1
|
Ortiz-Corredor F, Sandoval-Salcedo A, Castellar-Leones S, Soto-Pena D, Ruíz-Ospina E, Suarez-Obando F. Trajectories of motor function in children with Duchenne muscular dystrophy: A longitudinal study on a Colombian population. Eur J Paediatr Neurol 2023; 47:105-109. [PMID: 37856935 DOI: 10.1016/j.ejpn.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/22/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
Duchenne Muscular Dystrophy (DMD) is characterized by an initial increase in motor function followed by a plateau phase and then entering a phase of steady decline. However, motor evolution of DMD have not been evaluated in developing countries. Therefore, this study aims to evaluate the trajectory of motor function in a sample of Colombian children with DMD. We included 119 children with DMD aged 4.8-19.3 years (mean follow-up = 1.7 years). A linear mixed model was used with age as the time scale and adjusted for covariates using a stepwise regression. Participants showed a progressive decline in motor skills from the age of 5 years with a decrease in speed around the age of 11 years (p < 0.001). After age 11, the decline in motor function was observed to continue until age 20 but at a slower rate (βAge = -9.64. and βAge2 = 0.18, p < 0.001 for both). Educational inclusion, glucocorticoid treatment and the number of mutated exons were shown to be associated with the motor performance. These findings may indicate that the evolution of DMD maintains similar patterns between high income countries and the Colombian population. They allow us to adapt and develop treatments that impact the population with DMD in Colombia, based in international evidence.
Collapse
Affiliation(s)
- Fernando Ortiz-Corredor
- Universidad Nacional de Colombia, Facultad de Medicina, Sede Bogotá, Colombia; Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia.
| | | | - Sandra Castellar-Leones
- Universidad Nacional de Colombia, Facultad de Medicina, Sede Bogotá, Colombia; Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia
| | | | - Edicson Ruíz-Ospina
- Universidad Nacional de Colombia, Facultad de Medicina, Sede Bogotá, Colombia; Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia
| | - Fernando Suarez-Obando
- Universidad Nacional de Colombia, Facultad de Medicina, Sede Bogotá, Colombia; Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia; Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Colombia
| |
Collapse
|
2
|
Stefano MED, Ferretti V, Mozzetta C. Synaptic alterations as a neurodevelopmental trait of Duchenne muscular dystrophy. Neurobiol Dis 2022; 168:105718. [PMID: 35390481 DOI: 10.1016/j.nbd.2022.105718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/14/2023] Open
Abstract
Dystrophinopaties, e.g., Duchenne muscular dystrophy (DMD), Becker muscular dystrophy and X-linked dilated cardiomyopathy are inherited neuromuscular diseases, characterized by progressive muscular degeneration, which however associate with a significant impact on general system physiology. The more severe is the pathology and its diversified manifestations, the heavier are its effects on organs, systems, and tissues other than muscles (skeletal, cardiac and smooth muscles). All dystrophinopaties are characterized by mutations in a single gene located on the X chromosome encoding dystrophin (Dp427) and its shorter isoforms, but DMD is the most devasting: muscular degenerations manifests within the first 4 years of life, progressively affecting motility and other muscular functions, and leads to a fatal outcome between the 20s and 40s. To date, after years of studies on both DMD patients and animal models of the disease, it has been clearly demonstrated that a significant percentage of DMD patients are also afflicted by cognitive, neurological, and autonomic disorders, of varying degree of severity. The anatomical correlates underlying neural functional damages are established during embryonic development and the early stages of postnatal life, when brain circuits, sensory and motor connections are still maturing. The impact of the absence of Dp427 on the development, differentiation, and consolidation of specific cerebral circuits (hippocampus, cerebellum, prefrontal cortex, amygdala) is significant, and amplified by the frequent lack of one or more of its lower molecular mass isoforms. The most relevant aspect, which characterizes DMD-associated neurological disorders, is based on morpho-functional alterations of selective synaptic connections within the affected brain areas. This pathological feature correlates neurological conditions of DMD to other severe neurological disorders, such as schizophrenia, epilepsy and autistic spectrum disorders, among others. This review discusses the organization and the role of the dystrophin-dystroglycan complex in muscles and neurons, focusing on the neurological aspect of DMD and on the most relevant morphological and functional synaptic alterations, in both central and autonomic nervous systems, described in the pathology and its animal models.
