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De Paepe B. What Nutraceuticals Can Do for Duchenne Muscular Dystrophy: Lessons Learned from Amino Acid Supplementation in Mouse Models. Biomedicines 2023; 11:2033. [PMID: 37509672 PMCID: PMC10377666 DOI: 10.3390/biomedicines11072033] [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: 06/28/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Duchenne muscular dystrophy (DMD), the severest form of muscular dystrophy, is characterized by progressive muscle weakness with fatal outcomes most often before the fourth decade of life. Despite the recent addition of molecular treatments, DMD remains a disease without a cure, and the need persists for the development of supportive therapies aiming to help improve patients' quality of life. This review focuses on the therapeutical potential of amino acid and derivative supplements, summarizing results obtained in preclinical studies in murine disease models. Several promising compounds have emerged, with L-arginine, N-acetylcysteine, and taurine featuring among the most intensively investigated. Their beneficial effects include reduced inflammatory, oxidative, fibrotic, and necrotic damage to skeletal muscle tissues. Improvement of muscle strength and endurance have been reported; however, mild side effects have also surfaced. More explorative, placebo-controlled and long-term clinical trials would need to be conducted in order to identify amino acid formulae that are safe and of true benefit to DMD patients.
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Affiliation(s)
- Boel De Paepe
- Department of Neurology, Ghent University & Neuromuscular Reference Center, Ghent University Hospital, Route 830, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Moludi J, Qaisar SA, Kadhim MM, Ahmadi Y, Davari M. Protective and therapeutic effectiveness of taurine supplementation plus low calorie diet on metabolic parameters and endothelial markers in patients with diabetes mellitus: a randomized, clinical trial. Nutr Metab (Lond) 2022; 19:49. [PMID: 35870947 PMCID: PMC9308194 DOI: 10.1186/s12986-022-00684-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 05/31/2022] [Indexed: 12/22/2022] Open
Abstract
Background Taurine supplementation as a sulfur-containing amino acid may attenuate and/or alleviate diabetes-induced complications and endothelial dysfunction via its anti-inflammatory and antioxidant activities. Our purpose was to investigate the effect of Taurine supplementation on endothelial dysfunction markers, oxidative stress, inflammation, and glycemic control in patients with type 2 diabetes mellitus (T2DM). Methods In the current clinical trial, 120 patients with T2DM were randomly allocated to take either Taurine (containing 1 g Taurine, n = 60) or placebo (n = 60) three times per day for an eight-week period. Moreover, all patients were on a low-calorie diet. The primary outcome was fasting blood glucose (FBG) and endothelial markers including sera intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule (VCAM), and matrix metallopeptidase 9 (MMP-9). The secondary outcome was dietary intake, anthropometric indices, serum insulin and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), total antioxidant capacity (TAC), tumor necrosis factor (TNF), high-sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), and lipid profile.
Results After 8 weeks, Taurine-supplemented patients had a considerable decrease in serum insulin and HOMA-IR compared to placebo group. However, Taurine supplementation did not improve other metabolic parameters including lipid profiles, glycated hemoglobin, and fasting blood glucose (FBG). There was a significant decline in MDA, TNF, and hs-CRP levels after these eight-week period of Taurine supplementation. In addition, the Taurine group had fewer serum levels of endothelial dysfunction markers than the placebo group. Conclusions The evidence from our study revealed that Taurine supplementation significantly reduced insulin and HOMA-IR, as well as oxidative stress, inflammation, and endothelial markers in individuals with T2DM.
Trial registration The protocol of the study was recorded in the Iranian Registry of Clinical Trials (IRCT20180712040438N3).
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The Role of Taurine in Skeletal Muscle Functioning and Its Potential as a Supportive Treatment for Duchenne Muscular Dystrophy. Metabolites 2022; 12:metabo12020193. [PMID: 35208266 PMCID: PMC8879184 DOI: 10.3390/metabo12020193] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 02/01/2023] Open
Abstract
Taurine (2-aminoethanesulfonic acid) is required for ensuring proper muscle functioning. Knockout of the taurine transporter in mice results in low taurine concentrations in the muscle and associates with myofiber necrosis and diminished exercise capacity. Interestingly, regulation of taurine and its transporter is altered in the mdx mouse, a model for Duchenne Muscular Dystrophy (DMD). DMD is a genetic disorder characterized by progressive muscle degeneration and weakness due to the absence of dystrophin from the muscle membrane, causing destabilization and contraction-induced muscle cell damage. This review explores the physiological role of taurine in skeletal muscle and the consequences of a disturbed balance in DMD. Its potential as a supportive treatment for DMD is also discussed. In addition to genetic correction, that is currently under development as a curative treatment, taurine supplementation has the potential to reduce muscle inflammation and improve muscle strength in patients.
