000001534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional analysis. OBJECTIVE The aim of this study was to determine whether the surgical treatment for scoliosis due to Duchenne muscular dystrophy (DMD) has decreased over a recent 11-year period, specifically, after the wide acceptance of glucocorticoid treatment for DMD. SUMMARY OF BACKGROUND DATA DMD can result in a flaccid neuromuscular scoliosis that has been traditionally treated surgically. In 2004, a comparative study demonstrated that glucocorticoid treatment decreased the progression of scoliosis in DMD. METHODS We used the Nationwide Inpatient Sample from 2001 to 2012 to identify patients with DMD undergoing spinal fusion. Demographic information (age, hospital size, location, geographic status) was collected. We examined the distribution of patient and hospital characteristics among cohorts undergoing spinal fusion from 2001 to 2004 (period 1; before publication of the comparative study), 2005 to 2008 (period 2; immediately following publication of the comparative study), and 2009 to 2012 (period 3; moderate duration following publication of the comparative study). RESULTS We identified 1874 males undergoing spinal fusion. During this period, the overall rate of DMD surgeries declined by 48%-from 1.87 surgeries in 2001 to 0.97 surgeries in 2012 per million US males per year. This decline was significantly pronounced following the publication of the comparative study [periods 2 and 3; For period 2 vs. period 1: incidence rate ratio (IRR) = 0.71, 95% confidence interval (95% CI) = 0.56-0.91, P = 0.01; For period 3 vs. period 1: IRR = 0.77, 95% CI = 0.61-0.97, P = 0.03]. CONCLUSION Our study demonstrates a significant decrease in the rate of scoliosis surgery for DMD from 2001 to 2012. It appears that the decline in surgical treatment could be related to the publication and landmark study demonstrating decreased progression of scoliosis with glucocorticoid treatment. LEVEL OF EVIDENCE 3.
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24
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Takeuchi F, Komaki H, Nakamura H, Yonemoto N, Kashiwabara K, Kimura E, Takeda S. Trends in steroid therapy for Duchenne muscular dystrophy in Japan. Muscle Nerve 2016; 54:673-80. [PMID: 26910583 PMCID: PMC5113709 DOI: 10.1002/mus.25083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 02/05/2016] [Accepted: 02/16/2016] [Indexed: 01/10/2023]
Abstract
Introduction: We conducted a study to reveal trends in steroid prescription for Duchenne muscular dystrophy (DMD) patients in Japan. Methods: We asked patients (ages 5–20 years) identified in the patient registry and their clinicians about steroid therapy experiences. Regimen, dose, and starting age were compared among 3 subgroups according to prednisolone initiation year (2000–2004, 2005–2009, and 2010–2013). Results: Among 157 prednisolone users, 4 different regimens were used. Dose frequencies were: every other day (98 patients), daily (44 patients), 10 days on 20 days off (14 patients), and weekly (1 patient). Median starting age was 6 years, and median dose was 0.42 mg/kg/day. There was an increase in daily regimen use from 2005–2009 (n = 9, 16%) to 2010–2013 (n = 33, 36%). Conclusions: This study revealed a transition over time in steroid use from expert opinion to evidence‐based recommendation. Clinical research should be encouraged to optimize medication worldwide. Muscle Nerve54: 673–680, 2016
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Affiliation(s)
- Fumi Takeuchi
- Department of Clinical Research Support, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hirofumi Komaki
- Department of Child Neurology, National Center of Neurology and Psychiatry 4-1-1 Ogawa-higashi, Kodaira, Tokyo, 187-8551, Japan.
