3-D reconstruction of the human skeleton during motion

L’analisi del movimento umano ha come obiettivo la descrizione del movimento assoluto e relativo dei segmenti ossei del soggetto e, ove richiesto, dei relativi tessuti molli durante l’esecuzione di esercizi fisici. La bioingegneria mette a disposizione dell’analisi del movimento gli strumenti ed i metodi necessari per una valutazione quantitativa di efficacia, funzione e/o qualità del movimento umano, consentendo al clinico l’analisi di aspetti non individuabili con gli esami tradizionali. Tali valutazioni possono essere di ausilio all’analisi clinica di pazienti e, specialmente con riferimento a problemi ortopedici, richiedono una elevata accuratezza e precisione perché il loro uso sia valido. Il miglioramento della affidabilità dell’analisi del movimento ha quindi un impatto positivo sia sulla metodologia utilizzata, sia sulle ricadute cliniche della stessa. Per perseguire gli obiettivi scientifici descritti, è necessario effettuare una stima precisa ed accurata della posizione e orientamento nello spazio dei segmenti ossei in esame durante l’esecuzione di un qualsiasi atto motorio. Tale descrizione può essere ottenuta mediante la definizione di un modello della porzione del corpo sotto analisi e la misura di due tipi di informazione: una relativa al movimento ed una alla morfologia. L’obiettivo è quindi stimare il vettore posizione e la matrice di orientamento necessari a descrivere la collocazione nello spazio virtuale 3D di un osso utilizzando le posizioni di punti, definiti sulla superficie cutanea ottenute attraverso la stereofotogrammetria. Le traiettorie dei marker, così ottenute, vengono utilizzate per la ricostruzione della posizione e dell’orientamento istantaneo di un sistema di assi solidale con il segmento sotto esame (sistema tecnico) (Cappozzo et al. 2005). Tali traiettorie e conseguentemente i sistemi tecnici, sono affetti da due tipi di errore, uno associato allo strumento di misura e l’altro associato alla presenza di tessuti molli interposti tra osso e cute. La propagazione di quest’ultimo ai risultati finali è molto più distruttiva rispetto a quella dell’errore strumentale che è facilmente minimizzabile attraverso semplici tecniche di filtraggio (Chiari et al. 2005). In letteratura è stato evidenziato che l’errore dovuto alla deformabilità dei tessuti molli durante l’analisi del movimento umano provoca inaccuratezze tali da mettere a rischio l’utilizzabilità dei risultati. A tal proposito Andriacchi scrive: “attualmente, uno dei fattori critici che rallentano il progresso negli studi del movimento umano è la misura del movimento scheletrico partendo dai marcatori posti sulla cute” (Andriacchi et al. 2000). Relativamente alla morfologia, essa può essere acquisita, ad esempio, attraverso l’utilizzazione di tecniche per bioimmagini. Queste vengono fornite con riferimento a sistemi di assi locali in generale diversi dai sistemi tecnici. Per integrare i dati relativi al movimento con i dati morfologici occorre determinare l’operatore che consente la trasformazione tra questi due sistemi di assi (matrice di registrazione) e di conseguenza è fondamentale l’individuazione di particolari terne di riferimento, dette terne anatomiche. L’identificazione di queste terne richiede la localizzazione sul segmento osseo di particolari punti notevoli, detti repere anatomici, rispetto ad un sistema di riferimento solidale con l’osso sotto esame. Tale operazione prende il nome di calibrazione anatomica. Nella maggior parte dei laboratori di analisi del movimento viene implementata una calibrazione anatomica a “bassa risoluzione” che prevede la descrizione della morfologia dell’osso a partire dall’informazione relativa alla posizione di alcuni repere corrispondenti a prominenze ossee individuabili tramite palpazione. Attraverso la stereofotogrammetria è quindi possibile registrare la posizione di questi repere rispetto ad un sistema tecnico. Un diverso approccio di calibrazione anatomica può essere realizzato avvalendosi delle tecniche ad “alta risoluzione”, ovvero attraverso l’uso di bioimmagini. In questo caso è necessario disporre di una rappresentazione digitale dell’osso in un sistema di riferimento morfologico e localizzare i repere d’interesse attraverso palpazione in ambiente virtuale (Benedetti et al. 1994 ; Van Sint Jan et al. 2002; Van Sint Jan et al. 2003). Un simile approccio è difficilmente applicabile nella maggior parte dei laboratori di analisi del movimento, in quanto normalmente non si dispone della strumentazione necessaria per ottenere le bioimmagini; inoltre è noto che tale strumentazione in alcuni casi può essere invasiva. Per entrambe le calibrazioni anatomiche rimane da tenere in considerazione che, generalmente, i repere anatomici sono dei punti definiti arbitrariamente all’interno di un’area più vasta e irregolare che i manuali di anatomia definiscono essere il repere anatomico. L’identificazione dei repere attraverso una loro descrizione verbale è quindi povera in precisione e la difficoltà nella loro identificazione tramite palpazione manuale, a causa della presenza dei tessuti molli interposti, genera errori sia in precisione che in accuratezza. Tali errori si propagano alla stima della cinematica e della dinamica articolare (Ramakrishnan et al. 1991; Della Croce et al. 1999). Della Croce (Della Croce et al. 1999) ha inoltre evidenziato che gli errori che influenzano la collocazione