1
|
Tawil R, Wagner KR, Hamel JI, Leung DG, Statland JM, Wang LH, Genge A, Sacconi S, Lochmüller H, Reyes-Leiva D, Diaz-Manera J, Alonso-Perez J, Muelas N, Vilchez JJ, Pestronk A, Gibson S, Goyal NA, Hayward LJ, Johnson N, LoRusso S, Freimer M, Shieh PB, Subramony SH, van Engelen B, Kools J, Leinhard OD, Widholm P, Morabito C, Moxham CM, Cadavid D, Mellion ML, Odueyungbo A, Tracewell WG, Accorsi A, Ronco L, Gould RJ, Shoskes J, Rojas LA, Jiang JG. Safety and efficacy of losmapimod in facioscapulohumeral muscular dystrophy (ReDUX4): a randomised, double-blind, placebo-controlled phase 2b trial. Lancet Neurol 2024; 23:477-486. [PMID: 38631764 DOI: 10.1016/s1474-4422(24)00073-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Facioscapulohumeral muscular dystrophy is a hereditary progressive myopathy caused by aberrant expression of the transcription factor DUX4 in skeletal muscle. No approved disease-modifying treatments are available for this disorder. We aimed to assess the safety and efficacy of losmapimod (a small molecule that inhibits p38α MAPK, a regulator of DUX4 expression, and p38β MAPK) for the treatment of facioscapulohumeral muscular dystrophy. METHODS We did a randomised, double-blind, placebo-controlled phase 2b trial at 17 neurology centres in Canada, France, Spain, and the USA. We included adults aged 18-65 years with type 1 facioscapulohumeral muscular dystrophy (ie, with loss of repression of DUX4 expression, as ascertained by genotyping), a Ricci clinical severity score of 2-4, and at least one skeletal muscle judged using MRI to be suitable for biopsy. Participants were randomly allocated (1:1) to either oral losmapimod (15 mg twice a day) or matching placebo for 48 weeks, via an interactive response technology system. The investigator, study staff, participants, sponsor, primary outcome assessors, and study monitor were masked to the treatment allocation until study closure. The primary endpoint was change from baseline to either week 16 or 36 in DUX4-driven gene expression in skeletal muscle biopsy samples, as measured by quantitative RT-PCR. The primary efficacy analysis was done in all participants who were randomly assigned and who had available data for assessment, according to the modified intention-to-treat principle. Safety and tolerability were assessed as secondary endpoints. This study is registered at ClinicalTrials.gov, number NCT04003974. The phase 2b trial is complete; an open-label extension is ongoing. FINDINGS Between Aug 27, 2019, and Feb 27, 2020, 80 people were enrolled. 40 were randomly allocated to losmapimod and 40 to placebo. 54 (68%) participants were male and 26 (33%) were female, 70 (88%) were White, and mean age was 45·7 (SD 12·5) years. Least squares mean changes from baseline in DUX4-driven gene expression did not differ significantly between the losmapimod (0·83 [SE 0·61]) and placebo (0·40 [0·65]) groups (difference 0·43 [SE 0·56; 95% CI -1·04 to 1·89]; p=0·56). Losmapimod was well tolerated. 29 treatment-emergent adverse events (nine drug-related) were reported in the losmapimod group compared with 23 (two drug-related) in the placebo group. Two participants in the losmapimod group had serious adverse events that were deemed unrelated to losmapimod by the investigators (alcohol poisoning and suicide attempt; postoperative wound infection) compared with none in the placebo group. No treatment discontinuations due to adverse events occurred and no participants died during the study. INTERPRETATION Although losmapimod did not significantly change DUX4-driven gene expression, it was associated with potential improvements in prespecified structural outcomes (muscle fat infiltration), functional outcomes (reachable workspace, a measure of shoulder girdle function), and patient-reported global impression of change compared with placebo. These findings have informed the design and choice of efficacy endpoints for a phase 3 study of losmapimod in adults with facioscapulohumeral muscular dystrophy. FUNDING Fulcrum Therapeutics.
Collapse
Affiliation(s)
- Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Kathryn R Wagner
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Johanna I Hamel
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Doris G Leung
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Leo H Wang
- University of Washington, Seattle, WA, USA
| | - Angela Genge
- Montreal Neurological Institute and Hospital, Montreal, QC, Canada
| | - Sabrina Sacconi
- Peripheral Nervous System and Muscle Department, Nice University Hospital and University of Côte d'Azur, Nice, France
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute, Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada; Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - David Reyes-Leiva
- Institut de Recerca IIB Sant Pau, Hospital Universitari Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Diaz-Manera
- Institut de Recerca IIB Sant Pau, Hospital Universitari Santa Creu i Sant Pau, Barcelona, Spain; John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle, UK
| | - Jorge Alonso-Perez
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitario Nuestra Señora de Candelaria, Fundación Canaria Instituto de Investigación Sanitaria de Canarias, Santa Cruz de Tenerife, Tenerife, Spain; Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Nuria Muelas
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitari i Politecnic La Fe and Neuromuscular Reference Centre, Valencia, Spain; Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Juan J Vilchez
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Alan Pestronk
- Washington University in St Louis, St Louis, MO, USA
| | | | | | | | | | | | - Miriam Freimer
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Perry B Shieh
- University of California at Los Angeles, Los Angeles, CA, USA
| | - S H Subramony
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Baziel van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Joost Kools
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Olof Dahlqvist Leinhard
- AMRA Medical, Linköping, Sweden; Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Per Widholm
- AMRA Medical, Linköping, Sweden; Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Radiology, Linköping University, Linköping, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Wang LH, Leung DG, Wagner KR, Lowry SJ, McDermott MP, Eichinger K, Higgs K, Walker M, Lewis L, Martens WB, Mul K, Sansone VA, Shieh P, Elsheikh B, LoRusso S, Butterfield RJ, Johnson N, Preston MR, Messina C, Carraro E, Tawil R, Statland J. Lean tissue mass measurements by dual-energy X-ray absorptiometry and associations with strength and functional outcome measures in facioscapulohumeral muscular dystrophy. Neuromuscul Disord 2023; 33:63-68. [PMID: 37400350 PMCID: PMC10527411 DOI: 10.1016/j.nmd.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is a slowly progressive disease of skeletal muscle. Dual energy X-ray absorptiometry (DEXA) is a widely available, cost-effective and sensitive technique for measuring whole body and regional lean tissue mass and has been used in prior clinical trials in neuromuscular diseases. The Clinical Trial Readiness to Solve Barriers to Drug Development in FSHD (ReSolve) study is a prospective, longitudinal, observational multisite study. We obtained concurrent DEXA scans and functional outcome measurements in 185 patients with FSHD at the baseline visit. We determined the associations between lean tissue mass in the upper and lower extremities and corresponding clinical outcome measures. There were moderate correlations between upper and lower extremity lean tissue mass and their corresponding strengths and function. Lean tissue mass obtained by DEXA scan may be useful as a biomarker in future clinical trials in FSHD.
