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Abdulhady H, Sakr HM, Elsayed NS, El-Sobky TA, Fahmy N, Saadawy AM, Elsedfy H. Ambulatory Duchenne muscular dystrophy children: cross-sectional correlation between function, quantitative muscle ultrasound and MRI. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2022; 41:1-14. [PMID: 35465338 PMCID: PMC9004336 DOI: 10.36185/2532-1900-063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/11/2022] [Indexed: 01/24/2023]
Abstract
Duchenne muscular dystrophy (DMD) is a progressive genetic muscle disease. Quantitative muscle ultrasound (US), muscle MRI, and functional tools are important to delineate characteristics of muscle involvement. We aimed to establish correlations between clinical/functional and above-named imaging tools respecting their diagnostic and prognostic role in DMD children. A cross-sectional retrospective study of 27 steroid-naive, ambulant male children/adolescents with genetically-confirmed DMD (mean age, 8.8 ± 3.3 years). Functional performance was assessed using motor function measure (MFM) which assess standing/transfer (D1), proximal (D2) and distal (D3) motor function, and six-minute walk test (6MWT). Imaging evaluation included quantitative muscle MRI which measured muscle fat content in a specific location of right rectus femoris by mDixon sequence. Quantitative muscle US measured right rectus femoris muscle brightness in standardized US image as an indicator of muscle fat content. We found a highly significant positive correlation between the mean MFM total score and 6MWT (R = 0.537, p = 0.007), and a highly significant negative correlation between fat content by muscle US and MFM total score (R = -0.603, p = 0.006) and its D1 subscore (R =-0.712, p = 0.001), and a significant negative correlation between fat content by US and 6MWT (R = -0.529, p = 0.02), and a significant positive correlation between muscle fat content by mDixon MRI and patient's age (R = 0.617, p = 0.01). Quantitative muscle US correlates significantly with clinical/functional assessment tools as MFM and 6MWT, and augments their role in disease-tracking of DMD. Quantitative muscle US has the potential to act as a substitute to functional assessment tools.
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Affiliation(s)
- Hala Abdulhady
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam M. Sakr
- Department of Diagnostic and Interventional Radiology and Molecular Imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt,Correspondence Hossam M. Sakr Department of Diagnostic and Interventional Radiology and Molecular Imaging Faculty of Medicine, Ain Shams University, Abbassia square, 11381 Cairo, Egypt. E-mail:
| | - Nermine S. Elsayed
- Department of Medical Genetics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer A. El-Sobky
- Division of Pediatric Orthopedics, Department of Orthopedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nagia Fahmy
- Neuromuscular Unit, Department of Neuropsychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr M. Saadawy
- Department of Diagnostic and Interventional Radiology and Molecular Imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Elsedfy
- Department of Medical Genetics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Simon NG, Noto YI, Zaidman CM. Skeletal muscle imaging in neuromuscular disease. J Clin Neurosci 2016; 33:1-10. [PMID: 27612670 DOI: 10.1016/j.jocn.2016.01.041] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023]
Abstract
Skeletal muscle imaging is increasingly used as a complement to clinical and electrophysiological examination in neuromuscular disease. Ultrasound and MRI have developed as the modalities of choice, each with strengths and limitations. Characteristic changes of muscle denervation and myopathy are seen on imaging which may delineate the nature of the disease process or help guide muscle biopsy. Identifying patterns of muscle involvement in hereditary myopathies may inform genetic testing. This review discusses skeletal muscle imaging in neuromuscular disease focusing on practical applications of current and emerging ultrasound and MRI techniques.
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Affiliation(s)
- Neil G Simon
- St Vincent's Clinical School, University of New South Wales, Level 5 deLacy Building, St Vincent's Hospital, Victoria Street, Darlinghurst, NSW 2010, Australia; Department of Neurology, St Vincent's Hospital, Darlinghurst, NSW, Australia.
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Brain and Mind Centre, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Craig M Zaidman
- Department of Neurology, Washington University in St. Louis, St Louis, MO, USA
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Circulating miRNAs are generic and versatile therapeutic monitoring biomarkers in muscular dystrophies. Sci Rep 2016; 6:28097. [PMID: 27323895 PMCID: PMC4914855 DOI: 10.1038/srep28097] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/26/2016] [Indexed: 12/29/2022] Open
Abstract
The development of medical approaches requires preclinical and clinical trials for assessment of therapeutic efficacy. Such evaluation entails the use of biomarkers, which provide information on the response to the therapeutic intervention. One newly-proposed class of biomarkers is the microRNA (miRNA) molecules. In muscular dystrophies (MD), the dysregulation of miRNAs was initially observed in muscle biopsy and later extended to plasma samples, suggesting that they may be of interest as biomarkers. First, we demonstrated that dystromiRs dysregulation occurs in MD with either preserved or disrupted expression of the dystrophin-associated glycoprotein complex, supporting the utilization of dystromiRs as generic biomarkers in MD. Then, we aimed at evaluation of the capacity of miRNAs as monitoring biomarkers for experimental therapeutic approach in MD. To this end, we took advantage of our previously characterized gene therapy approach in a mouse model for α-sarcoglycanopathy. We identified a dose-response correlation between the expression of miRNAs on both muscle tissue and blood serum and the therapeutic benefit as evaluated by a set of new and classically-used evaluation methods. This study supports the utility of profiling circulating miRNAs for the evaluation of therapeutic outcome in medical approaches for MD.