nello spazio delle terne anatomiche non dipendono soltanto dalla precisione con cui vengono identificati i repere anatomici, ma anche dalle regole che si utilizzano per definire le terne. E’ infine necessario evidenziare che la palpazione manuale richiede tempo e può essere effettuata esclusivamente da personale altamente specializzato, risultando quindi molto onerosa (Simon 2004). La presente tesi prende lo spunto dai problemi sopra elencati e ha come obiettivo quello di migliorare la qualità delle informazioni necessarie alla ricostruzione della cinematica 3D dei segmenti ossei in esame affrontando i problemi posti dall’artefatto di tessuto molle e le limitazioni intrinseche nelle attuali procedure di calibrazione anatomica. I problemi sono stati affrontati sia mediante procedure di elaborazione dei dati, sia apportando modifiche ai protocolli sperimentali che consentano di conseguire tale obiettivo. Per quanto riguarda l’artefatto da tessuto molle, si è affrontato l’obiettivo di sviluppare un metodo di stima che fosse specifico per il soggetto e per l’atto motorio in esame e, conseguentemente, di elaborare un metodo che ne consentisse la minimizzazione. Il metodo di stima è non invasivo, non impone restrizione al movimento dei tessuti molli, utilizza la sola misura stereofotogrammetrica ed è basato sul principio della media correlata. Le prestazioni del metodo sono state valutate su dati ottenuti mediante una misura 3D stereofotogrammetrica e fluoroscopica sincrona (Stagni et al. 2005), (Stagni et al. 2005). La coerenza dei risultati raggiunti attraverso i due differenti metodi permette di considerare ragionevoli le stime dell’artefatto ottenute con il nuovo metodo. Tale metodo fornisce informazioni sull’artefatto di pelle in differenti porzioni della coscia del soggetto e durante diversi compiti motori, può quindi essere utilizzato come base per un piazzamento ottimo dei marcatori. Lo si è quindi utilizzato come punto di partenza per elaborare un metodo di compensazione dell’errore dovuto all’artefatto di pelle che lo modella come combinazione lineare degli angoli articolari di anca e ginocchio. Il metodo di compensazione è stato validato attraverso una procedura di simulazione sviluppata ad-hoc. Relativamente alla calibrazione anatomica si è ritenuto prioritario affrontare il problema associato all’identificazione dei repere anatomici perseguendo i seguenti obiettivi: 1. migliorare la precisione nell’identificazione dei repere e, di conseguenza, la ripetibilità dell’identificazione delle terne anatomiche e della cinematica articolare, 2. diminuire il tempo richiesto, 3. permettere che la procedura di identificazione possa essere eseguita anche da personale non specializzato. Il perseguimento di tali obiettivi ha portato alla implementazione dei seguenti metodi: • Inizialmente è stata sviluppata una procedura di palpazione virtuale automatica. Dato un osso digitale, la procedura identifica automaticamente i punti di repere più significativi, nella maniera più precisa possibile e senza l'ausilio di un operatore esperto, sulla base delle informazioni ricavabili da un osso digitale di riferimento (template), preliminarmente palpato manualmente. • E’ stato poi condotto uno studio volto ad indagare i fattori metodologici che influenzano le prestazioni del metodo funzionale nell’individuazione del centro articolare d’anca, come prerequisito fondamentale per migliorare la procedura di calibrazione anatomica. A tale scopo sono stati confrontati diversi algoritmi, diversi cluster di marcatori ed è stata valutata la prestazione del metodo in presenza di compensazione dell’artefatto di pelle. • E’stato infine proposto un metodo alternativo di calibrazione anatomica basato sull’individuazione di un insieme di punti non etichettati, giacenti sulla superficie dell’osso e ricostruiti rispetto ad un TF (UP-CAST). A partire dalla posizione di questi punti, misurati su pelvi coscia e gamba, la morfologia del relativo segmento osseo è stata stimata senza identificare i repere, bensì effettuando un’operazione di matching dei punti misurati con un modello digitale dell’osso in esame. La procedura di individuazione dei punti è stata eseguita da personale non specializzato nell’individuazione dei repere anatomici. Ai soggetti in esame è stato richiesto di effettuare dei cicli di cammino in modo tale da poter indagare gli effetti della nuova procedura di calibrazione anatomica sulla determinazione della cinematica articolare. I risultati ottenuti hanno mostrato, per quel che riguarda la identificazione dei repere, che il metodo proposto migliora sia la precisione inter- che intraoperatore, rispetto alla palpazione convenzionale (Della Croce et al. 1999). E’ stato inoltre riscontrato un notevole miglioramento, rispetto ad altri protocolli (Charlton et al. 2004; Schwartz et al. 2004), nella ripetibilità della cinematica 3D di anca e ginocchio. Bisogna inoltre evidenziare che il protocollo è stato applicato da operatori non specializzati nell’identificazione dei repere anatomici. Grazie a questo miglioramento, la presenza di diversi operatori nel laboratorio non genera una riduzione di ripetibilità. Infine, il tempo richiesto per la procedura è drasticamente diminuito. Per una analisi che include la pelvi e i due arti inferiori, ad esempio, l’identificazione dei 16 repere caratteristici usando la calibrazione convenzionale richiede circa 15 minuti, mentre col nuovo metodo tra i 5 e i 10 minuti.