Collapse
Affiliation(s)
- Leo H Wang
- University of Washington, Department of Neurology, WA, USA.
| | - Doris G Leung
- Kennedy Krieger Institute, The Johns Hopkins School of Medicine, MD, USA
| | - Kathryn R Wagner
- Kennedy Krieger Institute, The Johns Hopkins School of Medicine, MD, USA
| | | | - Michael P McDermott
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, NY, USA; University of Rochester Medical Center, Department of Neurology, NY, USA
| | - Katy Eichinger
- University of Rochester Medical Center, Department of Neurology, NY, USA
| | - Kiley Higgs
- University of Kansas Medical Center, Department of Neurology, KS, USA
| | - Michaela Walker
- University of Kansas Medical Center, Department of Neurology, KS, USA
| | - Leann Lewis
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, NY, USA
| | - William B Martens
- University of Rochester Medical Center, Department of Biostatistics and Computational Biology, NY, USA
| | | | - Valeria A Sansone
- The NEMO Clinical Center, Neurorehabilitation Unit, University of Milan, Department of Neurology, Milan, Italy
| | - Perry Shieh
- University of California, Los Angeles, CA, USA
| | | | | | | | | | | | - Carmelo Messina
- Galeazzi Institute, Radiology Department, University of Milan, Italy
| | - Elena Carraro
- The NEMO Clinical Center, Neurorehabilitation Unit, University of Milan, Department of Neurology, Milan, Italy
| | - Rabi Tawil
- University of Rochester Medical Center, Department of Neurology, NY, USA
| | - Jeff Statland
- University of Kansas Medical Center, Department of Neurology, KS, USA
| |
Collapse
|
3
|
Mohassel P, Yun P, Syeda S, Batra A, Bradley AJ, Donkervoort S, Monges S, Cohen JS, Leung DG, Munell F, Ortez C, Sánchez‐Montáñez A, Karachunski P, Brandsema J, Medne L, Chaudhry V, Tasca G, Foley AR, Udd B, Arai AE, Walter GA, Bönnemann CG. A comprehensive study of skeletal muscle imaging in FHL1-related reducing body myopathy. Ann Clin Transl Neurol 2023; 10:1442-1455. [PMID: 37483011 PMCID: PMC10424657 DOI: 10.1002/acn3.51834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE FHL1-related reducing body myopathy is an ultra-rare, X-linked dominant myopathy. In this cross-sectional study, we characterize skeletal muscle ultrasound, muscle MRI, and cardiac MRI findings in FHL1-related reducing body myopathy patients. METHODS Seventeen patients (11 male, mean age 35.4, range 12-76 years) from nine independent families with FHL1-related reducing body myopathy underwent clinical evaluation, muscle ultrasound (n = 11/17), and lower extremity muscle MRI (n = 14/17), including Dixon MRI (n = 6/17). Muscle ultrasound echogenicity was graded using a modified Heckmatt scale. T1 and STIR axial images of the lower extremity muscles were evaluated for pattern and distribution of abnormalities. Quantitative analysis of intramuscular fat fraction was performed using the Dixon MRI images. Cardiac studies included electrocardiogram (n = 15/17), echocardiogram (n = 17/17), and cardiac MRI (n = 6/17). Cardiac muscle function, T1 maps, T2-weighted black blood images, and late gadolinium enhancement patterns were analyzed. RESULTS Muscle ultrasound showed a distinct pattern of increased echointensity in skeletal muscles with a nonuniform, multifocal, and "geographical" distribution, selectively involving the deeper fascicles of muscles such as biceps and tibialis anterior. Lower extremity muscle MRI showed relative sparing of gluteus maximus, rectus femoris, gracilis, and lateral gastrocnemius muscles and an asymmetric and multifocal, "geographical" pattern of T1 hyperintensity within affected muscles. Cardiac studies revealed mild and nonspecific abnormalities on electrocardiogram and echocardiogram with unremarkable cardiac MRI studies. INTERPRETATION Skeletal muscle ultrasound and muscle MRI reflect the multifocal aggregate formation in muscle in FHL1-related reducing body myopathy and are practical and informative tools that can aid in diagnosis and monitoring of disease progression.