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Lopes M, Coimbra MA, Costa MDC, Ramos F. Food supplement vitamins, minerals, amino-acids, fatty acids, phenolic and alkaloid-based substances: An overview of their interaction with drugs. Crit Rev Food Sci Nutr 2021:1-35. [PMID: 34792411 DOI: 10.1080/10408398.2021.1997909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Food supplements are a widespread group of products ingested as a diet complement, whose consumption has recently skyrocketed due to the consumers' concern with their well-being. Among food supplements, vitamin- and mineral-based ones are the top sellers, and the demand of others, such as those containing polyphenols, is increasing. Owing to their alleged natural characteristics, consumers take the safety of food supplements for granted, and use them even when taking medicines. Thus, their potential interactions with drugs have been sparsely evaluated. This manuscript aims to bring forth an up-to-date overview of the most important knowledge involving the interactions between food supplements and drugs, relevant to be aware by nutritionists and other healthcare professionals. To this end, an extensive bibliographic review was conducted focusing on peer reviewed data from experimental in vivo evidence and clinical studies whenever major clinical interactions have been reported. Elder people and polymedicated or chronic patients are especially vulnerable to the therapeutic ineffectiveness and toxicity caused by these types of interactions. Drugs used to treat cardiovascular, autoimmune, nervous, and oncological diseases are commonly involved in important clinical interactions with food supplements, many with a narrow therapeutic margin.
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Affiliation(s)
- Maria Lopes
- Faculty of Pharmacy, Azinhaga de Santa Comba, University of Coimbra, Coimbra, Portugal.,REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, Oporto, Portugal
| | - Manuel A Coimbra
- LAQV/REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal.,Economic and Food Safety Authority (ASAE) Scientific Council, Rua Rodrigo da Fonseca, Lisboa, Portugal
| | - Maria do Céu Costa
- Economic and Food Safety Authority (ASAE) Scientific Council, Rua Rodrigo da Fonseca, Lisboa, Portugal.,CBIOS-Universidade Lusófona's Research Centre for Biosciences & Health Technologies, Lisboa, Portugal.,NICiTeS, Polytechnic Institute of Lusophony, ERISA-Escola Superior de Saúde Ribeiro Sanches, Lisboa, Portugal
| | - Fernando Ramos
- Faculty of Pharmacy, Azinhaga de Santa Comba, University of Coimbra, Coimbra, Portugal.,REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, Oporto, Portugal.,Economic and Food Safety Authority (ASAE) Scientific Council, Rua Rodrigo da Fonseca, Lisboa, Portugal
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An Overview of Physical Exercise and Antioxidant Supplementation Influences on Skeletal Muscle Oxidative Stress. Antioxidants (Basel) 2021; 10:antiox10101528. [PMID: 34679663 PMCID: PMC8532825 DOI: 10.3390/antiox10101528] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022] Open
Abstract
One of the essential injuries caused by moderate to high-intensity and short-duration physical activities is the overproduction of reactive oxygen species (ROS), damaging various body tissues such as skeletal muscle (SM). However, ROS is easily controlled by antioxidant defense systems during low to moderate intensity and long-term exercises. In stressful situations, antioxidant supplements are recommended to prevent ROS damage. We examined the response of SM to ROS generation during exercise using an antioxidant supplement treatment strategy in this study. The findings of this review research are paradoxical due to variances in antioxidant supplements dose and duration, intensity, length, frequency, types of exercise activities, and, in general, the lack of a regular exercise and nutrition strategy. As such, further research in this area is still being felt.