A new approach for the dynamic modelling of the human knee

Mathematical models of the knee joint are important tools which have both theoretical and practical applications. They are used by researchers to fully understand the stabilizing role of the components of the joint, by engineers as an aid for prosthetic design, by surgeons during the planning of an operation or during the operation itself, and by orthopedists for diagnosis and rehabilitation purposes. The principal aims of knee models are to reproduce the restraining function of each structure of the joint and to replicate the relative motion of the bones which constitute the joint itself. It is clear that the first point is functional to the second one. However, the standard procedures for the dynamic modelling of the knee tend to be more focused on the second aspect: the motion of the joint is correctly replicated, but the stabilizing role of the articular components is somehow lost. A first contribution of this dissertation is the definition of a novel approach — called sequential approach — for the dynamic modelling of the knee. The procedure makes it possible to develop more and more sophisticated models of the joint by a succession of steps, starting from a first simple model of its passive motion. The fundamental characteristic of the proposed procedure is that the results obtained at each step do not worsen those already obtained at previous steps, thus preserving the restraining function of the knee structures. The models which stem from the first two steps of the sequential approach are then presented. The result of the first step is a model of the passive motion of the knee, comprehensive of the patello-femoral joint. Kinematical and anatomical considerations lead to define a one degree of freedom rigid link mechanism, whose members represent determinate components of the joint. The result of the second step is a stiffness model of the knee. This model is obtained from the first one, by following the rules of the proposed procedure. Both models have been identified from experimental data by means of an optimization procedure. The simulated motions of the models then have been compared to the experimental ones. Both models accurately reproduce the motion of the joint under the corresponding loading conditions. Moreover, the sequential approach makes sure the results obtained at the first step are not worsened at the second step: the stiffness model can also reproduce the passive motion of the knee with the same accuracy than the previous simpler model. The procedure proved to be successful and thus promising for the definition of more complex models which could also involve the effect of muscular forces.