Collapse
Affiliation(s)
- Maria Egle De Stefano
- Department of Biology and Biotechnology "Charles Darwin", Sapienza University of Rome, 00185 Rome, Italy; Center for Research in Neurobiology Daniel Bovet, Sapienza University of Rome, 00185 Rome, Italy.
| | - Valentina Ferretti
- Department of Biology and Biotechnology "Charles Darwin", Sapienza University of Rome, 00185 Rome, Italy; Center for Research in Neurobiology Daniel Bovet, Sapienza University of Rome, 00185 Rome, Italy
| | - Chiara Mozzetta
- Institute of Molecular Biology and Pathology (IBPM), National Research Council (CNR) of Italy c/o Department of Biology and Biotechnology "Charles Darwin", Sapienza University of Rome, 00185 Rome, Italy
| |
Collapse
|
3
|
Lingineni K, Aggarwal V, Morales JF, Conrado DJ, Corey D, Vong C, Burton J, Larkindale J, Romero K, Schmidt S, Kim S. Development of a model-based clinical trial simulation platform to optimize the design of clinical trials for Duchenne muscular dystrophy. CPT Pharmacometrics Syst Pharmacol 2022; 11:318-332. [PMID: 34877803 PMCID: PMC8923721 DOI: 10.1002/psp4.12753] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 12/23/2022] Open
Abstract
Early clinical trials of therapies to treat Duchenne muscular dystrophy (DMD), a fatal genetic X‐linked pediatric disease, have been designed based on the limited understanding of natural disease progression and variability in clinical measures over different stages of the continuum of the disease. The objective was to inform the design of DMD clinical trials by developing a disease progression model‐based clinical trial simulation (CTS) platform based on measures commonly used in DMD trials. Data were integrated from past studies through the Duchenne Regulatory Science Consortium founded by the Critical Path Institute (15 clinical trials and studies, 1505 subjects, 27,252 observations). Using a nonlinear mixed‐effects modeling approach, longitudinal dynamics of five measures were modeled (NorthStar Ambulatory Assessment, forced vital capacity, and the velocities of the following three timed functional tests: time to stand from supine, time to climb 4 stairs, and 10 meter walk‐run time). The models were validated on external data sets and captured longitudinal changes in the five measures well, including both early disease when function improves as a result of growth and development and the decline in function in later stages. The models can be used in the CTS platform to perform trial simulations to optimize the selection of inclusion/exclusion criteria, selection of measures, and other trial parameters. The data sets and models have been reviewed by the US Food and Drug Administration and the European Medicines Agency; have been accepted into the Fit‐for‐Purpose and Qualification for Novel Methodologies pathways, respectively; and will be submitted for potential endorsement by both agencies.
Collapse
Affiliation(s)
- Karthik Lingineni
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, Florida, USA
| | | | - Juan Francisco Morales
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, Florida, USA
| | | | - Diane Corey
- Critical Path Institute, Tucson, Arizona, USA
| | - Camille Vong
- Global Product Development, Pfizer Inc, Cambridge, Massachusetts, USA
| | | | | | | | - Stephan Schmidt
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, Florida, USA
| | - Sarah Kim
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, Florida, USA
| | | |
Collapse
|
4
|
Implementation of Motor Function Measure score percentile curves - Predicting motor function loss in Duchenne muscular dystrophy. Eur J Paediatr Neurol 2022; 36:78-83. [PMID: 34929615 DOI: 10.1016/j.ejpn.2021.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/16/2022]
Abstract
The Motor Function Measure is a standardized scoring system to evaluate motor function and monitor disease progression in neuromuscular diseases such as Duchenne muscular dystrophy. There are no available reference percentile curves for this measure. The aim of this analysis was to generate Motor Function Measure percentile curves for ambulant and non-ambulant patients affected by Duchenne Muscular Dystrophy, providing the opportunity to better evaluate the status and progression of an individual patient compared to other patients in the same age group. Data of patients aged between 6 and 15 years (819 measurements) was obtained from the international Motor Function Measure database. Age-dependent percentile curves were estimated using a "Generalized additive model for location, scale and shape" as suggested by the World Health Organisation Multicentre Growth Reference Study Group. Percentile curves for the Motor Function Measure total score and its sub-scores for patients with and without treatment with glucocorticoids are presented. Mean scores decline with age. Patients treated with glucocorticoids have higher mean values compared to glucocorticoid-naïve patients at the same age. The percentile curves with the online tool extend the clinical utility of the Motor Function Measure by facilitating the interpretation of individual standing and disease progression.
