1
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Nelson TS, Duran P, Calderon-Rivera A, Gomez K, Loya-Lopez S, Khanna R. Mouse models of non-dystrophic and dystrophic myotonia exhibit nociplastic pain-like behaviors. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.19.599732. [PMID: 38948724 PMCID: PMC11212949 DOI: 10.1101/2024.06.19.599732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Pain is a prominent and debilitating symptom in myotonic disorders, yet its physiological mechanisms remain poorly understood. This study assessed preclinical pain-like behavior in murine models of pharmacologically induced myotonia and myotonic dystrophy type 1 (DM1). In both myotonia congenita and DM1, impairment of the CLCN1 gene, which encodes skeletal muscle voltage-gated CLC-1 chloride channels, reduces chloride ion conductance in skeletal muscle cells, leading to prolonged muscle excitability and delayed relaxation after contraction. We used the CLC-1 antagonist anthracene-9-carboxylic acid (9-AC) at intraperitoneal doses of 30 or 60 mg/kg and HSA LR20b DM1 mice to model CLC-1-induced myotonia. Our experimental approach included in vivo pain behavioral testing, ex vivo calcium imaging, and whole-cell current-clamp electrophysiology in mouse dorsal root ganglion (DRG) neurons. A single injection of 9-AC induced myotonia in mice, which persisted for several hours and resulted in long-lasting allodynic pain-like behavior. Similarly, HSA LR20b mice exhibited both allodynia and hyperalgesia. Despite these pain-like behaviors, DRG neurons did not show signs of hyperexcitability in either myotonic model. These findings suggest that myotonia induces nociplastic pain-like behavior in preclinical rodents, likely through central sensitization mechanisms rather than peripheral sensitization. This study provides insights into the pathophysiology of pain in myotonic disorders and highlights the potential of using myotonic mouse models to explore pain mechanisms and assess novel analgesics. Future research should focus on the central mechanisms involved in myotonia-induced pain and develop targeted therapies to alleviate this significant clinical burden.
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Affiliation(s)
- Tyler S. Nelson
- Department of Pharmacology and Therapeutics, McKnight Brain Institute, and Pain and Addiction Therapeutics (PATH) Collaboratory, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Paz Duran
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA
| | - Aida Calderon-Rivera
- Department of Pharmacology and Therapeutics, McKnight Brain Institute, and Pain and Addiction Therapeutics (PATH) Collaboratory, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Kimberly Gomez
- Department of Pharmacology and Therapeutics, McKnight Brain Institute, and Pain and Addiction Therapeutics (PATH) Collaboratory, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Santiago Loya-Lopez
- Department of Pharmacology and Therapeutics, McKnight Brain Institute, and Pain and Addiction Therapeutics (PATH) Collaboratory, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Rajesh Khanna
- Department of Pharmacology and Therapeutics, McKnight Brain Institute, and Pain and Addiction Therapeutics (PATH) Collaboratory, University of Florida College of Medicine, Gainesville, FL 32610, USA
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2
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Farinato A, Cavalluzzi MM, Altamura C, Campanale C, Laghetti P, Saltarella I, Delre P, Barbault A, Tarantino N, Milani G, Rotondo NP, Di Cesare Mannelli L, Ghelardini C, Pierno S, Mangiatordi GF, Lentini G, Desaphy JF. Development of Riluzole Analogs with Improved Use-Dependent Inhibition of Skeletal Muscle Sodium Channels. ACS Med Chem Lett 2023; 14:999-1008. [PMID: 37465302 PMCID: PMC10350938 DOI: 10.1021/acsmedchemlett.3c00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
Several commercially available and newly synthesized riluzole analogs were evaluated in vitro as voltage-gated skeletal muscle sodium-channel blockers. Data obtained from the patch-clamp technique demonstrated that potency is well correlated with lipophilicity and the introduction of a protonatable amino function in the benzothiazole 2-position enhances the use-dependent behavior. The most interesting compound, the 2-piperazine analog of riluzole (14), although slightly less potent than the parent compound in the patch-clamp assay as well as in an in vitro model of myotonia, showed greater use-dependent Nav1.4 blocking activity. Docking studies allowed the identification of the key interactions that 14 makes with the amino acids of the local anesthetic binding site within the pore of the channel. The reported results pave the way for the identification of novel compounds useful in the treatment of cell excitability disorders.