New functional and biomechanical assessments for the improvement of the surgical navigation systems for joint replacement in the human lower limb

In case of severe osteoarthritis at the knee causing pain, deformity, and loss of stability and mobility, the clinicians consider that the substitution of these surfaces by means of joint prostheses. The objectives to be pursued by this surgery are: complete pain elimination, restoration of the normal physiological mobility and joint stability, correction of all deformities and, thus, of limping. The knee surgical navigation systems have bee developed in computer-aided surgery in order to improve the surgical final outcome in total knee arthroplasty. These systems provide the surgeon with quantitative and real-time information about each surgical action, like bone cut executions and prosthesis component alignment, by mean of tracking tools rigidly fixed onto the femur and the tibia. Nevertheless, there is still a margin of error due to the incorrect surgical procedures and to the still limited number of kinematic information provided by the current systems. Particularly, patello-femoral joint kinematics is not considered in knee surgical navigation. It is also unclear and, thus, a source of misunderstanding, what the most appropriate methodology is to study the patellar motion. In addition, also the knee ligamentous apparatus is superficially considered in navigated total knee arthroplasty, without taking into account how their physiological behavior is altered by this surgery. The aim of the present research work was to provide new functional and biomechanical assessments for the improvement of the surgical navigation systems for joint replacement in the human lower limb. This was mainly realized by means of the identification and development of new techniques that allow a thorough comprehension of the functioning of the knee joint, with particular attention to the patello-femoral joint and to the main knee soft tissues. A knee surgical navigation system with active markers was used in all research activities presented in this research work. Particularly, preliminary test were performed in order to assess the system accuracy and the robustness of a number of navigation procedures. Four studies were performed in-vivo on patients requiring total knee arthroplasty and randomly implanted by means of traditional and navigated procedures in order to check for the real efficacy of the latter with respect to the former. In order to cope with assessment of patello-femoral joint kinematics in the intact and replaced knees, twenty in-vitro tests were performed by using a prototypal tracking tool also for the patella. In addition to standard anatomical and articular recommendations, original proposals for defining the patellar anatomical-based reference frame and for studying the patello-femoral joint kinematics were reported and used in these tests. These definitions were applied to two further in-vitro tests in which, for the first time, also the implant of patellar component insert was fully navigated. In addition, an original technique to analyze the main knee soft tissues by means of anatomical-based fiber mappings was also reported and used in the same tests. The preliminary instrumental tests revealed a system accuracy within the millimeter and a good inter- and intra-observer repeatability in defining all anatomical reference frames. In in-vivo studies, the general alignments of femoral and tibial prosthesis components and of the lower limb mechanical axis, as measured on radiographs, was more satisfactory, i.e. within ±3°, in those patient in which total knee arthroplasty was performed by navigated procedures. As for in-vitro tests, consistent patello-femoral joint kinematic patterns were observed over specimens throughout the knee flexion arc. Generally, the physiological intact knee patellar motion was not restored after the implant. This restoration was successfully achieved in the two further tests where all component implants, included the patellar insert, were fully navigated, i.e. by means of intra-operative assessment of also patellar component positioning and general tibio-femoral and patello-femoral joint assessment. The tests for assessing the behavior of the main knee ligaments revealed the complexity of the latter and the different functional roles played by the several sub-bundles compounding each ligament. Also in this case, total knee arthroplasty altered the physiological behavior of these knee soft tissues. These results reveal in-vitro the relevance and the feasibility of the applications of new techniques for accurate knee soft tissues monitoring, patellar tracking assessment and navigated patellar resurfacing intra-operatively in the contest of the most modern operative techniques. This present research work gives a contribution to the much controversial knowledge on the normal and replaced of knee kinematics by testing the reported new methodologies. The consistence of these results provides fundamental information for the comprehension and improvements of knee orthopedic treatments. In the future, the reported new techniques can be safely applied in-vivo and also adopted in other joint replacements.