Collapse
|
5
|
Ricci G, Bello L, Torri F, Schirinzi E, Pegoraro E, Siciliano G. Therapeutic opportunities and clinical outcome measures in Duchenne muscular dystrophy. Neurol Sci 2022; 43:625-633. [PMID: 35608735 PMCID: PMC9126754 DOI: 10.1007/s10072-022-06085-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/14/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Duchenne muscular dystrophy (DMD) is a devastatingly severe genetic muscle disease characterized by childhood-onset muscle weakness, leading to loss of motor function and premature death due to respiratory and cardiac insufficiency. DISCUSSION In the following three and half decades, DMD kept its paradigmatic role in the field of muscle diseases, with first systematic description of disease progression with ad hoc outcome measures and the first attempts at correcting the disease-causing gene defect by several molecular targets. Clinical trials are critical for developing and evaluating new treatments for DMD. CONCLUSIONS In the last 20 years, research efforts converged in characterization of the disease mechanism and development of therapeutic strategies. Same effort needs to be dedicated to the development of outcome measures able to capture clinical benefit in clinical trials.
Collapse
Affiliation(s)
- Giulia Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Bello
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Francesca Torri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Erika Schirinzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
6
|
Lloyd Morris EH, Estilow T, Glanzman AM, Cusack SV, Yum SW. Improving Temporomandibular Range of Motion in People With Duchenne Muscular Dystrophy and Spinal Muscular Atrophy. Am J Occup Ther 2020; 74:7402205080p1-7402205080p10. [DOI: 10.5014/ajot.2020.030825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Evan Harry Lloyd Morris
- Evan Harry Lloyd Morris, MBA, MA, OTR/L, is Manager, Developmental Services, Rady Children’s Hospital, San Diego, CA;
| | - Timothy Estilow
- Timothy Estilow, OTR/L, is Occupational Therapist, Occupational Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Allan M. Glanzman
- Allan M. Glanzman, PT, DPT, is Physical Therapist, Physical Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Stacy Victoria Cusack
- Stacy Victoria Cusack, MS, OTR/L, is Occupational Therapist, Occupational Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sabrina W. Yum
- Sabrina W. Yum, MD, is Attending Physician, Neurology Department, Children’s Hospital of Philadelphia, Philadelphia, PA, and Assistant Professor of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
7
|
Luiz LC, Marson FAL, Bresciani Almeida CC, Toro AADC, Nucci A, Ribeiro JD. Analysis of motor and respiratory function in Duchenne muscular dystrophy patients. Respir Physiol Neurobiol 2019; 262:1-11. [PMID: 30660861 DOI: 10.1016/j.resp.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/28/2018] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Duchenne muscular dystrophy(DMD) shows motor and respiratory impairment. METHODS 19 DMD patients (DMDG) (nine ambulatory and 10 non-ambulatory) were evaluated through motor function measure (MFM), 6-minute walk test (6MWT), respiratory muscle strength, cough peak flow, spirometry and volumetric capnography (VCap) tools. Control group that performed spirometry and VCap (CG1-n = 17) were different from those that performed the 6MWT (CG2-n = 8). RESULTS The follow tools were assessed (p < 0.05): (i) MFM: Ambulatory patients showed higher values than non-ambulatory patients; (ii) 6MWT: DMDG walked a shorter distance and showed higher respiratory rate at rest and heart rate (HR) at rest than CG2; (iii) Spirometry: DMDG and non-ambulatory patients had minor values achieved in spirometry when compared with CG1 and ambulatory patients, respectively; (iv) VCap: DMDG when compared with CG1 showed: (<11 years-old) lower values in VCap parameters; (>11 years-old): higher HR and lower slope 2. There was correlation between spirometry, mainly for zFEV1/FVC, and MFM. CONCLUSION DMDG showed motor (MFM/6MWT) and respiratory (spirometry/VCap) deterioration when compared with CG. Non-ambulatory condition was associated with worse MFM and spirometry.
Collapse
Affiliation(s)
- Lívia Cocato Luiz
- Department of Pediatrics, School of Medical Sciences, University of Campinas, 13081-970, P.O. Box: 6111 Campinas, São Paulo, Brazil.
| | - Fernando Augusto Lima Marson
- Department of Pediatrics, School of Medical Sciences, University of Campinas, 13081-970, P.O. Box: 6111 Campinas, São Paulo, Brazil; Department of Medical Genetics and Genomic Medicine, School of Medical Sciences, University of Campinas, 13081-970, P.O. Box: 6111 Campinas, São Paulo, Brazil; Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, School of Medical Sciences, University of Campinas, 13081-970, P.O. Box: 6111 Campinas, São Paulo, Brazil.