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The Interplay of Mitophagy and Inflammation in Duchenne Muscular Dystrophy. Life (Basel) 2021; 11:life11070648. [PMID: 34357020 PMCID: PMC8307817 DOI: 10.3390/life11070648] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/11/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked neuromuscular disease caused by a pathogenic disruption of the DYSTROPHIN gene that results in non-functional dystrophin protein. DMD patients experience loss of ambulation, cardiac arrhythmia, metabolic syndrome, and respiratory failure. At the molecular level, the lack of dystrophin in the muscle results in myofiber death, fibrotic infiltration, and mitochondrial dysfunction. There is no cure for DMD, although dystrophin-replacement gene therapies and exon-skipping approaches are being pursued in clinical trials. Mitochondrial dysfunction is one of the first cellular changes seen in DMD myofibers, occurring prior to muscle disease onset and progresses with disease severity. This is seen by reduced mitochondrial function, abnormal mitochondrial morphology and impaired mitophagy (degradation of damaged mitochondria). Dysfunctional mitochondria release high levels of reactive oxygen species (ROS), which can activate pro-inflammatory pathways such as IL-1β and IL-6. Impaired mitophagy in DMD results in increased inflammation and further aggravates disease pathology, evidenced by increased muscle damage and increased fibrosis. This review will focus on the critical interplay between mitophagy and inflammation in Duchenne muscular dystrophy as a pathological mechanism, as well as describe both candidate and established therapeutic targets that regulate these pathways.
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Davidson ZE, Hughes I, Ryan MM, Kornberg AJ, Cairns AG, Jones K, Hutchence M, Sampaio H, Morrison M, Truby H. Effect of a multicomponent nutritional supplement on functional outcomes for Duchenne muscular dystrophy: A randomized controlled trial. Clin Nutr 2021; 40:4702-4711. [PMID: 34237697 DOI: 10.1016/j.clnu.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/15/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS Duchenne muscular dystrophy (DMD) is an X-linked neuromuscular condition causing progressive muscle weakness and premature death. Whilst effective treatments such as gene therapy are developed, families often seek complementary therapies such as nutrition supplements to help their son maintain function; however, there is limited evidence supporting the use of nutritional supplements in DMD. This study aimed to compare the effect of a Standard nutritional supplement with an Enhanced nutritional supplement combining three nutriceuticals on functional outcomes in ambulatory boys with Duchenne muscular dystrophy (DMD). DESIGN A 50-week double blinded, randomized, controlled crossover trial was conducted in four Australian neuromuscular centres. Primary outcome measures were 6-min walk distance (6MWD) and community ambulation (StepWatch™ Activity Monitoring). Secondary outcome measures included body composition and quality of life. Serum 25-hydroxyvitamin D was measured. RESULTS Twenty-seven boys completed the intervention. Traditional crossover analysis demonstrated the Enhanced supplement compared to the Standard supplement was associated with a difference of +12 (95% CI: -16, 40) metres in 6MWD, +0.5 (95% CI: -53, 54) inactive minutes per day and -95 (95% CI: -887, 696) steps per day. A mixed effect model indicated a potentially clinically important effect of the Enhanced supplement on the 6MWD of +31 (95% CI: -19, 81) metres. Mean serum 25 hydroxyvitamin D levels at week 50 was 94 (95% CI: 84, 104) nmol/L. There was no observable effect of either supplement regime on body composition or quality of life. CONCLUSIONS Whilst a positive effect of the Enhanced supplement on functional outcomes was observed, this finding was inconclusive due to the small sample size. The results do not support the use of combined nutritional supplements to improve body composition or quality of life in DMD. A dose of 2000 IU vitamin D was an adequate dose to raise serum 25-hydroxyvitamin D over 50 weeks. CLINICAL TRIAL REGISTRY Registry #: ACTRN12610000462088, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12610000462088.
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Affiliation(s)
- Zoe E Davidson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Neurology Department, Royal Children's Hospital, Parkville, Victoria, Australia.