Spatial mechanisms for modelling the human ankle passive motion

Knowledge on how ligaments and articular surfaces guide passive motion at the human ankle joint complex is fundamental for the design of relevant surgical treatments. The dissertation presents a possible improvement of this knowledge by a new kinematic model of the tibiotalar articulation. In this dissertation two one-DOF spatial equivalent mechanisms are presented for the simulation of the passive motion of the human ankle joint: the 5-5 fully parallel mechanism and the fully parallel spherical wrist mechanism. These mechanisms are based on the main anatomical structures of the ankle joint, namely the talus/calcaneus and the tibio/fibula bones at their interface, and the TiCaL and CaFiL ligaments. In order to show the accuracy of the models and the efficiency of the proposed procedure, these mechanisms are synthesized from experimental data and the results are compared with those obtained both during experimental sessions and with data published in the literature. Experimental results proved the efficiency of the proposed new mechanisms to simulate the ankle passive motion and, at the same time, the potentiality of the mechanism to replicate the ankle’s main anatomical structures quite well. The new mechanisms represent a powerful tool for both pre-operation planning and new prosthesis design.

Molecular characterization of the human gut microbiota: the effect of aging

Age-related physiological changes in the gastrointestinal tract, as well as modification in lifestyle, nutritional behaviour, and functionality of the host immune system, inevitably affect the gut microbiota. The study presented here is focused on the application and comparison of two different microarray approaches for the characterization of the human gut microbiota, the HITChip and the HTF-Microb.Array, with particular attention to the effects of the aging process on the composition of this ecosystem. By using the Human Intestinal Tract Chip (HITChip), recently developed at the Wageningen University, The Netherland, we explored the age-related changes of gut microbiota during the whole adult lifespan, from young adults, through elderly to centenarians. We observed that the microbial composition and diversity of the gut ecosystem of young adults and seventy-years old people is highly similar but differs significantly from that of the centenarians. After 100 years of symbiotic association with the human host, the microbiota is characterized by a rearrangement in the Firmicutes population and an enrichment of facultative anaerobes. The presence of such a compromised microbiota in the centenarians is associated with an increased inflammation status, also known as inflamm-aging, as determined by a range of peripheral blood inflammatory markers. In parallel, we overtook the development of our own phylogenetic microarray with a lower number of targets, aiming the description of the human gut microbiota structure at high taxonomic level. The resulting chip was called High Taxonomic level Fingerprinting Microbiota Array (HTF-Microb.Array), and was based on the Ligase Detection Reaction (LDR) technology, which allowed us to develop a fast and sensitive tool for the fingerprint of the human gut microbiota in terms of presence/absence of the principal groups. The validation on artificial DNA mixes, as well as the pilot study involving eight healthy young adults, demonstrated that the HTF-Microb.Array can be used to successfully characterize the human gut microbiota, allowing us to obtain results which are in approximate accordance with the most recent characterizations. Conversely, the evaluation of the relative abundance of the target groups on the bases of the relative fluorescence intensity probes response still has some hindrances, as demonstrated by comparing the HTF.Microb.Array and HITChip high taxonomic level fingerprints of the same centenarians.

Investigating the role of single point mutations in the human proteome: a computational study

In the post genomic era with the massive production of biological data the understanding of factors affecting protein stability is one of the most important and challenging tasks for highlighting the role of mutations in relation to human maladies. The problem is at the basis of what is referred to as molecular medicine with the underlying idea that pathologies can be detailed at a molecular level. To this purpose scientific efforts focus on characterising mutations that hamper protein functions and by these affect biological processes at the basis of cell physiology. New techniques have been developed with the aim of detailing single nucleotide polymorphisms (SNPs) at large in all the human chromosomes and by this information in specific databases are exponentially increasing. Eventually mutations that can be found at the DNA level, when occurring in transcribed regions may then lead to mutated proteins and this can be a serious medical problem, largely affecting the phenotype. Bioinformatics tools are urgently needed to cope with the flood of genomic data stored in database and in order to analyse the role of SNPs at the protein level. In principle several experimental and theoretical observations are suggesting that protein stability in the solvent-protein space is responsible of the correct protein functioning. Then mutations that are found disease related during DNA analysis are often assumed to perturb protein stability as well. However so far no extensive analysis at the proteome level has investigated whether this is the case. Also computationally methods have been developed to infer whether a mutation is disease related and independently whether it affects protein stability. Therefore whether the perturbation of protein stability is related to what it is routinely referred to as a disease is still a big question mark. In this work we have tried for the first time to explore the relation among mutations at the protein level and their relevance to diseases with a large-scale computational study of the data from different databases. To this aim in the first part of the thesis for each mutation type we have derived two probabilistic indices (for 141 out of 150 possible SNPs): the perturbing index (Pp), which indicates the probability that a given mutation effects protein stability considering all the “in vitro” thermodynamic data available and the disease index (Pd), which indicates the probability of a mutation to be disease related, given all the mutations that have been clinically associated so far. We find with a robust statistics that the two indexes correlate with the exception of all the mutations that are somatic cancer related. By this each mutation of the 150 can be coded by two values that allow a direct comparison with data base information. Furthermore we also implement computational methods that starting from the protein structure is suited to predict the effect of a mutation on protein stability and find that overpasses a set of other predictors performing the same task. The predictor is based on support vector machines and takes as input protein tertiary structures. We show that the predicted data well correlate with the data from the databases. All our efforts therefore add to the SNP annotation process and more importantly found the relationship among protein stability perturbation and the human variome leading to the diseasome.

