The pathogenesis of Duchenne muscular dystrophy: significance of experimental observations

The correlation analysis of functional factors and age with duchenne muscular dystrophy

Objective

To correlate existing evaluation tools with clinical information on Duchenne muscular dystrophy (DMD) patients following age and to investigate genetic mutation and its relationship with clinical function.

Method

The medical records of 121 children with DMD who had visited the pediatric rehabilitation clinic from 2006 to 2009 were reviewed. The mean patient age was 9.9±3.4 years and all subjects were male. Collected data included Brooke scale, Vignos scale, bilateral shoulder abductor and knee extensor muscles power, passive range of motion (PROM) of ankle dorsi-flexion, angle of scoliosis, peak cough flow (PCF), fractional shortening (FS), genetic abnormalities, and use of steroid.

Results

The Brooke and Vignos scales were linearly increased with age (Brooke (y₁), Vignos (y₂), age (x), y₁=0.345x-1.221, R_Brooke²=0.435, y₂=0.813x-3.079, R_Vignos²=0.558, p<0.001). In relation to the PROM of ankle dorsi-flexion, there was a linear decrease in both ankles (right and left R²=0.364, 0.372, p<0.001). Muscle power, Cobb angle, PCF, and FS showed diversity in their degrees, irrespective of age. The genetic test for dystrophin identified exon deletions in 58.0% (69/119), duplications in 9.2% (11/119), and no deletions or duplications in 32.8% (39/119). Statistically, the genetic abnormalities and use of steroid were not definitely associated with functional scale.

Conclusion

The Brooke scale, Vignos scale and PROM of ankle dorsi-flexion were partially available to assess DMD patients. However, this study demonstrates the limitations of preexisting scales and clinical parameters incomprehensively reflecting functional changes of DMD patients.

Characteristics of muscle fibers reconstituted in the regeneration process of masseter muscle in an mdx mouse model of muscular dystrophy

Mdx mice, which lack dystrophin, were examined for changes in the properties of muscle fibers in the growth process of the masseter muscle at the morphological, protein and transcriptional levels. The slow-type isoform, MyHC-1, and the fast-type isoforms, MyHC-2a, MyHC-2d and MyHC-2b, were examined at the protein and the transcriptional level. Morphological examination showed that in the mdx mouse masseter muscle, degeneration, necrosis, and regeneration occurred, particularly at the age of 4 weeks, and many regenerated muscle fibers with centrally located nuclei were observed at the age of 9 weeks. The results of examination at the protein and the transcriptional level showed that in the process of muscle fiber degeneration, necrosis, and regeneration, the mdx mouse masseter muscle acquires muscle fiber characteristics entirely different from those in the normal mouse masseter muscle. In particular, MyHC-1, which is rarely found in normal mice, was very strongly expressed.

The dystrophinopathies: an alternative to the structural hypothesis

Abnormal expression of the cytoskeletal protein dystrophin has deleterious consequences for skeletal muscle, cardiac muscle, and the central nervous system. A complete failure to express the protein produces Duchenne muscular dystrophy (DMD), in which there is extensive and progressive skeletal muscle necrosis, the development of a life-threatening dilated cardiomyopathy, and mild mental retardation. Dystrophin binds the F-actin cytoskeleton and is normally expressed in a complex of transmembrane proteins (the "dystrophin protein complex") that interact with external components of the basal lamina. One pathogenic model for DMD (the "structural hypothesis") suggests that this complex forms a structural bridge between the external basal lamina and the internal cytoskeleton and that the absence of dystrophin produces a defect in membrane structural support that renders skeletal muscle susceptible to plasmalemmal ruptures (or "tears") during the course of contractile activity. This review attempts to critically evaluate the structural hypothesis for DMD and presents an opposing model (the "channel aggregation model") that highlights the role of dystrophin in organizing the membrane cytoskeleton and the role of the cytoskeleton in aggregating ion channels and neurotransmitter receptors. Since ion channel aggregation is a process that is common across organ systems, the idea that channel function can be altered when aggregated ion channels interact with a dystrophic cytoskeleton has immediate implications for the expression of the dystrophinopathies in skeletal muscle, cardiac muscle, and the central nervous system.