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Affiliation(s)
- Alessandro Farinato
- Section
of Pharmacology, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Maria Maddalena Cavalluzzi
- Section
of Medicinal Chemistry, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Concetta Altamura
- Section
of Pharmacology, Department of Precision and Regenerative Medicine,
School of Medicine, University of Bari Aldo
Moro, 70124 Bari, Italy
| | - Carmen Campanale
- Section
of Pharmacology, Department of Precision and Regenerative Medicine,
School of Medicine, University of Bari Aldo
Moro, 70124 Bari, Italy
| | - Paola Laghetti
- Section
of Pharmacology, Department of Precision and Regenerative Medicine,
School of Medicine, University of Bari Aldo
Moro, 70124 Bari, Italy
| | - Ilaria Saltarella
- Section
of Pharmacology, Department of Precision and Regenerative Medicine,
School of Medicine, University of Bari Aldo
Moro, 70124 Bari, Italy
| | - Pietro Delre
- CNR
− Institute of Crystallography, via Amendola 122/o, 70126 Bari, Italy
| | - Arthur Barbault
- CNR
− Institute of Crystallography, via Amendola 122/o, 70126 Bari, Italy
| | - Nancy Tarantino
- Section
of Pharmacology, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Gualtiero Milani
- Section
of Medicinal Chemistry, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Natalie Paola Rotondo
- Section
of Medicinal Chemistry, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Lorenzo Di Cesare Mannelli
- Department
NEUROFARBA - Pharmaceutical and Nutraceutical Section, University of Firenze, 50139 Florence, Italy
| | - Carla Ghelardini
- Department
NEUROFARBA - Pharmaceutical and Nutraceutical Section, University of Firenze, 50139 Florence, Italy
| | - Sabata Pierno
- Section
of Pharmacology, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | | | - Giovanni Lentini
- Section
of Medicinal Chemistry, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Jean-François Desaphy
- Section
of Pharmacology, Department of Precision and Regenerative Medicine,
School of Medicine, University of Bari Aldo
Moro, 70124 Bari, Italy
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3
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Álvarez-Abril MC, García-Alcover I, Colonques-Bellmunt J, Garijo R, Pérez-Alonso M, Artero R, López-Castel A. Natural Compound Boldine Lessens Myotonic Dystrophy Type 1 Phenotypes in DM1 Drosophila Models, Patient-Derived Cell Lines, and HSA LR Mice. Int J Mol Sci 2023; 24:9820. [PMID: 37372969 PMCID: PMC10298378 DOI: 10.3390/ijms24129820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Myotonic dystrophy type 1 (DM1) is a complex rare disorder characterized by progressive muscle dysfunction, involving weakness, myotonia, and wasting, but also exhibiting additional clinical signs in multiple organs and systems. Central dysregulation, caused by an expansion of a CTG trinucleotide repeat in the DMPK gene's 3' UTR, has led to exploring various therapeutic approaches in recent years, a few of which are currently under clinical trial. However, no effective disease-modifying treatments are available yet. In this study, we demonstrate that treatments with boldine, a natural alkaloid identified in a large-scale Drosophila-based pharmacological screening, was able to modify disease phenotypes in several DM1 models. The most significant effects include consistent reduction in nuclear RNA foci, a dynamic molecular hallmark of the disease, and noteworthy anti-myotonic activity. These results position boldine as an attractive new candidate for therapy development in DM1.
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Affiliation(s)
| | - Irma García-Alcover
- Valentia BioPharma S.L., 46980 Paterna, Spain (R.A.)
- Human Translational Genomics Group, Institute for Biotechnology and Biomedicine (BIOTECMED), University of Valencia, 46100 Burjasot, Spain
| | | | - Raquel Garijo
- Valentia BioPharma S.L., 46980 Paterna, Spain (R.A.)
| | - Manuel Pérez-Alonso
- Valentia BioPharma S.L., 46980 Paterna, Spain (R.A.)
- Human Translational Genomics Group, Institute for Biotechnology and Biomedicine (BIOTECMED), University of Valencia, 46100 Burjasot, Spain
- Incliva Biomedical Research Institute, 46010 Valencia, Spain
| | - Rubén Artero
- Valentia BioPharma S.L., 46980 Paterna, Spain (R.A.)
- Human Translational Genomics Group, Institute for Biotechnology and Biomedicine (BIOTECMED), University of Valencia, 46100 Burjasot, Spain
- Incliva Biomedical Research Institute, 46010 Valencia, Spain
| | - Arturo López-Castel
- Valentia BioPharma S.L., 46980 Paterna, Spain (R.A.)