Collapse
Affiliation(s)
- Payam Mohassel
- Neurogenetics BranchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
- Present address:
Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Pomi Yun
- Neurogenetics BranchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
| | - Safoora Syeda
- Neurogenetics BranchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
| | - Abhinandan Batra
- Department of Physical TherapyUniversity of FloridaGainesvilleFLUSA
| | | | - Sandra Donkervoort
- Neurogenetics BranchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
| | - Soledad Monges
- Servicio de NeurologíaHospital de Pediatría J.P. GarrahanBuenos AiresArgentina
| | - Julie S. Cohen
- Department of NeurologyKennedy Krieger Institute, Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Doris G. Leung
- Department of NeurologyKennedy Krieger Institute, Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Francina Munell
- Pediatric NeurologyVall d'Hebron University HospitalBarcelonaSpain
| | - Carlos Ortez
- Department of Pediatric Neurology, Neuromuscular UnitHospital Sant Joan de Déu and Institut de Recerca Sant Joan de DéuBarcelonaSpain
| | - Angel Sánchez‐Montáñez
- Pediatric NeuroradiologyHospital Universitari Vall d'Hebron, Vall d'Hebron, Autonomous University of BarcelonaBarcelonaSpain
| | | | - John Brandsema
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Livija Medne
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Vinay Chaudhry
- Department of NeurologyUniversity of North CarolinaChapel HillNCUSA
| | - Giorgio Tasca
- Unità Operativa Complessa di NeurologiaFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- John Walton Muscular Dystrophy Research CentreNewcastle University and Newcastle Hospitals NHS Foundation TrustsNewcastleUpon TyneUK
| | - A. Reghan Foley
- Neurogenetics BranchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
| | - Bjarne Udd
- Folkhalsan Research Center, Department of Medical GeneticsUniversity of HelsinkiHelsinkiFinland
| | - Andrew E. Arai
- Advanced Cardiovascular Imaging LaboratoryNHLBI, NIHBethesdaMDUSA
| | - Glenn A. Walter
- Department of Physiology and Functional GenomicsUniversity of FloridaGainesvilleFLUSA
| | - Carsten G. Bönnemann
- Neurogenetics BranchNational Institute of Neurological Disorders and StrokeBethesdaMDUSA
| |
Collapse
|
4
|
Thornton CA, Moxley RT, Eichinger K, Heatwole C, Mignon L, Arnold WD, Ashizawa T, Day JW, Dent G, Tanner MK, Duong T, Greene EP, Herbelin L, Johnson NE, King W, Kissel JT, Leung DG, Lott DJ, Norris DA, Pucillo EM, Schell W, Statland JM, Stinson N, Subramony SH, Xia S, Bishop KM, Bennett CF. Antisense oligonucleotide targeting DMPK in patients with myotonic dystrophy type 1: a multicentre, randomised, dose-escalation, placebo-controlled, phase 1/2a trial. Lancet Neurol 2023; 22:218-228. [PMID: 36804094 DOI: 10.1016/s1474-4422(23)00001-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Myotonic dystrophy type 1 results from an RNA gain-of-function mutation, in which DM1 protein kinase (DMPK) transcripts carrying expanded trinucleotide repeats exert deleterious effects. Antisense oligonucleotides (ASOs) provide a promising approach to treatment of myotonic dystrophy type 1 because they reduce toxic RNA levels. We aimed to investigate the safety of baliforsen (ISIS 598769), an ASO targeting DMPK mRNA. METHODS In this dose-escalation phase 1/2a trial, adults aged 20-55 years with myotonic dystrophy type 1 were enrolled at seven tertiary referral centres in the USA and randomly assigned via an interactive web or phone response system to subcutaneous injections of baliforsen 100 mg, 200 mg, or 300 mg, or placebo (6:2 randomisation at each dose level), or to baliforsen 400 mg or 600 mg, or placebo (10:2 randomisation at each dose level), on days 1, 3, 5, 8, 15, 22, 29, and 36. Sponsor personnel directly involved with the trial, participants, and all study personnel were masked to treatment assignments. The primary outcome measure was safety in all participants who received at least one dose of study drug up to day 134. This trial is registered with ClinicalTrials.gov (NCT02312011), and is complete. FINDINGS Between Dec 12, 2014, and Feb 22, 2016, 49 participants were enrolled and randomly assigned to baliforsen 100 mg (n=7, one patient not dosed), 200 mg (n=6), 300 mg (n=6), 400 mg (n=10), 600 mg (n=10), or placebo (n=10). The safety population comprised 48 participants who received at least one dose of study drug. Treatment-emergent adverse events were reported for 36 (95%) of 38 participants assigned to baliforsen and nine (90%) of ten participants assigned to placebo. Aside from injection-site reactions, common treatment-emergent adverse events were headache (baliforsen: ten [26%] of 38 participants; placebo: four [40%] of ten participants), contusion (baliforsen: seven [18%] of 38; placebo: one [10%] of ten), and nausea (baliforsen: six [16%] of 38; placebo: two [20%] of ten). Most adverse events (baliforsen: 425 [86%] of 494; placebo: 62 [85%] of 73) were mild in severity. One participant (baliforsen 600 mg) developed transient thrombocytopenia considered potentially treatment related. Baliforsen concentrations in skeletal muscle increased with dose. INTERPRETATION Baliforsen was generally well tolerated. However, skeletal muscle drug concentrations were below levels predicted to achieve substantial target reduction. These results support the further investigation of ASOs as a therapeutic approach for myotonic dystrophy type 1, but suggest improved drug delivery to muscle is needed. FUNDING Ionis Pharmaceuticals, Biogen.