| | - Harumasa Nakamura
- Department of Clinical Research Support, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kousuke Kashiwabara
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - En Kimura
- Department of Clinical Research Support, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shin'ichi Takeda
- Department of Molecular Therapy, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
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Matthews E, Brassington R, Kuntzer T, Jichi F, Manzur AY. Corticosteroids for the treatment of Duchenne muscular dystrophy. Cochrane Database Syst Rev 2016; 2016:CD003725. [PMID: 27149418 PMCID: PMC8580515 DOI: 10.1002/14651858.cd003725.pub4] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy of childhood. Untreated, this incurable disease, which has an X-linked recessive inheritance, is characterised by muscle wasting and loss of walking ability, leading to complete wheelchair dependence by 13 years of age. Prolongation of walking is a major aim of treatment. Evidence from randomised controlled trials (RCTs) indicates that corticosteroids significantly improve muscle strength and function in boys with DMD in the short term (six months), and strength at two years (two-year data on function are very limited). Corticosteroids, now part of care recommendations for DMD, are largely in routine use, although questions remain over their ability to prolong walking, when to start treatment, longer-term balance of benefits versus harms, and choice of corticosteroid or regimen.We have extended the scope of this updated review to include comparisons of different corticosteroids and dosing regimens. OBJECTIVES To assess the effects of corticosteroids on prolongation of walking ability, muscle strength, functional ability, and quality of life in DMD; to address the question of whether benefit is maintained over the longer term (more than two years); to assess adverse events; and to compare efficacy and adverse effects of different corticosteroid preparations and regimens. SEARCH METHODS On 16 February 2016 we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL Plus, and LILACS. We wrote to authors of published studies and other experts. We checked references in identified trials, handsearched journal abstracts, and searched trials registries. SELECTION CRITERIA We considered RCTs or quasi-RCTs of corticosteroids (e.g. prednisone, prednisolone, and deflazacort) given for a minimum of three months to patients with a definite DMD diagnosis. We considered comparisons of different corticosteroids, regimens, and corticosteroids versus placebo. DATA COLLECTION AND ANALYSIS The review authors followed standard Cochrane methodology. MAIN RESULTS We identified 12 studies (667 participants) and two new ongoing studies for inclusion. Six RCTs were newly included at this update and important non-randomised cohort studies have also been published. Some important studies remain unpublished and not all published studies provide complete outcome data. PRIMARY OUTCOME MEASURE one two-year deflazacort RCT (n = 28) used prolongation of ambulation as an outcome measure but data were not adequate for drawing conclusions. SECONDARY OUTCOME MEASURES meta-analyses showed that corticosteroids (0.75 mg/kg/day prednisone or prednisolone) improved muscle strength and function versus placebo over six months (moderate quality evidence from up to four RCTs). Evidence from single trials showed 0.75 mg/kg/day superior to 0.3 mg/kg/day on most strength and function measures, with little evidence of further benefit at 1.5 mg/kg/day. Improvements were seen in time taken to rise from the floor (Gowers' time), timed walk, four-stair climbing time, ability to lift weights, leg function grade, and forced vital capacity. One new RCT (n = 66), reported better strength, function and quality of life with daily 0.75 mg/kg/day prednisone at 12 months. One RCT (n = 28) showed that deflazacort stabilised muscle strength versus placebo at two years, but timed function test results were too imprecise for conclusions to be drawn.One double-blind RCT (n = 64), largely at low risk of bias, compared daily prednisone (0.75 mg/kg/day) with weekend-only prednisone (5 mg/kg/weekend day), finding no overall difference in muscle strength and function over 12 months (moderate to low quality evidence). Two small RCTs (n = 52) compared daily prednisone 0.75 mg/kg/day with daily deflazacort 0.9 mg/kg/day, but study methods limited our ability to compare muscle strength or function. ADVERSE EFFECTS excessive weight gain, behavioural abnormalities, cushingoid appearance, and excessive hair growth were all previously shown to be more