- Human Translational Genomics Group, Institute for Biotechnology and Biomedicine (BIOTECMED), University of Valencia, 46100 Burjasot, Spain
- Incliva Biomedical Research Institute, 46010 Valencia, Spain
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4
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Altamura C, Saltarella I, Campanale C, Laghetti P, Desaphy JF. Drug repurposing in skeletal muscle ion channelopathies. Curr Opin Pharmacol 2023; 68:102329. [PMID: 36512979 DOI: 10.1016/j.coph.2022.102329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022]
Abstract
Skeletal muscle ion channelopathies are rare genetic diseases mainly characterized by myotonia (muscle stiffness) or periodic paralysis (muscle weakness). Here, we reviewed the available therapeutic options in non-dystrophic myotonias (NDM) and periodic paralyses (PP), which consists essentially in drug repositioning to address stiffness or weakness attacks. Empirical use followed by successful randomized clinical trials eventually led to the orphan drug designation and marketing authorization granting of mexiletine for NDM and dichlorphenamide for PP. Yet, these treatments neither consider the genetic cause of the diseases nor address the individual variability in drug response. Thus, ongoing research aims at the identification of repurposed drugs alternative to mexiletine and dichlorphenamide to allow personalization of treatment. This review highlights how drug repurposing may represent an efficient strategy in rare diseases, allowing reduction of drug development time and costs in a context in which the return on investment may be particularly challenging.
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Affiliation(s)
- Concetta Altamura
- Section of Pharmacology, Department of Precision and Regenerative Medicine, School of Medicine, University of Bari Aldo Moro, Piazza Giulo Cesare, 70124, Bari, Italy
| | - Ilaria Saltarella
- Section of Pharmacology, Department of Precision and Regenerative Medicine, School of Medicine, University of Bari Aldo Moro, Piazza Giulo Cesare, 70124, Bari, Italy
| | - Carmen Campanale
- Section of Pharmacology, Department of Precision and Regenerative Medicine, School of Medicine, University of Bari Aldo Moro, Piazza Giulo Cesare, 70124, Bari, Italy
| | - Paola Laghetti
- Section of Pharmacology, Department of Precision and Regenerative Medicine, School of Medicine, University of Bari Aldo Moro, Piazza Giulo Cesare, 70124, Bari, Italy
| | - Jean-François Desaphy
- Section of Pharmacology, Department of Precision and Regenerative Medicine, School of Medicine, University of Bari Aldo Moro, Piazza Giulo Cesare, 70124, Bari, Italy.
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5
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Suetterlin KJ, Männikkö R, Matthews E, Greensmith L, Hanna MG, Bostock H, Tan SV. Excitability properties of mouse and human skeletal muscle fibres compared by muscle velocity recovery cycles. Neuromuscul Disord 2022; 32:347-357. [PMID: 35339342 PMCID: PMC7614892 DOI: 10.1016/j.nmd.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 01/27/2022] [Accepted: 02/22/2022] [Indexed: 11/21/2022]
Abstract
Mouse models of skeletal muscle channelopathies are not phenocopies of human disease. In some cases (e.g. Myotonia Congenita) the phenotype is much more severe, whilst in others (e.g. Hypokalaemic periodic paralysis) rodent physiology is protective. This suggests a species' difference in muscle excitability properties. In humans these can be measured indirectly by the post-impulse changes in conduction velocity, using Muscle Velocity Recovery Cycles (MVRCs). We performed MVRCs in mice and compared their muscle excitability properties with humans. Mouse Tibialis Anterior MVRCs (n = 70) have only one phase of supernormality (increased conduction velocity), which is smaller in magnitude (p = 9 × 10-21), and shorter in duration (p = 3 × 10-24) than human (n = 26). This abbreviated supernormality is followed by a period of late subnormality (reduced velocity) in mice, which overlaps in time with the late supernormality seen in human MVRCs. The period of late subnormality suggests increased t-tubule Na+/K+-pump activity. The subnormal phase in mice was converted to supernormality by blocking ClC-1 chloride channels, suggesting relatively higher chloride conductance in skeletal muscle. Our findings help explain discrepancies in phenotype between mice and humans with skeletal muscle channelopathies and potentially other neuromuscular disorders. MVRCs are a valuable new tool to compare in vivo muscle membrane properties between species and will allow further dissection of the molecular mechanisms regulating muscle excitability.