Monocyte function in chickens with hereditary muscular dystrophy

Monocyte functions of Storrs strain muscular dystrophic (MD) chickens and Storrs control strain were compared. After short-term in vitro culture of monocytes, cells taken from Storrs MD chickens had a significantly lower incidence of cells capable of phagocytizing sheep red blood cells than did cells cultured from the control strain. In contrast, no difference was found in the ability of MD vs. control strain blood mononuclear cells to undergo in vitro chemotaxis in response to a bacterial culture supernatant. The study also revealed a distinct peripheral blood leukocyte profile of young MD chickens: elevated percentages and absolute numbers of granulocytes. The total leukocyte count in MD chickens was not significantly different from that of normal chickens. These findings extend previous observations concerning altered reticuloendothelial system function in MD strain chickens.

Oxidative stress and muscular dystrophy

Oxidative stress may be the fundamental basis of many of the structural, functional and biochemical changes characteristic of the inherited muscular dystrophies in animals and humans. The presence of by-products of oxidative damage, and the compensatory increases in cellular antioxidants, both indicate oxidative stress may be occurring in dystrophic muscle. Changes in the proportions and metabolism of cellular lipids, abnormal functions of cellular membranes, altered activity of membrane-bound enzymes such as the SR Ca2+-ATPase, disturbances in cellular protein turnover and energy production and a variety of other changes all indicate that these inherited muscular dystrophies appear more like the results of oxidative stress to muscle than any other type of underlying muscle disturbance. Particular details of these altered characteristics of dystrophic muscle, in combination with current knowledge on the processes of oxidative damage to cells, may provide some insight into the underlying biochemical defect responsible for the disease, as well as direct research towards the ultimate goal of an effective treatment.

Duchenne muscular dystrophy: assessment of experimental data from animals in relation to the human disease

Animals with inherited skeletal muscle degeneration are studied as models of Duchenne muscular dystrophy. Such investigations can provide significant information on various aspects of this disease but may not reveal the primary alteration in the gene product.

Beta-adrenergic ([3H] CGP-12177) receptors are elevated in slices of soleus muscle from CHE 147 dystrophic hamsters

We have utilized a muscle slice technique to compare the ontogeny of cell surface beta-adrenergic receptor binding in soleus and extensor digitorum longus (EDL) muscles of male Golden Syrian (GS) and Canadian Hybrid Farms 147 (CHF 147) dystrophic hamsters. Binding of the beta-adrenergic antagonist, [3H] CGP-12177 (CGP), to GS muscle slices was reversible, saturable, stereospecific and of high affinity. Bmax was higher in the soleus (2.57 +/- .12 fmol/mg wet wt) than in the EDL (1.6 +/- .17 fmol/mg wet wt) of adult animals while affinities were similar (0.35 +/- .06 and 0.24 +/- .04 nM respectively). No differences in binding characteristics were seen in EDL of GS compared to CHF 147 animals. In soleus slices frm GS hamsters, Bmax was highest at 16 days of age (5.72 +/- 0.26 fmol/mg), decreased between 16 and 29 days and remained constant until 300 days (2.51 +/- 0.52 fmol/mg). In dystrophic soleus slices, Bmax was also higher at 16 days than at any other age but receptor number decreased gradually, remaining higher than in GS until 90 days of age (p less than 0.05). The failure of beta-adrenergic receptor number to decrease at a normal rate may be implicated in the pathogenesis of hamster polymyopathy.

Activities of antioxidant enzymes in muscle, liver and lung of chickens with inherited muscular dystrophy

An inherited form of muscular dystrophy in chickens has been used as a model of Duchenne muscular dystrophy. The pectoralis major muscle of chickens with this disease showed a significantly elevated activity of catalase (CAT) one day after hatching, and by 7 days showed elevated superoxide dismutase (SOD), glutathione peroxidase (GPX) and glutathione-S-transferase (GST) activities. Increases were also found in tissues of the dystrophic birds that, unlike the pectoralis muscle, are considered to be unaffected by the pathology of muscular dystrophy. The soleus muscle contained significantly increased levels of SOD and GPX in 1 and 7 day old chickens, and increased GST in 1, 14, and 28 day old birds. CAT was significantly increased in liver from 1 and 7 day old chickens, while GPX was increased in lung from 1, 7 and 14 day old birds. These results support the possibility that excess oxygen free-radicals or altered cellular antioxidant defenses play some role in the pathogenesis of muscular dystrophy.