common with corticosteroids than placebo; we assessed the quality of evidence (for behavioural changes and weight gain) as moderate. Hair growth and cushingoid features were more frequent at 0.75 mg/kg/day than 0.3 mg/kg/day prednisone. Comparing daily versus weekend-only prednisone, both groups gained weight with no clear difference in body mass index (BMI) or in behavioural changes (low quality evidence for both outcomes, one study); the weekend-only group had a greater linear increase in height. Very low quality evidence suggested less weight gain with deflazacort than with prednisone at 12 months, and no difference in behavioural abnormalities. Data are insufficient to assess the risk of fractures or cataracts for any comparison.Non-randomised studies support RCT evidence in showing improved functional benefit from corticosteroids. These studies suggest sustained benefit for up to 66 months. Adverse effects were common, although generally manageable. According to a large comparative longitudinal study of daily or intermittent (10 days on, 10 days off) corticosteroid for a mean period of four years, a daily regimen prolongs ambulation and improves functional scores over the age of seven, but with a greater frequency of side effects than an intermittent regimen. AUTHORS' CONCLUSIONS Moderate quality evidence from RCTs indicates that corticosteroid therapy in DMD improves muscle strength and function in the short term (twelve months), and strength up to two years. On the basis of the evidence available for strength and function outcomes, our confidence in the effect estimate for the efficacy of a 0.75 mg/kg/day dose of prednisone or above is fairly secure. There is no evidence other than from non-randomised trials to establish the effect of corticosteroids on prolongation of walking. In the short term, adverse effects were significantly more common with corticosteroids than placebo, but not clinically severe. A weekend-only prednisone regimen is as effective as daily prednisone in the short term (12 months), according to low to moderate quality evidence from a single trial, with no clear difference in BMI (low quality evidence). Very low quality evidence indicates that deflazacort causes less weight gain than prednisone after a year's treatment. We cannot evaluate long-term benefits and hazards of corticosteroid treatment or intermittent regimens from published RCTs. Non-randomised studies support the conclusions of functional benefits, but also identify clinically significant adverse effects of long-term treatment, and a possible divergence of efficacy in daily and weekend-only regimens in the longer term. These benefits and adverse effects have implications for future research and clinical practice.
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Affiliation(s)
- Emma Matthews
- National Hospital for Neurology and NeurosurgeryMRC Centre for Neuromuscular DiseasesQueen SquareLondonUK
| | - Ruth Brassington
- National Hospital for Neurology and NeurosurgeryMRC Centre for Neuromuscular DiseasesQueen SquareLondonUK
| | - Thierry Kuntzer
- CHU Vaudois and University of LausanneNerve‐Muscle Unit, Service of NeurologyLausanneSwitzerland1011
| | - Fatima Jichi
- Joint Research Office, University College LondonUCL School of Life & Medical SciencesGower StreetLondonUKWC1E 6BT
| | - Adnan Y Manzur
- Great Ormond Street Hospital for Children NHS TrustDubowitz Neuromuscular CentreGreat Ormond StreetLondonUKWC1N 3JH
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Katz DM, Bird A, Coenraads M, Gray SJ, Menon DU, Philpot BD, Tarquinio DC. Rett Syndrome: Crossing the Threshold to Clinical Translation. Trends Neurosci 2016; 39:100-113. [PMID: 26830113 PMCID: PMC4924590 DOI: 10.1016/j.tins.2015.12.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 12/11/2022]
Abstract
Lying at the intersection between neurobiology and epigenetics, Rett syndrome (RTT) has garnered intense interest in recent years, not only from a broad range of academic scientists, but also from the pharmaceutical and biotechnology industries. In addition to the critical need for treatments for this devastating disorder, optimism for developing RTT treatments derives from a unique convergence of factors, including a known monogenic cause, reversibility of symptoms in preclinical models, a strong clinical research infrastructure highlighted by an NIH-funded natural history study and well-established clinics with significant patient populations. Here, we review recent advances in understanding the biology of RTT, particularly promising preclinical findings, lessons from past clinical trials, and critical elements of trial design for rare disorders.