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Affiliation(s)
- K J Suetterlin
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom; AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - R Männikkö
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - E Matthews
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom; Atkinson Morley Neuromuscular Centre, Department of Neurology, St Georges University Hospitals NHS Foundation Trust, London, United Kingdom
| | - L Greensmith
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - M G Hanna
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - H Bostock
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - S V Tan
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, United Kingdom; Department of Neurology and Clinical Neurophysiology, Guy's & St Thomas' NHS Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, United Kingdom
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6
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Myers JH, Denman K, DuPont C, Hawash AA, Novak KR, Koesters A, Grabner M, Dayal A, Voss AA, Rich MM. The mechanism underlying transient weakness in myotonia congenita. eLife 2021; 10:e65691. [PMID: 33904400 PMCID: PMC8079152 DOI: 10.7554/elife.65691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/24/2021] [Indexed: 12/23/2022] Open
Abstract
In addition to the hallmark muscle stiffness, patients with recessive myotonia congenita (Becker disease) experience debilitating bouts of transient weakness that remain poorly understood despite years of study. We performed intracellular recordings from muscle of both genetic and pharmacologic mouse models of Becker disease to identify the mechanism underlying transient weakness. Our recordings reveal transient depolarizations (plateau potentials) of the membrane potential to -25 to -35 mV in the genetic and pharmacologic models of Becker disease. Both Na+ and Ca2+ currents contribute to plateau potentials. Na+ persistent inward current (NaPIC) through NaV1.4 channels is the key trigger of plateau potentials and current through CaV1.1 Ca2+ channels contributes to the duration of the plateau. Inhibiting NaPIC with ranolazine prevents the development of plateau potentials and eliminates transient weakness in vivo. These data suggest that targeting NaPIC may be an effective treatment to prevent transient weakness in myotonia congenita.
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Affiliation(s)
- Jessica H Myers
- Department of Neuroscience, Cell Biology and Physiology, Wright State UniversityDaytonUnited States
| | - Kirsten Denman
- Department of Neuroscience, Cell Biology and Physiology, Wright State UniversityDaytonUnited States
| | - Chris DuPont
- Department of Neuroscience, Cell Biology and Physiology, Wright State UniversityDaytonUnited States
| | - Ahmed A Hawash
- Department of Dermatology & Cutaneous Surgery, University of MiamiMiamiUnited States
| | | | - Andrew Koesters
- Naval Medical Research Unit, Wright Patterson Air Force BaseDaytonUnited States
| | - Manfred Grabner
- Department of Pharmacology, Medical University of InnsbruckInnsbruckAustria
| | - Anamika Dayal
- Department of Pharmacology, Medical University of InnsbruckInnsbruckAustria
| | - Andrew A Voss
- Department of Biology, Wright State UniversityDaytonUnited States
| | - Mark M Rich
- Department of Neuroscience, Cell Biology and Physiology, Wright State UniversityDaytonUnited States
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7
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Desaphy JF, Altamura C, Vicart S, Fontaine B. Targeted Therapies for Skeletal Muscle Ion Channelopathies: Systematic Review and Steps Towards Precision Medicine. J Neuromuscul Dis 2021; 8:357-381. [PMID: 33325393 PMCID: PMC8203248 DOI: 10.3233/jnd-200582] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Skeletal muscle ion channelopathies include non-dystrophic myotonias (NDM), periodic paralyses (PP), congenital myasthenic syndrome, and recently identified congenital myopathies. The treatment of these diseases is mainly symptomatic, aimed at reducing muscle excitability in NDM or modifying triggers of attacks in PP. OBJECTIVE This systematic review collected the evidences regarding effects of pharmacological treatment on muscle ion channelopathies, focusing on the possible link between treatments and genetic background. METHODS We searched databases for randomized clinical trials (RCT) and other human studies reporting pharmacological treatments. Preclinical studies were considered to gain further information regarding mutation-dependent drug effects. All steps were performed by two independent investigators, while two others critically reviewed the entire process. RESULTS For NMD, RCT showed therapeutic benefits of mexiletine and lamotrigine, while other human studies suggest some efficacy of various sodium channel blockers and of the carbonic anhydrase inhibitor (CAI) acetazolamide. Preclinical studies suggest that mutations may alter sensitivity of the channel to sodium channel blockers in vitro, which has been translated to humans in some cases. For hyperkalemic and hypokalemic PP, RCT showed efficacy of the CAI dichlorphenamide in preventing paralysis. However, hypokalemic PP patients carrying sodium channel mutations may have fewer benefits from CAI compared to those carrying calcium channel mutations. Few data are available for treatment of congenital myopathies. CONCLUSIONS These studies provided limited information about the response to treatments of individual mutations or groups of mutations. A major effort is needed to perform human studies for designing a mutation-driven precision medicine in muscle ion channelopathies.