Collapse
Affiliation(s)
| | | | | | - Chad Heatwole
- Center for Health and Technology, University of Rochester, Rochester, NY, USA
| | - Laurence Mignon
- Translational Medicine, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | - W David Arnold
- Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tetsuo Ashizawa
- Neuroscience Research Program, Houston Methodist Research Institute, Houston, TX, USA
| | - John W Day
- Neuromuscular Medicine, Stanford University, Palo Alto, CA, USA
| | - Gersham Dent
- Neurodegeneration Development Unit, Biogen, Cambridge, MA, USA
| | | | - Tina Duong
- Neuromuscular Medicine, Stanford University, Palo Alto, CA, USA
| | - Ericka P Greene
- Neuromuscular Clinic, Houston Methodist Research Institute, Houston, TX, USA
| | - Laura Herbelin
- Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Wendy King
- Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John T Kissel
- Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Doris G Leung
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Donovan J Lott
- Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Daniel A Norris
- Pharmacokinetics and Clinical Pharmacology, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | | | - Wendy Schell
- Neuromuscular Clinic, Houston Methodist Research Institute, Houston, TX, USA
| | | | - Nikia Stinson
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Sub H Subramony
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Shuting Xia
- Biometrics, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | - Kathie M Bishop
- Clinical Development, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | | |
Collapse
|
5
|
Amanat M, Nemeth CL, Fine AS, Leung DG, Fatemi A. Antisense Oligonucleotide Therapy for the Nervous System: From Bench to Bedside with Emphasis on Pediatric Neurology. Pharmaceutics 2022; 14:2389. [PMID: 36365206 PMCID: PMC9695718 DOI: 10.3390/pharmaceutics14112389] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 09/05/2023] Open
Abstract
Antisense oligonucleotides (ASOs) are disease-modifying agents affecting protein-coding and noncoding ribonucleic acids. Depending on the chemical modification and the location of hybridization, ASOs are able to reduce the level of toxic proteins, increase the level of functional protein, or modify the structure of impaired protein to improve function. There are multiple challenges in delivering ASOs to their site of action. Chemical modifications in the phosphodiester bond, nucleotide sugar, and nucleobase can increase structural thermodynamic stability and prevent ASO degradation. Furthermore, different particles, including viral vectors, conjugated peptides, conjugated antibodies, and nanocarriers, may improve ASO delivery. To date, six ASOs have been approved by the US Food and Drug Administration (FDA) in three neurological disorders: spinal muscular atrophy, Duchenne muscular dystrophy, and polyneuropathy caused by hereditary transthyretin amyloidosis. Ongoing preclinical and clinical studies are assessing the safety and efficacy of ASOs in multiple genetic and acquired neurological conditions. The current review provides an update on underlying mechanisms, design, chemical modifications, and delivery of ASOs. The administration of FDA-approved ASOs in neurological disorders is described, and current evidence on the safety and efficacy of ASOs in other neurological conditions, including pediatric neurological disorders, is reviewed.
Collapse
Affiliation(s)
- Man Amanat
- Moser Center for Leukodystrophies, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Christina L. Nemeth
- Moser Center for Leukodystrophies, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Amena Smith Fine
- Moser Center for Leukodystrophies, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Doris G. Leung
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD 21205, USA
| | - Ali Fatemi
- Moser Center for Leukodystrophies, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| |
Collapse
|
6
|
Gummerson CE, Lo BD, Porosnicu Rodriguez KA, Cosner ZL, Hardenbergh D, Bongiorno DM, Wainger J, Hu K, Gamaldo C, Salas RME, Romo C, Leung DG. Broadening learning communities during COVID-19: developing a curricular framework for telemedicine education in neurology. BMC Med Educ 2021; 21:549. [PMID: 34715841 PMCID: PMC8554502 DOI: 10.1186/s12909-021-02979-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In response to the cancellation of clinical clerkships due to COVID-19, the Johns Hopkins (JH) Neurology Education Team developed a virtual elective to enhance medical students' clinical telemedicine skills and foster community between academic institutions. METHODS This two-week clinical elective, entitled "Virtual Patient Rounds in Neurology," was administered once in April 2020 and once in May 2020. The curriculum included attending/fellow-led Virtual Rounds, Student Presentations, and Asynchronous Educational Activities. We also developed a new lecture series entitled JHNeuroChats, which consisted of live synchronous lectures presented by JH faculty and Virtual Visiting Professors. Trainees and faculty from outside institutions were invited to participate in the JHNeuroChats. Students and faculty completed pre- and post-elective surveys to assess the educational impact of the elective. Student's t-tests were used to compare scores between pre- and post-elective surveys. RESULTS Seven JH medical students enrolled in each iteration of the elective, and an additional 337 trainees and faculty, representing 14 different countries, registered for the JHNeuroChats. We hosted 48 unique JHNeuroChats, 32 (66.7%) of which were led by invited Virtual Visiting Professors. At the end of the elective, students reported increased confidence in virtually obtaining a history (P < 0.0001) and performing a telehealth neurological physical exam (P < 0.0001), compared to the start of the course. In addition, faculty members reported increased confidence in teaching clinical medicine virtually, although these findings were not statistically significant (P = 0.15). CONCLUSIONS Despite the constraints imposed by COVID-19, this virtual Neurology elective increased medical students' confidence in certain telemedicine skills and successfully broadened our learning community to encompass learners from around the world. As virtual medical education becomes more prevalent, it is important that we are intentional in creating opportunities for shared learning across institutions. We believe that this elective can serve as a model for these future educational collaborations.
Collapse
Affiliation(s)
- Christine E Gummerson
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian D Lo
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Zoe L Cosner
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dylan Hardenbergh
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diana M Bongiorno
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julia Wainger
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katherine Hu
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charlene Gamaldo
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel M E Salas
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carlos Romo
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doris G Leung
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, 707 North Broadway, Room 400A, Baltimore, MD, 21205, USA.