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Affiliation(s)
- David M Katz
- Departments of Neurosciences and Psychiatry, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Adrian Bird
- Wellcome Trust Centre for Cell Biology, University of Edinburgh, Edinburgh, UK
| | - Monica Coenraads
- Rett Syndrome Research Trust, 67 Under Cliff Road, Trumbull, CT 06611, USA
| | - Steven J Gray
- Gene Therapy Center and Department of Ophthalmology, University of North Carolina, Chapel Hill, NC USA
| | - Debashish U Menon
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Benjamin D Philpot
- Department of Cell Biology and Physiology, Neuroscience Center, and Carolina Institute for Developmental Disabilities, UNC School of Medicine, Chapel Hill, NC 27599, USA
| | - Daniel C Tarquinio
- Children's Healthcare of Atlanta, Emory University, 1605 Chantilly Drive NE, Atlanta, GA 30324, USA
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Thorley M, Malatras A, Duddy W, Le Gall L, Mouly V, Butler Browne G, Duguez S. Changes in Communication between Muscle Stem Cells and their Environment with Aging. J Neuromuscul Dis 2015; 2:205-217. [PMID: 27858742 PMCID: PMC5240546 DOI: 10.3233/jnd-150097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aging is associated with both muscle weakness and a loss of muscle mass, contributing towards overall frailty in the elderly. Aging skeletal muscle is also characterised by a decreasing efficiency in repair and regeneration, together with a decline in the number of adult stem cells. Commensurate with this are general changes in whole body endocrine signalling, in local muscle secretory environment, as well as in intrinsic properties of the stem cells themselves. The present review discusses the various mechanisms that may be implicated in these age-associated changes, focusing on aspects of cell-cell communication and long-distance signalling factors, such as levels of circulating growth hormone, IL-6, IGF1, sex hormones, and inflammatory cytokines. Changes in the local environment are also discussed, implicating IL-6, IL-4, FGF-2, as well as other myokines, and processes that lead to thickening of the extra-cellular matrix. These factors, involved primarily in communication, can also modulate the intrinsic properties of muscle stem cells, including reduced DNA accessibility and repression of specific genes by methylation. Finally we discuss the decrease in the stem cell pool, particularly the failure of elderly myoblasts to re-quiesce after activation, and the consequences of all these changes on general muscle homeostasis.
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Affiliation(s)
- Matthew Thorley
- Sorbonne Universités, UPMC Univ Paris 06, Center of Research in Myology UMRS 974, F-75013, Paris, France.,INSERM UMRS 974, F-75013, Paris, France.,CNRS FRE 3617, F-75013, Paris, France.,Institut de Myologie, F-75013, Paris, France
| | - Apostolos Malatras
- Sorbonne Universités, UPMC Univ Paris 06, Center of Research in Myology UMRS 974, F-75013, Paris, France.,INSERM UMRS 974, F-75013, Paris, France.,CNRS FRE 3617, F-75013, Paris, France.,Institut de Myologie, F-75013, Paris, France
| | - William Duddy
- Sorbonne Universités, UPMC Univ Paris 06, Center of Research in Myology UMRS 974, F-75013, Paris, France.,INSERM UMRS 974, F-75013, Paris, France.,CNRS FRE 3617, F-75013, Paris, France.,Institut de Myologie, F-75013, Paris, France
| | - Laura Le Gall
- Sorbonne Universités, UPMC Univ Paris 06, Center of Research in Myology UMRS 974, F-75013, Paris, France.,INSERM UMRS 974, F-75013, Paris, France.,CNRS FRE 3617, F-75013, Paris, France.,Institut de Myologie, F-75013, Paris, France
| | - Vincent Mouly
- Sorbonne Universités, UPMC Univ Paris 06, Center of Research in Myology UMRS 974, F-75013, Paris, France.,INSERM UMRS 974, F-75013, Paris, France.,CNRS FRE 3617, F-75013, Paris, France.,Institut de Myologie, F-75013, Paris, France