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Godi C, Ambrosi A, Nicastro F, Previtali SC, Santarosa C, Napolitano S, Iadanza A, Scarlato M, Natali Sora MG, Tettamanti A, Gerevini S, Cicalese MP, Sitzia C, Venturini M, Falini A, Gatti R, Ciceri F, Cossu G, Torrente Y, Politi LS. Longitudinal MRI quantification of muscle degeneration in Duchenne muscular dystrophy. Ann Clin Transl Neurol 2016; 3:607-22. [PMID: 27606343 PMCID: PMC4999593 DOI: 10.1002/acn3.319] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/22/2016] [Accepted: 04/30/2016] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the usefulness of magnetic resonance imaging (MRI) in detecting the progression of Duchenne muscular dystrophy (DMD) by quantification of fat infiltration (FI) and muscle volume index (MVI, a residual-to-total muscle volume ratio). METHODS Twenty-six patients (baseline age: 5-12 years) with genetically proven DMD were longitudinally analyzed with lower limb 3T MRI, force measurements, and functional tests (Gowers, 10-m time, North Star Ambulatory Assessment, 6-min walking test). Five age-matched controls were also examined, with a total of 85 MRI studies. Semiquantitative (scores) and quantitative MRI (qMRI) analyses (signal intensity ratio - SIR, lower limb MVI, and individual muscle MVI) were carried out. Permutation and regression analyses according to both age and functional test-outcomes were calculated. Age-related quantitative reference curves of SIRs and MVIs were generated. RESULTS FI was present on glutei and adductor magnus in all patients since the age of 5, with a proximal-to-distal progression and selective sparing of sartorius and gracilis. Patients' qMRI measures were significantly different from controls' and among age classes. qMRI were more sensitive than force measurements and functional tests in assessing disease progression, allowing quantification also after loss of ambulation. Age-related curves with percentile values were calculated for SIRs and MVIs, to provide a reference background for future experimental therapy trials. SIRs and MVIs significantly correlated with all clinical measures, and could reliably predict functional outcomes and loss of ambulation. INTERPRETATIONS qMRI-based indexes are sensitive measures that can track the progression of DMD and represent a valuable tool for follow-up and clinical studies.
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Affiliation(s)
- Claudia Godi
- Neuroradiology Department Neuroradiology Research Group and CERMAC San Raffaele Scientific Institute and Vita-Salute San Raffaele University Milan Italy
| | - Alessandro Ambrosi
- CUSSB University Centre for Biomedical Sciences Vita-Salute San Raffaele University Milan Italy
| | - Francesca Nicastro
- Laboratory of Analysis and Rehabilitation of Motor Function Division of Neuroscience San Raffaele Scientific Institute Milan Italy
| | - Stefano C Previtali
- Division of Neuroscience Institute of Experimental Neurology (INSpe) San Raffaele Scientific Institute Milan Italy
| | - Corrado Santarosa
- Neuroradiology Department Neuroradiology Research Group and CERMAC San Raffaele Scientific Institute and Vita-Salute San Raffaele University Milan Italy
| | - Sara Napolitano
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET) and Pediatric Immunohematology and Bone Marrow Transplantation Unit San Raffaele Scientific Institute Milan Italy
| | - Antonella Iadanza
- Neuroradiology Department Neuroradiology Research Group and CERMAC San Raffaele Scientific Institute and Vita-Salute San Raffaele University Milan Italy
| | - Marina Scarlato
- Division of Neuroscience Institute of Experimental Neurology (INSpe) San Raffaele Scientific Institute Milan Italy
| | - Maria Grazia Natali Sora
- Division of Neuroscience Institute of Experimental Neurology (INSpe) San Raffaele Scientific Institute Milan Italy
| | - Andrea Tettamanti
- Laboratory of Analysis and Rehabilitation of Motor Function Division of Neuroscience San Raffaele Scientific Institute Milan Italy
| | - Simonetta Gerevini
- Neuroradiology Department Neuroradiology Research Group and CERMAC San Raffaele Scientific Institute and Vita-Salute San Raffaele University Milan Italy
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET) and Pediatric Immunohematology and Bone Marrow Transplantation Unit San Raffaele Scientific Institute Milan Italy
| | - Clementina Sitzia
- Stem Cell Laboratory Department of Pathophysiology and Transplantation Universitá degli Studi di Milano Fondazione IRCCS Cá Granda Ospedale Maggiore Policlinico Centro Dino Ferrari, Milan Italy
| | - Massimo Venturini
- Radiology Department San Raffaele Scientific Institute and Vita-Salute San Raffaele University Milan Italy
| | - Andrea Falini
- Neuroradiology Department Neuroradiology Research Group and CERMAC San Raffaele Scientific Institute and Vita-Salute San Raffaele University Milan Italy
| | - Roberto Gatti
- Laboratory of Analysis and Rehabilitation of Motor Function Division of Neuroscience San Raffaele Scientific Institute Milan Italy
| | - Fabio Ciceri
- Hematology and BMT Unit San Raffaele Scientific Institute and Vita-Salute San Raffaele University Milan Italy
| | - Giulio Cossu
- Institute of Inflammation and Repair University of Manchester Manchester United Kingdom
| | - Yvan Torrente
- Stem Cell Laboratory Department of Pathophysiology and Transplantation Universitá degli Studi di Milano Fondazione IRCCS Cá Granda Ospedale Maggiore Policlinico Centro Dino Ferrari, Milan Italy
| | - Letterio S Politi