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Affiliation(s)
- Jean-François Desaphy
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Concetta Altamura
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Savine Vicart
- Sorbonne Université, INSERM, Assistance Publique Hôpitaux de Paris, Centre de Recherche en Myologie-UMR 974, Reference center in neuro-muscular channelopathies, Institute of Myology, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Bertrand Fontaine
- Sorbonne Université, INSERM, Assistance Publique Hôpitaux de Paris, Centre de Recherche en Myologie-UMR 974, Reference center in neuro-muscular channelopathies, Institute of Myology, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
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8
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Stunnenberg BC, LoRusso S, Arnold WD, Barohn RJ, Cannon SC, Fontaine B, Griggs RC, Hanna MG, Matthews E, Meola G, Sansone VA, Trivedi JR, van Engelen BG, Vicart S, Statland JM. Guidelines on clinical presentation and management of nondystrophic myotonias. Muscle Nerve 2020; 62:430-444. [PMID: 32270509 PMCID: PMC8117169 DOI: 10.1002/mus.26887] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/26/2022]
Abstract
The nondystrophic myotonias are rare muscle hyperexcitability disorders caused by gain-of-function mutations in the SCN4A gene or loss-of-function mutations in the CLCN1 gene. Clinically, they are characterized by myotonia, defined as delayed muscle relaxation after voluntary contraction, which leads to symptoms of muscle stiffness, pain, fatigue, and weakness. Diagnosis is based on history and examination findings, the presence of electrical myotonia on electromyography, and genetic confirmation. In the absence of genetic confirmation, the diagnosis is supported by detailed electrophysiological testing, exclusion of other related disorders, and analysis of a variant of uncertain significance if present. Symptomatic treatment with a sodium channel blocker, such as mexiletine, is usually the first step in management, as well as educating patients about potential anesthetic complications.
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Affiliation(s)
- Bas C. Stunnenberg
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Samantha LoRusso
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - W. David Arnold
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Richard J. Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Stephen C. Cannon
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Bertrand Fontaine
- Assistance Publique-Hôpitaix de Paris, Sorbonne Université, INSERM, Service of Neuro-Myology and UMR 974, Institute of Myology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Robert C. Griggs
- Department of Neurology, University of Rochester, Rochester, New York
| | - Michael G. Hanna
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular diseases, UCL Queen Square Institute of Neurology, United Kingdom
| | - Emma Matthews
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular diseases, UCL Queen Square Institute of Neurology, United Kingdom
| | - Giovanni Meola
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Valeria A. Sansone
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Neurorehabilitation Unit, University of Milan, NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Jaya R. Trivedi
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas
| | | | - Savine Vicart
- Assistance Publique-Hôpitaix de Paris, Sorbonne Université, INSERM, Service of Neuro-Myology and UMR 974, Institute of Myology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Jeffrey M. Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
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9
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Desaphy JF, Farinato A, Altamura C, De Bellis M, Imbrici P, Tarantino N, Caccia C, Melloni E, Padoani G, Vailati S, Keywood C, Carratù MR, De Luca A, Conte D, Pierno S. Safinamide's potential in treating nondystrophic myotonias: Inhibition of skeletal muscle voltage-gated sodium channels and skeletal muscle hyperexcitability in vitro and in vivo. Exp Neurol 2020; 328:113287. [PMID: 32205118 DOI: 10.1016/j.expneurol.2020.113287] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/14/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022]
Abstract
The antiarrhythmic sodium-channel blocker mexiletine is used to treat patients with myotonia. However, around 30% of patients do not benefit from mexiletine due to poor tolerability or suboptimal response. Safinamide is an add-on therapy to levodopa for Parkinson's disease. In addition to MAOB inhibition, safinamide inhibits neuronal sodium channels, conferring anticonvulsant activity in models of epilepsy. Here, we investigated the effects of safinamide on skeletal muscle hNav1.4 sodium channels and in models of myotonia, in-vitro and in-vivo. Using patch-clamp, we showed that safinamide reversibly inhibited sodium currents in HEK293T cells transfected with hNav1.4. At the holding potential (hp) of -120 mV, the half-maximum inhibitory concentrations (IC50) were 160 and 33 μM at stimulation frequencies of 0.1 and 10 Hz, respectively. The calculated affinity constants of safinamide were dependent on channel state: 420 μM for closed channels and 9 μM for fast-inactivated channels. The p.F1586C mutation in hNav1.4 greatly impaired safinamide inhibition, suggesting that the drug binds to the local anesthetic receptor site in the channel pore. In a condition mimicking myotonia, i.e. hp. of -90 mV and 50-Hz stimulation, safinamide inhibited INa with an IC50 of 6 μM, being two-fold more potent than mexiletine. Using the two-intracellular microelectrodes current-clamp method, action potential firing was recorded in vitro in rat skeletal muscle fibers in presence of the chloride channel blocker, 9-anthracene carboxylic acid (9-AC), to increase excitability. Safinamide counteracted muscle fiber hyperexcitability with an IC50 of 13 μM. In vivo, oral safinamide was tested in the rat model of myotonia. In this model, intraperitoneal injection of 9-AC greatly increased the time of righting reflex (TRR) due to development of muscle stiffness. Safinamide counteracted 9-AC induced TRR increase with an ED50 of 1.2 mg/kg, which is 7 times lower than that previously determined for mexiletine. In conclusion, safinamide is a potent voltage and frequency dependent blocker of skeletal muscle sodium channels. Accordingly, the drug was able to counteract abnormal muscle hyperexcitability induced by 9-AC, both in vitro and in vivo. Thus, this study suggests that safinamide may have potential in treating myotonia and warrants further preclinical and human studies to fully evaluate this possibility.