| |
Collapse
|
7
|
Leung DG, Bocchieri AE, Ahlawat S, Jacobs MA, Parekh VS, Braverman V, Summerton K, Mansour J, Stinson N, Bibat G, Morris C, Marraffino S, Wagner KR. A phase Ib/IIa, open-label, multiple ascending-dose trial of domagrozumab in fukutin-related protein limb-girdle muscular dystrophy. Muscle Nerve 2021; 64:172-179. [PMID: 33961310 DOI: 10.1002/mus.27259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS In this study we report the results of a phase Ib/IIa, open-label, multiple ascending-dose trial of domagrozumab, a myostatin inhibitor, in patients with fukutin-related protein (FKRP)-associated limb-girdle muscular dystrophy. METHODS Nineteen patients were enrolled and assigned to one of three dosing arms (5, 20, or 40 mg/kg every 4 weeks). After 32 weeks of treatment, participants receiving the lowest dose were switched to the highest dose (40 mg/kg) for an additional 32 weeks. An extension study was also conducted. The primary endpoints were safety and tolerability. Secondary endpoints included muscle strength, timed function testing, pulmonary function, lean body mass, pharmacokinetics, and pharmacodynamics. As an exploratory outcome, muscle fat fractions were derived from whole-body magnetic resonance images. RESULTS Serum concentrations of domagrozumab increased in a dose-dependent manner and modest levels of myostatin inhibition were observed in both serum and muscle tissue. The most frequently occurring adverse events were injuries secondary to falls. There were no significant between-group differences in the strength, functional, or imaging outcomes studied. DISCUSSION We conclude that, although domagrozumab was safe in patients in limb-girdle muscular dystrophy type 2I/R9, there was no clear evidence supporting its efficacy in improving muscle strength or function.
Collapse
Affiliation(s)
- Doris G Leung
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alex E Bocchieri
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shivani Ahlawat
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael A Jacobs
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vishwa S Parekh
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA.,The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vladimir Braverman
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine Summerton
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jennifer Mansour
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Nikia Stinson
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Genila Bibat
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Carl Morris
- Solid Biosciences, Cambridge, Massachusetts, USA
| | | | - Kathryn R Wagner
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
8
|
Paik JJ, Casciola-Rosen L, Shin JY, Albayda J, Tiniakou E, Leung DG, Gutierrez-Alamillo L, Perin J, Florea L, Antonescu C, Leung SG, Purwin G, Koenig A, Christopher-Stine L. Study of Tofacitinib in Refractory Dermatomyositis: An Open-Label Pilot Study of Ten Patients. Arthritis Rheumatol 2021; 73:858-865. [PMID: 33258553 DOI: 10.1002/art.41602] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This open-label 12-week study was conducted to evaluate the efficacy and safety of tofacitinib, a JAK inhibitor, in treatment-refractory active dermatomyositis (DM). METHODS Tofacitinib in extended-release doses of 11 mg was administered daily to 10 subjects with DM. Prior to treatment, a complete washout of all steroid-sparing agents was performed. The primary outcome measure was assessment of disease activity improvement based on the International Myositis Assessment and Clinical Studies group definition of improvement. Response rate was measured as the total improvement score according to the 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) myositis response criteria. Secondary outcome measures included Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) scores, chemokine levels, immunohistochemical analysis of STAT1 expression in the skin, RNA sequencing analysis, and safety. RESULTS At 12 weeks, the primary outcome was met in all 10 subjects. Five (50%) of 10 subjects experienced moderate improvement in disease activity, and the other 50% experienced minimal improvement according to the 2016 ACR/EULAR myositis response criteria. The secondary outcome of the mean change in the CDASI activity score over 12 weeks was statistically significant (mean ± SD 28 ± 15.4 at baseline versus 9.5 ± 8.5 at 12 weeks) (P = 0.0005). Serum chemokine levels of CXCL9/CXCL10 showed a statistically significant change from baseline. A marked decrease in STAT1 signaling in association with suppression of interferon target gene expression was demonstrated in 3 of 9 skin biopsy samples from subjects with dermatomyositis. The mean ± SD level of creatine kinase in the 10 subjects at baseline was 82 ± 34.8 IU/liter, highlighting that disease activity was predominantly located in the skin. CONCLUSION This is the first prospective, open-label clinical trial of tofacitinib in DM that demonstrates strong clinical efficacy of a pan-JAK inhibitor, as measured by validated myositis response criteria. Future randomized controlled trials using JAK inhibitors should be considered for treating DM.
Collapse
Affiliation(s)
- Julie J Paik
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Jemima Albayda
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Tiniakou
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Doris G Leung
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Jamie Perin
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Liliana Florea
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Corina Antonescu
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sherry G Leung
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Grazyna Purwin
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | |
Collapse
|
9
|
Leung DG, Bocchieri AE, Ahlawat S, Jacobs MA, Parekh VS, Braverman V, Summerton K, Mansour J, Bibat G, Morris C, Marraffino S, Wagner KR. Longitudinal functional and imaging outcome measures in FKRP limb-girdle muscular dystrophy. BMC Neurol 2020; 20:196. [PMID: 32429923 PMCID: PMC7236878 DOI: 10.1186/s12883-020-01774-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Pathogenic variants in the FKRP gene cause impaired glycosylation of α-dystroglycan in muscle, producing a limb-girdle muscular dystrophy with cardiomyopathy. Despite advances in understanding the pathophysiology of FKRP-associated myopathies, clinical research in the limb-girdle muscular dystrophies has been limited by the lack of normative biomarker data to gauge disease progression. Methods Participants in a phase 2 clinical trial were evaluated over a 4-month, untreated lead-in period to evaluate repeatability and to obtain normative data for timed function tests, strength tests, pulmonary function, and body composition using DEXA and whole-body MRI. Novel deep learning algorithms were used to analyze MRI scans and quantify muscle, fat, and intramuscular fat infiltration in the thighs. T-tests and signed rank tests were used to assess changes in these outcome measures. Results Nineteen participants were observed during the lead-in period for this trial. No significant changes were noted in the strength, pulmonary function, or body composition outcome measures over the 4-month observation period. One timed function measure, the 4-stair climb, showed a statistically significant difference over the observation period. Quantitative estimates of muscle, fat, and intramuscular fat infiltration from whole-body MRI corresponded significantly with DEXA estimates of body composition, strength, and timed function measures. Conclusions We describe normative data and repeatability performance for multiple physical function measures in an adult FKRP muscular dystrophy population. Our analysis indicates that deep learning algorithms can be used to quantify healthy and dystrophic muscle seen on whole-body imaging. Trial registration This study was retrospectively registered in clinicaltrials.gov (NCT02841267) on July 22, 2016 and data supporting this study has been submitted to this registry.