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Monique M Ryan
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Neurology Department, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Andrew J Kornberg
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Neurology Department, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Anita G Cairns
- Neurosciences Department, Queensland's Children Hospital, South Brisbane, Queensland, Australia
| | - Kristi Jones
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics, University of Sydney, Sydney, Australia
| | - Meghan Hutchence
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Hugo Sampaio
- Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Australia
| | - Margot Morrison
- Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Helen Truby
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia
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Bamaga AK, Alghamdi F, Alshaikh N, Altwaijri W, Bashiri FA, Hundallah K, Abukhaled M, Muthaffar OY, Al-Mehmadi S, Jamaly TA, Al-Muhaizea MA, Al-Saman A. Consensus Statement on the Management of Duchenne Muscular Dystrophy in Saudi Arabia During the Coronavirus Disease 2019 Pandemic. Front Pediatr 2021; 9:629549. [PMID: 33681102 PMCID: PMC7927788 DOI: 10.3389/fped.2021.629549] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has caused overwhelming challenges in healthcare worldwide. During such an outbreak, some needs of high-risk groups who require regular follow-ups and long-term management are not met. The vulnerable populations include patients with Duchenne muscular dystrophy (DMD). Duchenne muscular dystrophy is characterized by respiratory complications caused by muscle weakness. Hence, patients with this condition are at high risk of severe diseases including COVID-19. Methods: To standardize care and provide optimal treatment to DMD patients in Saudi Arabia during the COVID-19 pandemic, a panel of experts including neurologists and pediatricians consolidated recommendations for healthcare professionals and caregivers. Results: During this pandemic, substituting unnecessary clinic visits with virtual clinic services was highly recommended, if possible, without compromising clinical outcomes. Duchenne muscular dystrophy patients with respiratory complications should be closely monitored, and those with cardiovascular complications must continue taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Moreover, individualized home-based rehabilitation management was preferred. Glucocorticoid and new gene correction therapies should be continued. However, new gene correction therapy must be post-poned in newly diagnosed patients. A multidisciplinary decision was required before the initiation of hydroxychloroquine based on the COVID-19 treatment protocol. Conclusion: COVID-19 has caused challenges and transformed access to health care. However, these limitations have provided opportunities for the health care system to adapt. Further, telemedicine has become a reliable platform for follow-up appointments that should be conducted by a multidisciplinary team including physicians, dieticians, and physical therapists.
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Affiliation(s)
- Ahmed K Bamaga
- Neurology Division, Pediatric Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.,Pediatric Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Nahla Alshaikh
- Pediatric Department, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Waleed Altwaijri
- Pediatric Department, King Saud Bin Abdulaziz University, Riyadh, Saudi Arabia.,Pediatric Department, King Abdullah Specialized Children Hospital, Riyadh, Saudi Arabia
| | - Fahad A Bashiri
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Division of Neurology, Department of Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Musaad Abukhaled
- Department of Neuroscience, King Faisal Specialist Hospital and Research Centre, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Osama Y Muthaffar
- Neurology Division, Pediatric Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.,Pediatric Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Sameer Al-Mehmadi
- Department of Pediatric Neurology, Children's Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | | | | | - Abdulaziz Al-Saman
- Pediatric Neurology Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Łoboda A, Dulak J. Muscle and cardiac therapeutic strategies for Duchenne muscular dystrophy: past, present, and future. Pharmacol Rep 2020; 72:1227-1263. [PMID: 32691346 PMCID: PMC7550322 DOI: 10.1007/s43440-020-00134-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a severe X-linked neuromuscular childhood disorder that causes progressive muscle weakness and degeneration and results in functional decline, loss of ambulation and early death of young men due to cardiac or respiratory failure. Although the major cause of the disease has been known for many years-namely mutation in the DMD gene encoding dystrophin, one of the largest human genes-DMD is still incurable, and its treatment is challenging. METHODS A comprehensive and systematic review of literature on the gene, cell, and pharmacological experimental therapies aimed at restoring functional dystrophin or to counteract the associated processes contributing to disease progression like inflammation, fibrosis, calcium signaling or angiogenesis was carried out. RESULTS Although some therapies lead to satisfying effects in skeletal muscle, they are highly ineffective in the heart; therefore, targeting defective cardiac and respiratory systems is vital in DMD patients. Unfortunately, most of the pharmacological compounds treat only the symptoms of the disease. Some drugs addressing the underlying cause, like eteplirsen, golodirsen, and ataluren, have recently been conditionally approved; however, they can correct only specific mutations in the DMD gene and are therefore suitable for small sub-populations of affected individuals. CONCLUSION In this review, we summarize the possible therapeutic options and describe the current status of various, still imperfect, strategies used for attenuating the disease progression.
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Affiliation(s)
- Agnieszka Łoboda
- Department of Medical Biotechnology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland.
| | - Józef Dulak
- Department of Medical Biotechnology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
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