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Affiliation(s)
- Jean-François Desaphy
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy.
| | - Alessandro Farinato
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Concetta Altamura
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Michela De Bellis
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Paola Imbrici
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Nancy Tarantino
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Carla Caccia
- Open R&D Department, Zambon S.p.A., Bresso, MI, Italy
| | - Elsa Melloni
- Open R&D Department, Zambon S.p.A., Bresso, MI, Italy
| | | | | | | | - Maria Rosaria Carratù
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Annamaria De Luca
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Diana Conte
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Sabata Pierno
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
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Hoppe K, Chaiklieng S, Lehmann‐Horn F, Jurkat‐Rott K, Wearing S, Klingler W. Elevation of extracellular osmolarity improves signs of myotonia congenita in vitro: a preclinical animal study. J Physiol 2019; 597:225-235. [PMID: 30284249 PMCID: PMC6312412 DOI: 10.1113/jp276528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/01/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS During myotonia congenita, reduced chloride (Cl- ) conductance results in impaired muscle relaxation and increased muscle stiffness after forceful voluntary contraction. Repetitive contraction of myotonic muscle decreases or even abolishes myotonic muscle stiffness, a phenomenon called 'warm up'. Pharmacological inhibition of low Cl- channels by anthracene-9-carboxylic acid in muscle from mice and ADR ('arrested development of righting response') muscle from mice showed a relaxation deficit under physiological conditions compared to wild-type muscle. At increased osmolarity up to 400 mosmol L-1 , the relaxation deficit of myotonic muscle almost reached that of control muscle. These effects were mediated by the cation and anion cotransporter, NKCC1, and anti-myotonic effects of hypertonicity were at least partly antagonized by the application of bumetanide. ABSTRACT Low chloride-conductance myotonia is caused by mutations in the skeletal muscle chloride (Cl- ) channel gene type 1 (CLCN1). Reduced Cl- conductance of the mutated channels results in impaired muscle relaxation and increased muscle stiffness after forceful voluntary contraction. Exercise decreases muscle stiffness, a phenomena called 'warm up'. To gain further insight into the patho-mechanism of impaired muscle stiffness and the warm-up phenomenon, we characterized the effects of increased osmolarity on myotonic function. Functional force and membrane potential measurements were performed on muscle specimens of ADR ('arrested development of righting response') mice (an animal model for low gCl- conductance myotonia) and pharmacologically-induced myotonia. Specimens were exposed to solutions of increasing osmolarity at the same time as force and membrane potentials were monitored. In the second set of experiments, ADR muscle and pharmacologically-induced myotonic muscle were exposed to an antagonist of NKCC1. Upon osmotic stress, ADR muscle was depolarized to a lesser extent than control wild-type muscle. High osmolarity diminished myotonia and facilitated the warm-up phenomenon as depicted by a faster muscle relaxation time (T90/10 ). Osmotic stress primarily resulted in the activation of the NKCC1. The inhibition of NKCC1 with bumetanide prevented the depolarization and reversed the anti-myotonic effect of high osmolarity. Increased osmolarity decreased signs of myotonia and facilitated the warm-up phenomenon in different in vitro models of myotonia. Activation of NKCC1 activity promotes warm-up and reduces the number of contractions required to achieve normal relaxation kinetics.