Collapse
Affiliation(s)
- Doris G Leung
- Center for Genetic Muscle Disorders, Hugo W. Moser Research Institute at Kennedy Krieger Institute, 716 North Broadway, Room 411, Baltimore, MD, 21205, USA. .,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Alex E Bocchieri
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Shivani Ahlawat
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Jacobs
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vishwa S Parekh
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA.,The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vladimir Braverman
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Katherine Summerton
- Center for Genetic Muscle Disorders, Hugo W. Moser Research Institute at Kennedy Krieger Institute, 716 North Broadway, Room 411, Baltimore, MD, 21205, USA
| | | | - Genila Bibat
- Center for Genetic Muscle Disorders, Hugo W. Moser Research Institute at Kennedy Krieger Institute, 716 North Broadway, Room 411, Baltimore, MD, 21205, USA
| | | | | | - Kathryn R Wagner
- Center for Genetic Muscle Disorders, Hugo W. Moser Research Institute at Kennedy Krieger Institute, 716 North Broadway, Room 411, Baltimore, MD, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
10
|
Abstract
Recent years have seen steady progress in the identification of genetic muscle diseases as well as efforts to develop treatment for these diseases. Consequently, sensitive and objective new methods are required to identify and monitor muscle pathology. Magnetic resonance imaging offers multiple potential biomarkers of disease severity in the muscular dystrophies. This Review uses a pathology-based approach to examine the ways in which MRI and spectroscopy have been used to study muscular dystrophies. Methods that have been used to quantitate intramuscular fat, edema, fiber orientation, metabolism, fibrosis, and vascular perfusion are examined, and this Review describes how MRI can help diagnose these conditions and improve upon existing muscle biomarkers by detecting small increments of disease-related change. Important challenges in the implementation of imaging biomarkers, such as standardization of protocols and validating imaging measurements with respect to clinical outcomes, are also described.
Collapse
Affiliation(s)
- Doris G Leung
- Center for Genetic Muscle Disorders, Hugo W. Moser Research Institute at Kennedy Krieger Institute, 716 North Broadway, Room 411, Baltimore, Maryland, 21205.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
11
|
Mammen AL, Roda RH, Leung DG. Myopathy: Recent Progress, Current Therapies, and Future Directions. Neurotherapeutics 2018; 15:837-839. [PMID: 30443717 PMCID: PMC6277290 DOI: 10.1007/s13311-018-00688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 50 South Drive, Room 1141, Building 50, MSC 8024, Bethesda, MD, 20892, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Ricardo H Roda
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doris G Leung
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Genetic Muscle Disorders at Kennedy Krieger Institute, Baltimore, MD, USA
| |
Collapse
|
12
|
Leung DG, Wang X, Barker PB, Carrino JA, Wagner KR. Multivoxel proton magnetic resonance spectroscopy in facioscapulohumeral muscular dystrophy. Muscle Nerve 2018; 57:958-963. [PMID: 29266323 DOI: 10.1002/mus.26048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Facioscapulohumeral muscular dystrophy (FSHD) is a hereditary disorder that causes progressive muscle wasting. This study evaluates the use of proton magnetic resonance spectroscopy (1 H MRS) as a biomarker of muscle strength and function in FSHD. METHODS Thirty-six individuals with FSHD and 15 healthy controls underwent multivoxel 1 H MRS of a cross-section of the mid-thigh. Concentrations of creatine, intramyocellular and extramyocellular lipids, and trimethylamine (TMA)-containing compounds in skeletal muscle were calculated. Metabolite concentrations for individuals with FSHD were compared with those of controls. The relationship between metabolite concentrations and muscle strength was also examined. RESULTS The TMA/creatine (Cr) ratio in individuals with FSHD was reduced compared with controls. The TMA/Cr ratio in the hamstrings also showed a moderate linear correlation with muscle strength. DISCUSSION 1 H MRS offers a potential method of detecting early muscle pathology in FSHD prior to the development of fat infiltration. Muscle Nerve 57: 958-963, 2018.
Collapse
Affiliation(s)
- Doris G Leung
- Center for Genetic Muscle Disorders, Hugo W. Moser Research Institute at Kennedy Krieger Institute, 716 North Broadway, Room 411, Baltimore, Maryland, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xin Wang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Peter B Barker
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Kathryn R Wagner
- Center for Genetic Muscle Disorders, Hugo W. Moser Research Institute at Kennedy Krieger Institute, 716 North Broadway, Room 411, Baltimore, Maryland, 21205, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
13
|
Leung DG. Magnetic resonance imaging in facioscapulohumeral muscular dystrophy. Muscle Nerve 2018; 57:872-874. [PMID: 29328515 DOI: 10.1002/mus.26064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Doris G Leung
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, 716 North Broadway, Room 411, Baltimore, Maryland, 21205, USA.,Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
14
|
Kalia V, Leung DG, Sneag DB, Del Grande F, Carrino JA. Erratum: Advanced MRI Techniques for Muscle Imaging. Semin Musculoskelet Radiol 2017; 21:648. [PMID: 29025192 DOI: 10.1055/s-0037-1606344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Vivek Kalia
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Doris G Leung
- The Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Filippo Del Grande
- Servizio si Radiologia del Sottoceneri, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| |
Collapse
|
15
|
Abstract
AbstractAdvanced magnetic resonance imaging (MRI) techniques can evaluate a wide array of muscle pathologies including acute or chronic muscle injury, musculotendinous response to injury, intramuscular collections and soft tissue masses, and others. In recent years, MRI has played a more important role in muscle disease diagnosis and monitoring. MRI provides excellent spatial and contrast resolution and helps direct optimal sites for muscle biopsy. Whole-body MRI now helps identify signature patterns of muscular involvement in large anatomical regions with relative ease. Quantitative MRI has advanced the evaluation and disease tracking of muscle atrophy and fatty infiltration in entities such as muscular dystrophies. Multivoxel magnetic resonance spectroscopy (MRS) now allows a more thorough, complete evaluation of a muscle of interest without the inherent sampling bias of single-voxel MRS or biopsy. Diffusion MRI allows quantification of muscle inflammation and capillary perfusion as well as muscle fiber tracking.