| | - Celize Cruz Bresciani Almeida
- Department of Pediatrics, School of Medical Sciences, University of Campinas, 13081-970, P.O. Box: 6111 Campinas, São Paulo, Brazil.
| | | | - Anamarli Nucci
- Department of Neurology, School of Medical Sciences, University of Campinas, 13081-970, P.O. Box: 6111 Campinas, São Paulo, Brazil.
| | - José Dirceu Ribeiro
- Department of Pediatrics, School of Medical Sciences, University of Campinas, 13081-970, P.O. Box: 6111 Campinas, São Paulo, Brazil; Laboratory of Pulmonary Physiology, Center for Pediatrics Investigation, School of Medical Sciences, University of Campinas, 13081-970, P.O. Box: 6111 Campinas, São Paulo, Brazil.
| |
Collapse
|
8
|
Delalande O, Molza AE, Dos Santos Morais R, Chéron A, Pollet É, Raguenes-Nicol C, Tascon C, Giudice E, Guilbaud M, Nicolas A, Bondon A, Leturcq F, Férey N, Baaden M, Perez J, Roblin P, Piétri-Rouxel F, Hubert JF, Czjzek M, Le Rumeur E. Dystrophin's central domain forms a complex filament that becomes disorganized by in-frame deletions. J Biol Chem 2018. [PMID: 29535188 DOI: 10.1074/jbc.m117.809798] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Dystrophin, encoded by the DMD gene, is critical for maintaining plasma membrane integrity during muscle contraction events. Mutations in the DMD gene disrupting the reading frame prevent dystrophin production and result in severe Duchenne muscular dystrophy (DMD); in-frame internal deletions allow production of partly functional internally deleted dystrophin and result in less severe Becker muscular dystrophy (BMD). Many known BMD deletions occur in dystrophin's central domain, generally considered to be a monotonous rod-shaped domain based on the knowledge of spectrin family proteins. However, the effects caused by these deletions, ranging from asymptomatic to severe BMD, argue against the central domain serving only as a featureless scaffold. We undertook structural studies combining small-angle X-ray scattering and molecular modeling in an effort to uncover the structure of the central domain, as dystrophin has been refractory to characterization. We show that this domain appears to be a tortuous and complex filament that is profoundly disorganized by the most severe BMD deletion (loss of exons 45-47). Despite the preservation of large parts of the binding site for neuronal nitric oxide synthase (nNOS) in this deletion, computational approaches failed to recreate the association of dystrophin with nNOS. This observation is in agreement with a strong decrease of nNOS immunolocalization in muscle biopsies, a parameter related to the severity of BMD phenotypes. The structural description of the whole dystrophin central domain we present here is a first necessary step to improve the design of microdystrophin constructs toward the goal of a successful gene therapy for DMD.
Collapse
Affiliation(s)
- Olivier Delalande
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France,
| | - Anne-Elisabeth Molza
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France
| | - Raphael Dos Santos Morais
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France.,the Synchrotron SOLEIL, 91190 Saint Aubin, France.,the Laboratoire Léon-Brillouin, UMR 12 CEA-CNRS, Université Paris-Saclay, CEA-Saclay, 91191 Gif-sur-Yvette Cedex, France
| | - Angélique Chéron
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France
| | - Émeline Pollet
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France
| | - Céline Raguenes-Nicol
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France
| | - Christophe Tascon
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France
| | - Emmanuel Giudice
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France
| | - Marine Guilbaud
- the Sorbonne Universités UPMC-INSERM-UMRS 97-CNRS FRE 3617, Institut de Myologie, 75013 Paris, France
| | - Aurélie Nicolas
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France
| | - Arnaud Bondon
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France.,the Université Rennes, CNRS, Institut des Sciences Chimiques de Rennes-UMR 6226, PRISM, 35000 Rennes, France
| | - France Leturcq
- the Sorbonne Universités UPMC-INSERM-UMRS 97-CNRS FRE 3617, Institut de Myologie, 75013 Paris, France.,the AP-HP, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Laboratoire de Biochimie et Génétique Moléculaire, 75014 Paris, France
| | - Nicolas Férey
- the CNRS UPR3251, Université Paris XI, 91403 Orsay Cedex, France
| | - Marc Baaden
- the CNRS UPR9080, Université Paris Diderot, Sorbonne Paris Cité, 75005 Paris, France
| | - Javier Perez
- the Synchrotron SOLEIL, 91190 Saint Aubin, France
| | - Pierre Roblin