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Affiliation(s)
- Kerstin Hoppe
- Department of AnaesthesiaCritical Care Medicine and Pain TherapyUniversity of FrankfurtFrankfurtGermany
| | - Sunisa Chaiklieng
- Division of Neurophysiology in the Center of Rare DiseasesUlm UniversityUlmGermany
- Faculty of Public HealthKhon Knen UniversityMuang Khon KaenThailand
| | - Frank Lehmann‐Horn
- Division of Neurophysiology in the Center of Rare DiseasesUlm UniversityUlmGermany
| | - Karin Jurkat‐Rott
- Department of NeuroanaesthesiologyNeurosurgical UniversityGuenzburgGermany
| | - Scott Wearing
- Institute of Health and Biomedical InnovationQueensland University of TechnologyKelvin GroveQLDAustralia
| | - Werner Klingler
- Institute of Health and Biomedical InnovationQueensland University of TechnologyKelvin GroveQLDAustralia
- Department of NeuroanaesthesiologyNeurosurgical UniversityGuenzburgGermany
- Department of AnaesthesiologyIntensive Care Medicine and Pain TherapySRH KlinikumSigmarringenGermany
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Farinato A, Altamura C, Desaphy JF. Effects of Benzothiazolamines on Voltage-Gated Sodium Channels. Handb Exp Pharmacol 2018; 246:233-250. [PMID: 28939972 DOI: 10.1007/164_2017_46] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Benzothiazole is a versatile fused heterocycle that aroused much interest in drug discovery as anticonvulsant, neuroprotective, analgesic, anti-inflammatory, antimicrobial, and anticancer. Two benzothiazolamines, riluzole and lubeluzole, are known blockers of voltage-gated sodium (Nav) channels. Riluzole is clinically used as a neuroprotectant in amyotrophic lateral sclerosis. Inhibition of Nav channels by riluzole is voltage-dependent due to preferential binding to inactivated sodium channels. Yet the drug exerts little use-dependent block, probably because it lacks protonable amine. One important property is riluzole ability to inhibit persistent Na+ currents, which likely contributes to its neuroprotective activity. Lubeluzole showed promising neuroprotective effects in animal stroke models, but failed to show benefits in acute ischemic stroke in humans. One important concern is its propensity to prolong the cardiac QT interval, due to hERG K+ channel block. Lubeluzole very potently inhibits Nav channels in a voltage- and use-dependent manner, due to its great preferential affinity for inactivated channels and the presence of a protonable amine group. Patch-clamp experiments suggest that the binding sites of both drugs overlap the local anesthetic receptor within the ion-conducting pathway. Riluzole and lubeluzole displayed very potent antimyotonic activity in a rat model of myotonia, a pathological skeletal muscle condition characterized by high-frequency runs of action potentials. Such results well support the repurposing of riluzole as an antimyotonic drug, allowing the launch of a pilot study in myotonic patients. Riluzole, lubeluzole, and new Nav channel blockers built on the benzothiazolamine scaffold will certainly continue to be investigated for possible clinical applications.
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Affiliation(s)
- Alessandro Farinato
- Section of Pharmacology, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Concetta Altamura
- Section of Pharmacology, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Jean-François Desaphy
- Section of Pharmacology, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy.
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Skov M, de Paoli FV, Nielsen OB, Pedersen TH. The anti-convulsants lacosamide, lamotrigine, and rufinamide reduce myotonia in isolated human and rat skeletal muscle. Muscle Nerve 2017; 56:136-142. [PMID: 27783415 DOI: 10.1002/mus.25452] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 10/14/2016] [Accepted: 10/19/2016] [Indexed: 11/11/2022]
Abstract
INTRODUCTION In myotonia congenita, loss of ClC-1 Cl- channel function results in skeletal muscle hyperexcitability and myotonia. Anti-myotonic treatment has typically targeted the voltage-gated sodium channel in skeletal muscle (Nav1.4). In this study we explored whether 3 sodium channel-modulating anti-epileptics can reduce myotonia in isolated rat and human muscle. METHODS Dissected muscles were rendered myotonic by ClC-1 channel inhibition. The ability of the drugs to suppress myotonia was then assessed from subclinical to maximal clinical concentrations. Drug synergy was determined using isobole plots. RESULTS All drugs were capable of abolishing myotonia in both rat and human muscles. Lamotrigine and rufinamide completely suppressed myotonia at submaximal clinical concentrations, whereas lacosamide had to be raised above the maximal clinical concentration to suppress myotonia completely. A synergistic effect of lamotrigine and rufinamide was observed. CONCLUSION These findings suggest that lamotrigine and rufinamide could be considered for anti-myotonic treatment in myotonia congenita. Muscle Nerve 56: 136-142, 2017.