| | - Gillian Butler Browne
- Sorbonne Universités, UPMC Univ Paris 06, Center of Research in Myology UMRS 974, F-75013, Paris, France.,CNRS FRE 3617, F-75013, Paris, France.,INSERM UMRS 974, F-75013, Paris, France.,CNRS FRE 3617, F-75013, Paris, France.,Institut de Myologie, F-75013, Paris, France
| | - Stéphanie Duguez
- Sorbonne Universités, UPMC Univ Paris 06, Center of Research in Myology UMRS 974, F-75013, Paris, France.,INSERM UMRS 974, F-75013, Paris, France.,CNRS FRE 3617, F-75013, Paris, France.,Institut de Myologie, F-75013, Paris, France
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Matsumura T, Komaki H, Kawai M. [Survey of the actual state of medical care of patients with Duchenne muscular dystrophy in Japan]. Rinsho Shinkeigaku 2015; 55:637-45. [PMID: 26156259 DOI: 10.5692/clinicalneurol.cn-000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It has been suggested that many physicians feel it is difficult to manage patients with Duchenne muscular dystrophy (DMD) and that support from experts is required. Therefore, to assess the effects of Japanese practical guidelines for DMD, we distributed a survey questionnaire to certified neurologists and child neurologists in Japan. The survey revealed the actual state of medical care for patients with DMD in Japan prior to publication of guidelines. Many pediatric patients visited academic medical centers (AMCs) and general hospitals (GHs). In contrast, adult patients visited mainly National Hospital Organization (NHO) hospitals and other hospitals that can manage cardiopulmonary care and inpatient therapy. Medical insurance approval for steroid therapy was well known by subjects surveyed. Beta-blockers and angiotensin converting enzyme inhibitors were widely used as cardioprotective agents. However, the rates of obtaining written informed consent before genetic testing, regular radiological testing for scoliosis, usage of mechanical-assisted cough, disaster response plan instruction for patients receiving mechanical ventilation, and management of patients with female dystrophinopathy were below satisfactory. More than 20% of doctors surveyed practiced or recommended muscle strengthening training. Although the details of the training were not specified, this may indicate overuse of resistance training exercises. Our goal is to promote an educational campaign to better disseminate best practice care and clinical guidelines. We plan to conduct another round of surveys in several years to assess the effects of the clinical guidelines.
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Affiliation(s)
- Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Toneyama National Hospital
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Kimura E, Nakamura H, Mitsuhashi S, Takeuchi F, Mori-Yoshimura M, Shimizu R, Komaki H, Hayashi YK, Nishino I, Kawai M, Takeda S. [Infrastructure for the clinical research of muscular dystrophies: remudy and MDCTN]. Rinsho Shinkeigaku 2014; 54:1069-70. [PMID: 25519964 DOI: 10.5692/clinicalneurol.54.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Remudy, operated by the NCNP, runs two national registries for Dystrophinopathy and GNE myopathy in Japan under the collaboration with the TREAT-NMD alliance. The aim is to construct the clinical research infrastructure and accelerate the clinical development research for these rare diseases. We successfully provide the data sets for the feasibility studies, send out the appropriate information of the clinical trials for the candidates to speed up the recruitment for trials, collaboration with the Muscular Dystrophy Clinical Trial Network: MDCTN, as well as present the natural history and epidemiological data of the rare diseases with a new 'registry based' research style. Remudy provides a prototype of the clinical research infrastructure to over come the rare and incurable diseases.