- the Synchrotron SOLEIL, 91190 Saint Aubin, France.,the INRA-Biopolymères, Interaction et Assemblages, 44000 Nantes, France
| | - France Piétri-Rouxel
- the Sorbonne Universités UPMC-INSERM-UMRS 97-CNRS FRE 3617, Institut de Myologie, 75013 Paris, France
| | - Jean-François Hubert
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France
| | - Mirjam Czjzek
- the Sorbonne Universités, UPMC Université Paris 06, 75006 Paris, France, and.,the CNRS UMR 8227, Integrative Biology of Marine Models, 29688 Roscoff Cedex, France
| | - Elisabeth Le Rumeur
- From the Université de Rennes, CNRS, Institut de Génétique et Développement de Rennes-UMR 6290, 35000 Rennes, France
| |
Collapse
|
9
|
Lim KRQ, Maruyama R, Yokota T. Eteplirsen in the treatment of Duchenne muscular dystrophy. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:533-545. [PMID: 28280301 PMCID: PMC5338848 DOI: 10.2147/dddt.s97635] [Citation(s) in RCA: 304] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Duchenne muscular dystrophy is a fatal neuromuscular disorder affecting around one in 3,500–5,000 male births that is characterized by progressive muscular deterioration. It is inherited in an X-linked recessive fashion and is caused by loss-of-function mutations in the DMD gene coding for dystrophin, a cytoskeletal protein that stabilizes the plasma membrane of muscle fibers. In September 2016, the US Food and Drug Administration granted accelerated approval for eteplirsen (or Exondys 51), a drug that acts to promote dystrophin production by restoring the translational reading frame of DMD through specific skipping of exon 51 in defective gene variants. Eteplirsen is applicable for approximately 14% of patients with DMD mutations. This article extensively reviews and discusses the available information on eteplirsen to date, focusing on pharmacological, efficacy, safety, and tolerability data from preclinical and clinical trials. Issues faced by eteplirsen, particularly those relating to its efficacy, will be identified. Finally, the place of eteplirsen and exon skipping as a general therapeutic strategy in Duchenne muscular dystrophy treatment will be discussed.
Collapse
Affiliation(s)
- Kenji Rowel Q Lim
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta
| | - Rika Maruyama
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta
| | - Toshifumi Yokota
- Department of Medical Genetics, Faculty of Medicine and Dentistry, University of Alberta; The Friends of Garrett Cumming Research & Muscular Dystrophy Canada, HM Toupin Neurological Science Research Chair, Edmonton, AB, Canada
| |
Collapse
|
10
|
Havens MA, Hastings ML. Splice-switching antisense oligonucleotides as therapeutic drugs. Nucleic Acids Res 2016; 44:6549-63. [PMID: 27288447 PMCID: PMC5001604 DOI: 10.1093/nar/gkw533] [Citation(s) in RCA: 290] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/02/2016] [Indexed: 01/09/2023] Open
Abstract
Splice-switching oligonucleotides (SSOs) are short, synthetic, antisense, modified nucleic acids that base-pair with a pre-mRNA and disrupt the normal splicing repertoire of the transcript by blocking the RNA–RNA base-pairing or protein–RNA binding interactions that occur between components of the splicing machinery and the pre-mRNA. Splicing of pre-mRNA is required for the proper expression of the vast majority of protein-coding genes, and thus, targeting the process offers a means to manipulate protein production from a gene. Splicing modulation is particularly valuable in cases of disease caused by mutations that lead to disruption of normal splicing or when interfering with the normal splicing process of a gene transcript may be therapeutic. SSOs offer an effective and specific way to target and alter splicing in a therapeutic manner. Here, we discuss the different approaches used to target and alter pre-mRNA splicing with SSOs. We detail the modifications to the nucleic acids that make them promising therapeutics and discuss the challenges to creating effective SSO drugs. We highlight the development of SSOs designed to treat Duchenne muscular dystrophy and spinal muscular atrophy, which are currently being tested in clinical trials.
Collapse
Affiliation(s)
- Mallory A Havens
- Department of Biology, Lewis University, Romeoville, IL 60446, USA
| | - Michelle L Hastings
- Department of Cell Biology and Anatomy, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
| |
Collapse
|
11
|
Ribeiro D, Stuckey DW. The Action Duchenne 13th International Annual Conference, November 6-7, 2015, London, UK. EBioMedicine 2016; 2:1836-7. [PMID: 26844248 PMCID: PMC4703741 DOI: 10.1016/j.ebiom.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 11/30/2022] Open
|
12
|
|