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Affiliation(s)
- Martin Skov
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000, Aarhus C, Denmark
| | - Frank V de Paoli
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000, Aarhus C, Denmark.,Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Ole B Nielsen
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000, Aarhus C, Denmark
| | - Thomas H Pedersen
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000, Aarhus C, Denmark
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Increased sodium channel use-dependent inhibition by a new potent analogue of tocainide greatly enhances in vivo antimyotonic activity. Neuropharmacology 2016; 113:206-216. [PMID: 27743929 PMCID: PMC5154332 DOI: 10.1016/j.neuropharm.2016.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/08/2016] [Accepted: 10/11/2016] [Indexed: 01/19/2023]
Abstract
Although the sodium channel blocker, mexiletine, is the first choice drug in myotonia, some myotonic patients remain unsatisfied due to contraindications, lack of tolerability, or incomplete response. More therapeutic options are thus needed for myotonic patients, which require clinical trials based on solid preclinical data. In previous structure-activity relationship studies, we identified two newly-synthesized derivatives of tocainide, To040 and To042, with greatly enhanced potency and use-dependent behavior in inhibiting sodium currents in frog skeletal muscle fibers. The current study was performed to verify their potential as antimyotonic agents. Patch-clamp experiments show that both compounds, especially To042, are greatly more potent and use-dependent blockers of human skeletal muscle hNav1.4 channels compared to tocainide and mexiletine. Reduced effects on F1586C hNav1.4 mutant suggest that the compounds bind to the local anesthetic receptor, but that the increased hindrance and lipophilia of the N-substituent may further strengthen drug-receptor interaction and use-dependence. Compared to mexiletine, To042 was 120 times more potent to block hNav1.4 channels in a myotonia-like cellular condition and 100 times more potent to improve muscle stiffness in vivo in a previously-validated rat model of myotonia. To explore toxicological profile, To042 was tested on hERG potassium currents, motor coordination using rotarod, and C2C12 cell line for cytotoxicity. All these experiments suggest a satisfactory therapeutic index for To042. This study shows that, owing to a huge use-dependent block of sodium channels, To042 is a promising candidate drug for myotonia and possibly other membrane excitability disorders, warranting further preclinical and human studies. To040 and To042 are potent use-dependent hNav1.4 sodium channel blockers. The compounds strengthen the molecular interaction at the local anesthetic receptor. To042 is 120-fold more potent than mexiletine in vitro in myotonia-like conditions. To042 is 100-fold more potent than mexiletine in vivo in a rat model of myotonia. To042 is a promising antimyotonic drug deserving further investigation.
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Desaphy JF, Carbonara R, Costanza T, Conte Camerino D. Preclinical evaluation of marketed sodium channel blockers in a rat model of myotonia discloses promising antimyotonic drugs. Exp Neurol 2014; 255:96-102. [PMID: 24613829 PMCID: PMC4004800 DOI: 10.1016/j.expneurol.2014.02.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 02/17/2014] [Accepted: 02/26/2014] [Indexed: 12/25/2022]
Abstract
Although the sodium channel blocker mexiletine is considered the first-line drug in myotonia, some patients experiment adverse effects, while others do not gain any benefit. Other antimyotonic drugs are thus needed to offer mexiletine alternatives. In the present study, we used a previously-validated rat model of myotonia congenita to compare six marketed sodium channel blockers to mexiletine. Myotonia was induced in the rat by injection of anthracen-9-carboxylic acid, a muscle chloride channel blocker. The drugs were given orally and myotonia was evaluated by measuring the time of righting reflex. The drugs were also tested on sodium currents recorded in a cell line transfected with the human skeletal muscle sodium channel hNav1.4 using patch-clamp technique. In vivo, carbamazepine and propafenone showed antimyotonic activity at doses similar to mexiletine (ED50 close to 5mg/kg); flecainide and orphenadrine showed greater potency (ED50 near 1mg/kg); lubeluzole and riluzole were the more potent (ED50 near 0.1mg/kg). The antimyotonic activity of drugs in vivo was linearly correlated with their potency in blocking hNav1.4 channels in vitro. Deviation was observed for propafenone and carbamazepine, likely due to pharmacokinetics and multiple targets. The comparison of the antimyotonic dose calculated in rats with the current clinical dose in humans strongly suggests that all the tested drugs may be used safely for the treatment of human myotonia. Considering the limits of mexiletine tolerability and the occurrence of non-responders, this study proposes an arsenal of alternative drugs, which may prove useful to increase the quality of life of individuals suffering from non-dystrophic myotonia. Further clinical trials are warranted to confirm these results.
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Affiliation(s)
- Jean-François Desaphy
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari-Aldo Moro, Bari I-70125, Italy.
| | - Roberta Carbonara
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari-Aldo Moro, Bari I-70125, Italy
| | - Teresa Costanza
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari-Aldo Moro, Bari I-70125, Italy
| | - Diana Conte Camerino
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari-Aldo Moro, Bari I-70125, Italy
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