Gene therapy delivered micro-dystrophins co-localize with transgenic utrophin in dystrophic skeletal muscle fibers

Duchenne muscular dystrophy (DMD) is a devastating muscle disease caused by the absence of functional dystrophin. There are multiple ongoing clinical trials for DMD that are testing gene therapy treatments consisting of adeno-associated viral (AAV) vectors carrying miniaturized versions of dystrophin optimized for function, termed micro-dystrophins (μDys). Utrophin, the fetal homolog of dystrophin, has repeatedly been reported to be upregulated in human DMD muscle as a compensatory mechanism, but whether µDys displaces full-length utrophin is unknown. In this study, dystrophin/utrophin-deficient mice with transgenic overexpression of full-length utrophin in skeletal muscles were systemically administered low doses of either AAV6-CK8e-Hinge3-µDys (μDysH3) or AAV6-CK8e-μDys5 (μDys5). We used immunofluorescence to qualitatively assess the localization of μDys with transgenic utrophin and neuronal nitric oxide synthase (nNOS) in quadriceps muscles. μDys protein resulting from both gene therapies co-localized at myofiber membranes with transgenic utrophin. We also confirmed the sarcolemmal co-localization of nNOS with μDys5, but not with transgenic utrophin expression or μDysH3. Transgenic utrophin expression and μDys proteins produced from both therapies stabilize the dystrophin-glycoprotein complex as observed by sarcolemmal localization of β-dystroglycan. This study suggests that µDys gene therapy will likely not inhibit any endogenous compensation by utrophin in DMD muscle.

Micro-dystrophin gene therapy demonstrates long-term cardiac efficacy in a severe Duchenne muscular dystrophy model

Micro-dystrophin gene replacement therapies for Duchenne muscular dystrophy (DMD) are currently in clinical trials, but have not been thoroughly investigated for their efficacy on cardiomyopathy progression to heart failure. We previously validated Fiona/dystrophin-utrophin-deficient (dko) mice as a DMD cardiomyopathy model that progresses to reduced ejection fraction indicative of heart failure. Adeno-associated viral (AAV) vector delivery of an early generation micro-dystrophin prevented cardiac pathology and functional decline through 1 year of age in this new model. We now show that gene therapy using a micro-dystrophin optimized for skeletal muscle efficacy (AAV-μDys5), and which is currently in a clinical trial, is able to fully prevent cardiac pathology and cardiac strain abnormalities and maintain normal (>45%) ejection fraction through 18 months of age in Fiona/dko mice. Early treatment with AAV-μDys5 prevents inflammation and fibrosis in Fiona/dko hearts. Collagen in cardiac fibrotic scars becomes more tightly packed from 12 to 18 months in Fiona/dko mice, but the area of fibrosis containing tenascin C does not change. Increased tight collagen correlates with unexpected improvements in Fiona/dko whole-heart function that maintain impaired cardiac strain and strain rate. This study supports micro-dystrophin gene therapy as a promising intervention for preventing DMD cardiomyopathy progression.

Outpatient percutaneous heel cord lengthening in children

Outpatient percutaneous tendo Achillis lengthening is a quick, complication-free, inexpensive approach to a common pediatric orthopedic problem. The procedure is a known alternative to conventional open procedures, but it is not widely used. This study outlines the advantage of the percutaneous procedure performed in outpatient surgery with the patient under a general anesthetic. Fifty-five patients were operated on between December 1980 and March 1984. Overall results were excellent, with 97% improvement in gait. There were no infections. Percutaneous heel cord lengthening in children is a safe and simple operation, yielding results equal to those of open procedures. The advantage of outpatient surgery adds a further positive dimension to this procedure.

Determination of catecholamines in tissue and body fluids using microbore HPLC with amperometric detection

Performance of microbore reverse phase HPLC coupled with amperometric detection is detailed for the analysis of catecholamines in small tissue samples and human blood plasma and cerebrospinal fluid. Extraction procedures for pre-concentration and clean-up of these samples are described. Marked signal enhancement is observed due to the smaller column volume as well as the increased coulometric yield which results from the lower flow rates used with this technique. Detection limits of 0.2 to 0.5 picograms are obtained allowing analysis of catecholamines in extremely small tissue samples or small volumes of cerebrospinal fluid or plasma.

An improved technique for extracting catecholamines from body fluids

This paper describes a technique for selectively extracting catecholamines from body fluids prior to quantification by high-performance liquid chromatography with electrochemical detection. The technique is a two-stage process, the first stage involves the extraction of cations from the sample whilst the second stage is a liquid-liquid extraction involving the complexation of the cationic catecholamines with diphenylborate. This technique provides a very specific extraction procedure which results in chromatograms with no interfering compounds, and gives absolute recoveries of 70-80% for noradrenaline (NA), adrenaline (A) and dihydroxybenzylamine (internal standard), with similar relative recoveries of the 3 compounds. The intra-assay coefficients of variation for the measurement of catecholamines in venous plasma taken from resting subjects, are 8-9% for both NA and A, whilst the inter-assay values are 8% for NA and 20% for A.

Circumstances influencing umbilical-cord plasma catecholamines at delivery

Blood gases and plasma catecholamines were measured in umbilical arterial and venous blood samples after delivery. In all cases umbilical arterial noradrenaline concentrations were higher than venous levels. The lowest concentrations of noradrenaline were found after elective caesarean section. Vaginal delivery, particularly when accompanied by instrumental manipulation, was associated with significantly higher concentrations of arterial noradrenaline. High concentrations of catecholamines were commonly recorded in those deliveries showing evidence of acid-base disturbance. Noradrenaline was the predominant catecholamine in all cases. A linear relation was demonstrated between arterial noradrenaline and arteriovenous noradrenaline difference.