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Affiliation(s)
- En Kimura
- National Center of Neurology and Psychiatry, Japan
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Mori-Yoshimura M, Hayashi YK, Yonemoto N, Nakamura H, Murata M, Takeda S, Nishino I, Kimura E. Nationwide patient registry for GNE myopathy in Japan. Orphanet J Rare Dis 2014; 9:150. [PMID: 25303967 PMCID: PMC4203883 DOI: 10.1186/s13023-014-0150-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/16/2014] [Indexed: 12/05/2022] Open
Abstract
Background GNE myopathy is a slowly progressive autosomal recessive myopathy caused by mutations in the GNE (glucosamine (UDP-N-acetyl)-2-epimerase/N-acetylmannosamine kinase) gene. This study aimed to (1) develop a nationwide patient registry for GNE myopathy in order to facilitate the planning of clinical trials and recruitment of candidates, and (2) gain further insight into the disease for the purpose of improving therapy and care. Methods Medical records of genetically-confirmed patients with GNE myopathy at the National Center Hospital of the National Center of Neurology and Psychiatry (NCNP) were retrospectively reviewed in order to obtain data reflecting the severity and progression of the disease. We also referred to items in the datasheet of the nationwide registry of dystrophinopathy patients in the Registry of Muscular Dystrophies (Remudy). Items selected for the registration sheet included age, sex, age at onset, past history and complications, family history, body weight and height, pathological findings of muscle biopsy, grip power, walking ability, respiratory function, cardiac function, willingness to join upcoming clinical trials, and participation in patient associations. A copy of the original genetic analysis report was required of each patient. Results We successfully established the Remudy-GNE myopathy. Currently, 121 patients are registered nationwide, and 93 physicians from 73 hospitals collaborated to establish the registry. The mean age at onset was 27.7 ± 9.6 years, and 19.8% (24/121) of patients could walk without assistance. Mean presumed durations from onset to use of assistive devices (cane and/or braces) and a wheelchair, and loss of ambulation were 12.4, 15.2, and 21.1 years, respectively. Three patients had a past history and/or complication of idiopathic thrombocytopenia. To share the progress of this study with the community, newsletters were published on a regular basis, and included information regarding new phase I clinical trials for GNE myopathy. The newsletters also served as a medium to bring attention to the importance of respiratory evaluation and care for respiratory insufficiency. Conclusion The Japanese Remudy-GNE myopathy is useful for clarifying the natural history of the disease and recruiting patients with genetically-confirmed GNE myopathy for clinical trials. Electronic supplementary material The online version of this article (doi:10.1186/s13023-014-0150-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Madoka Mori-Yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira 187-8551, Tokyo, Japan.
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Lott DJ, Forbes SC, Mathur S, Germain SA, Senesac CR, Lee Sweeney H, Walter GA, Vandenborne K. Assessment of intramuscular lipid and metabolites of the lower leg using magnetic resonance spectroscopy in boys with Duchenne muscular dystrophy. Neuromuscul Disord 2014; 24:574-82. [PMID: 24798221 DOI: 10.1016/j.nmd.2014.03.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to use proton magnetic resonance spectroscopy to assess intramuscular lipid and metabolites of lower leg muscles in boys with Duchenne muscular dystrophy (DMD) and determine its relationship with strength and functional ability. Spectroscopic measurements were obtained from four muscles of the lower leg in 25 boys with DMD (9.2±3.1 years) and 10 healthy boys (10.2±2.6 years). Lipid fractions and metabolite concentrations were also determined. Muscle strength, a timed functional test, and the Modified Brooke Lower Extremity Functional Scale were also determined. Lipid fractions were higher (p<0.01) for the DMD group than healthy subjects for all muscles, and lipid fraction was found to be greater in the older DMD boys. The peroneal muscle demonstrated a significant difference in lipid fraction in all DMD age groups. Lipid fractions in all muscles correlated with functional measures (r=0.52-0.70, p<0.001), with smaller inverse correlations with the strength measure (r=-0.36 to -0.56, p<0.05). These findings provide quantifiable information regarding intramuscular lipid and metabolite levels of different muscles across various age groups in boys with DMD and may be used in determining the effect of interventions in future clinical trials.
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Affiliation(s)
- Donovan J Lott
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA.
| | - Sean C Forbes
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sean A Germain
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Claudia R Senesac
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - H Lee Sweeney
- Department of Physiology, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
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