Collapse
Affiliation(s)
- Vivek Kalia
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Doris G Leung
- The Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Filippo Del Grande
- Servizio si Radiologia del Sottoceneri, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| |
Collapse
|
16
|
Wong EG, Parker AM, Leung DG, Brigham EP, Arbaje AI. Association of severity of illness and intensive care unit readmission: A systematic review. Heart Lung 2016; 45:3-9.e2. [PMID: 26702501 DOI: 10.1016/j.hrtlng.2015.10.040] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/27/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine whether ICU readmission is associated with higher severity of illness scores in adult patients. BACKGROUND Readmissions to the intensive care unit (ICU) are associated with increased costs, morbidity, and mortality. METHODS We performed searches of MEDLINE, EMBASE, and grey literature databases. We selected studies reporting data from adults who were hospitalized in an ICU, received severity of illness scores, and were discharged from the ICU. Characteristics of readmitted and non-readmitted patients were examined. RESULTS We screened 4766 publications and included 31 studies in our analysis. In most studies, severity of illness scores were higher in patients readmitted to the ICU. Readmission was also associated with higher mortality and longer ICU and hospital stays. Excessive heterogeneity precluded the reporting of results in the form of a meta-analysis. CONCLUSIONS ICU readmission is associated with higher severity of illness scores during the same hospitalization in adult patients.
Collapse
Affiliation(s)
- Evan G Wong
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ann M Parker
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Doris G Leung
- The Hugo W. Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Emily P Brigham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
17
|
Leung DG, Carrino JA, Wagner KR, Jacobs MA. Whole-body magnetic resonance imaging evaluation of facioscapulohumeral muscular dystrophy. Muscle Nerve 2015; 52:512-20. [PMID: 25641525 DOI: 10.1002/mus.24569] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 12/22/2014] [Accepted: 01/07/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Facioscapulohumeral muscular dystrophy (FSHD) is a hereditary disorder that causes progressive muscle wasting. Increasing knowledge of the pathophysiology of FSHD has stimulated interest in developing biomarkers of disease severity. METHODS Two groups of MRI scans were analyzed: whole-body scans from 13 subjects with FSHD; and upper and lower extremity scans from 34 subjects with FSHD who participated in the MYO-029 clinical trial. Muscles were scored for fat infiltration and edema-like changes. Fat infiltration scores were compared with muscle strength and function. RESULTS The analysis revealed a distinctive pattern of both frequent muscle involvement and frequent sparing in FSHD. Averaged fat infiltration scores for muscle groups in the legs correlated with quantitative muscle strength and 10-meter walk times. CONCLUSIONS Advances in MRI technology allow for acquisition of rapid, high-quality, whole-body imaging in diffuse muscle disease. This technique offers a promising disease biomarker in FSHD and other muscle diseases.
Collapse
Affiliation(s)
- Doris G Leung
- Center for Genetic Muscle Disorders, The Hugo W. Moser Research Institute, Kennedy Krieger Institute, 707 North Broadway, 400A, Baltimore, Maryland, 21205, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John A Carrino
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Kathryn R Wagner
- Center for Genetic Muscle Disorders, The Hugo W. Moser Research Institute, Kennedy Krieger Institute, 707 North Broadway, 400A, Baltimore, Maryland, 21205, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael A Jacobs
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sidney Kimmel Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
18
|
Abstract
INTRODUCTION There is little information on magnetic resonance imaging (MRI) phenotypes of Becker muscular dystrophy (BMD). This study presents the MRI phenotyping of the upper and lower extremities of a large cohort of BMD patients. METHODS In this retrospective study, MRI images of 33 BMD subjects were evaluated for severity, distribution, and symmetry of involvement. RESULTS Teres major, triceps long head, biceps brachii long head, gluteus maximus, gluteus medius, vasti, adductor longus, adductor magnus, semitendinosus, semimembranosus, and biceps femoris muscles showed the highest severity and frequency of involvement. All analyzed muscles had a high frequency of symmetric involvement. There was significant variability of involvement between muscles within some muscle groups, most notably the arm abductors, posterior arm muscles, medial thigh muscles, and lateral hip rotators. CONCLUSIONS This study showed a distinctive pattern of involvement of extremity muscles in BMD subjects.