- Neuroradiology Department Neuroradiology Research Group and CERMAC San Raffaele Scientific Institute and Vita-Salute San Raffaele University Milan Italy; Neuroimaging Research Division of Hematology/Oncology Boston Children's Hospital Boston MA USA; Department of Pediatrics Harvard Medical School Boston MA USA; University of Massachusetts Memorial Medical Center and University of Massachusetts Medical School Worcester MA USA
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Hogrel JY, Wary C, Moraux A, Azzabou N, Decostre V, Ollivier G, Canal A, Lilien C, Ledoux I, Annoussamy M, Reguiba N, Gidaro T, Le Moing AG, Cardas R, Voit T, Carlier PG, Servais L. Longitudinal functional and NMR assessment of upper limbs in Duchenne muscular dystrophy. Neurology 2016; 86:1022-30. [PMID: 26888987 DOI: 10.1212/wnl.0000000000002464] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 12/03/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To explore the value of nuclear magnetic resonance (NMR) and functional assessments for follow-up of ambulatory and nonambulatory patients with Duchenne muscular dystrophy (DMD). METHODS Twenty-five 53-skippable patients with DMD were included in this study; 15 were nonambulatory at baseline. All patients underwent clinical and functional assessments every 6 months using the Motor Function Measure (MFM), hand grip and key pinch strength, MoviPlate, and NMR spectroscopy and imaging studies. RESULTS Upper limb distal strength decreased in nonambulatory patients over the period of 1 year; ambulatory patients showed improvement during the same period. The same applied for several NMRS indices, such as phosphocreatine/adenosine triphosphate, which decreased in older patients but increased in younger ambulatory patients. Fat infiltration in the upper limbs increased linearly with age. Almost all NMR and functional assessment results correlated. CONCLUSIONS Our results underscore complementarity of functional and NMR assessments in patients with DMD. Sensitivity to change of various indices may differ according to disease stage.
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Affiliation(s)
- Jean-Yves Hogrel
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France.
| | - Claire Wary
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Amélie Moraux
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Noura Azzabou
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Valérie Decostre
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Gwenn Ollivier
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Aurélie Canal
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Charlotte Lilien
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Isabelle Ledoux
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | | | - Nacera Reguiba
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Teresa Gidaro
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | | | - Ruxandra Cardas
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Thomas Voit
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Pierre G Carlier
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
| | - Laurent Servais
- From the Institut de Myologie, GH Pitié-Salpêtrière, Paris, France
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LoMauro A, D'Angelo MG, Aliverti A. Assessment and management of respiratory function in patients with Duchenne muscular dystrophy: current and emerging options. Ther Clin Risk Manag 2015; 11:1475-88. [PMID: 26451113 PMCID: PMC4592047 DOI: 10.2147/tcrm.s55889] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked myopathy resulting in progressive weakness and wasting of all the striated muscles including the respiratory muscles. The consequences are loss of ambulation before teen ages, cardiac involvement and breathing difficulties, the main cause of death. A cure for DMD is not currently available. In the last decades the survival of patients with DMD has improved because the natural history of the disease can be changed thanks to a more comprehensive therapeutic approach. This comprises interventions targeted to the manifestations and complications of the disease, particularly in the respiratory care. These include: 1) pharmacological intervention, namely corticosteroids and idebenone that significantly reduce the decline of spirometric parameters; 2) rehabilitative intervention, namely lung volume recruitment techniques that help prevent atelectasis and slows the rate of decline of pulmonary function; 3) scoliosis treatment, namely steroid therapy that is used to reduce muscle inflammation/degeneration and prolong ambulation in order to delay the onset of scoliosis, being an additional contribution to the restrictive lung pattern; 4) cough assisted devices that improve airway clearance thus reducing the risk of pulmonary infections; and 5) non-invasive mechanical ventilation that is essential to treat nocturnal hypoventilation, sleep disordered breathing, and ultimately respiratory failure. Without any intervention death occurs within the first 2 decades, however, thanks to this multidisciplinary therapeutic approach life expectancy of a newborn with DMD nowadays can be significantly prolonged up to his fourth decade. This review is aimed at providing state-of-the-art methods and techniques for the assessment and management of respiratory function in DMD patients.
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Affiliation(s)
- Antonella LoMauro
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Andrea Aliverti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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