Collapse
Affiliation(s)
- Neda Faridian-Aragh
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, 601 North Caroline Street, JHOC 5165, Baltimore, Maryland, 21287, USA
| | | | | | | |
Collapse
|
19
|
Leung DG, Herzka DA, Thompson WR, He B, Bibat G, Tennekoon G, Russell SD, Schuleri KH, Lardo AC, Kass DA, Thompson RE, Judge DP, Wagner KR. Sildenafil does not improve cardiomyopathy in Duchenne/Becker muscular dystrophy. Ann Neurol 2014; 76:541-9. [PMID: 25042693 DOI: 10.1002/ana.24214] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/27/2014] [Accepted: 06/29/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Duchenne and Becker muscular dystrophies (DBMD) are allelic disorders caused by mutations in dystrophin. Adults with DBMD develop life-threatening cardiomyopathy. Inhibition of phosphodiesterase 5 (PDE5) improves cardiac function in mouse models of DBMD. To determine whether the PDE5-inhibitor sildenafil benefits human dystrophinopathy, we conducted a randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov, number NCT01168908). METHODS Adults with DBMD and cardiomyopathy (ejection fraction ≤ 50%) were randomized to receive sildenafil (20mg 3× daily) or placebo for 6 months. All subjects received an additional 6 months of open-label sildenafil. The primary endpoint was change in left ventricular end-systolic volume (LVESV) on cardiac magnetic resonance imaging. Secondary cardiac endpoints, skeletal muscle function, and quality of life were also assessed. RESULTS An interim analysis (performed after 15 subjects completed the blinded phase) revealed that 29% (4 of 14) of subjects had a ≥10% increase in LVESV after 6 months of sildenafil compared to 13% (1 of 8) of subjects receiving placebo. Subjects with LVESV > 120ml at baseline were more likely to worsen at 12 months regardless of treatment assignment (p = 0.035). Due to the higher number of subjects worsening on sildenafil, the data and safety monitoring board recommended early termination of the study. There were no statistically significant differences in outcome measures between treatment arms. INTERPRETATION Due to the small sample size, comparisons between groups must be interpreted with caution. However, this trial suggests that sildenafil is unlikely to improve cardiac function in adults with DBMD.
Collapse
Affiliation(s)
- Doris G Leung
- Hugo W. Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD; Departments of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Leung DG, Taylor HA, Lindy AS, Basehore MJ, Mammen AL. A case of progressive quadriceps weakness and elevated creatine kinase level mimicking inclusion body myositis. Arthritis Care Res (Hoboken) 2014; 66:328-33. [PMID: 24022920 DOI: 10.1002/acr.22156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/03/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Doris G Leung
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland
| | | | | | | | | |
Collapse
|
21
|
Abstract
The muscular dystrophies comprise a heterogeneous group of genetic disorders that produce progressive skeletal muscle weakness and wasting. There has been rapid growth and change in our understanding of these disorders in recent years, and advances in basic science are being translated into increasing numbers of clinical trials. This review will discuss therapeutic developments in 3 of the most common forms of muscular dystrophy: Duchenne muscular dystrophy, facioscapulohumeral muscular dystrophy, and myotonic dystrophy. Each of these disorders represents a different class of genetic disease (monogenic, epigenetic, and repeat expansion disorders), and the approach to therapy addresses the diverse and complex molecular mechanisms involved in these diseases. The large number of novel pharmacologic agents in development with good biologic rationale and strong proof of concept suggests there will be an improved quality of life for individuals with muscular dystrophy.
Collapse
Affiliation(s)
- Doris G Leung
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD; Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | | |
Collapse
|
22
|
Rahimov F, King OD, Leung DG, Bibat GM, Emerson CP, Kunkel LM, Wagner KR. Transcriptional profiling in facioscapulohumeral muscular dystrophy to identify candidate biomarkers. Proc Natl Acad Sci U S A 2012; 109:16234-9. [PMID: 22988124 PMCID: PMC3479603 DOI: 10.1073/pnas.1209508109] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is a progressive neuromuscular disorder caused by contractions of repetitive elements within the macrosatellite D4Z4 on chromosome 4q35. The pathophysiology of FSHD is unknown and, as a result, there is currently no effective treatment available for this disease. To better understand the pathophysiology of FSHD and develop mRNA-based biomarkers of affected muscles, we compared global analysis of gene expression in two distinct muscles obtained from a large number of FSHD subjects and their unaffected first-degree relatives. Gene expression in two muscle types was analyzed using GeneChip Gene 1.0 ST arrays: biceps, which typically shows an early and severe disease involvement; and deltoid, which is relatively uninvolved. For both muscle types, the expression differences were mild: using relaxed cutoffs for differential expression (fold change ≥1.2; nominal P value <0.01), we identified 191 and 110 genes differentially expressed between affected and control samples of biceps and deltoid muscle tissues, respectively, with 29 genes in common. Controlling for a false-discovery rate of <0.25 reduced the number of differentially expressed genes in biceps to 188 and in deltoid to 7. Expression levels of 15 genes altered in this study were used as a "molecular signature" in a validation study of an additional 26 subjects and predicted them as FSHD or control with 90% accuracy based on biceps and 80% accuracy based on deltoids.
Collapse
Affiliation(s)
- Fedik Rahimov
- Program in Genomics, Division of Genetics, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115
- The Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Center and
| | - Oliver D. King
- The Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Center and
- Boston Biomedical Research Institute, Watertown, MA 02472
| | - Doris G. Leung
- Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, MD 21205; Departments of
- Neurology and
| | - Genila M. Bibat
- Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, MD 21205; Departments of
| | - Charles P. Emerson
- The Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Center and
- Boston Biomedical Research Institute, Watertown, MA 02472
| | - Louis M. Kunkel
- Program in Genomics, Division of Genetics, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115
- The Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Center and
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115
| | - Kathryn R. Wagner
- Hugo W. Moser Research Institute at Kennedy Krieger Institute, Baltimore, MD 21205; Departments of
- Neurology and
- Neuroscience, The Johns Hopkins School of Medicine, Baltimore, MD 21205; and
| |
Collapse
|
23
|
Leung DG, Germain-Lee EL, Denger BE, Wagner KR. Report on the Second Endocrine Aspects Of Duchenne Muscular Dystrophy Conference December 1-2, 2010, Baltimore, Maryland, USA. Neuromuscul Disord 2011; 21:594-601. [PMID: 21763136 DOI: 10.1016/j.nmd.2011.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/07/2011] [Accepted: 04/15/2011] [Indexed: 11/28/2022]
Affiliation(s)
- D G Leung
- Center for Genetic Muscle Disorders, The Kennedy Krieger Institute, USA
| | | | | | | |
Collapse
|