The Role of Multiple Social Categorisation in Promoting the Inclusion in the Human Group of Outgroup Members

New mechanisms for modelling the motion of the human ankle complex

The relevance of human joint models was shown in the literature. In particular, the great importance of models for the joint passive motion simulation (i.e. motion under virtually unloaded conditions) was outlined. They clarify the role played by the principal anatomical structures of the articulation, enhancing the comprehension of surgical treatments, and in particular the design of total ankle replacement and ligament reconstruction. Equivalent rigid link mechanisms proved to be an efficient tool for an accurate simulation of the joint passive motion. This thesis focuses on the ankle complex (i.e. the anatomical structure composed of the tibiotalar and the subtalar joints), which has a considerable role in human locomotion. The lack of interpreting models of this articulation and the poor results of total ankle replacement arthroplasty have strongly suggested devising new mathematical models capable of reproducing the restraining function of each structure of the joint and of replicating the relative motion of the bones which constitute the joint itself. In this contest, novel equivalent mechanisms are proposed for modelling the ankle passive motion. Their geometry is based on the joint’s anatomical structures. In particular, the role of the main ligaments of the articulation is investigated under passive conditions by means of nine 5-5 fully parallel mechanisms. Based on this investigation, a one-DOF spatial mechanism is developed for modelling the passive motion of the lower leg. The model considers many passive structures constituting the articulation, overcoming the limitations of previous models which took into account few anatomical elements of the ankle complex. All the models have been identified from experimental data by means of optimization procedure. Then, the simulated motions have been compared to the experimental one, in order to show the efficiency of the approach and thus to deduce the role of each anatomical structure in the ankle kinematic behavior.

Metagenomic trajectory of gut microbiome in the human lifespan

Co-evolving with the human host, gut microbiota establishes configurations, which vary under the pressure of inflammation, disease, ageing, diet and lifestyle. In order to describe the multi-stability of the microbiome-host relationship, we studied specific tracts of the bacterial trajectory during the human lifespan and we characterized peculiar deviations from the hypothetical development, caused by disease, using molecular techniques, such as phylogenetic microarray and next-generation sequencing. Firstly, we characterized the enterocyte-associated microbiota in breast-fed infants and adults, describing remarkable differences between the two groups of subjects. Successively, we investigated the impact of atopy on the development of the microbiome in Italian childrens, highlithing conspicuous deviations from the child-type microbiota of the Italian controls. To explore variation in the gut microbiota depending on geographical origins, which reflect different lifestyles, we compared the phylogenetic diversity of the intestinal microbiota of the Hadza hunter-gatherers of Tanzania and Italian adults. Additionally, we characterized the aged-type microbiome, describing the changes occurred in the metabolic potential of the gut microbiota of centenarians with respect to younger individuals, as a part of the pathophysiolology of the ageing process. Finally, we evaluated the impact of a probiotics intervention on the intestinal microbiota of elderly people, showing the repair of some age-related dysbioses. These studies contribute to elucidate several aspects of the intestinal microbiome development during the human lifespan, depicting the microbiota as an extremely plastic entity, capable of being reconfigured in response to different environmental factors and/or stressors of endogenous origin.

Transcriptional dynamics of the human DMD locus

The human DMD locus encodes dystrophin protein. Absence or reduced levels of dystrophin (DMD or BMD phenotype, respectively) lead to progressive muscle wasting. Little is known about the complex coordination of dystrophin expression and its transcriptional regulation is a field of intense interest. In this work we found that DMD locus harbours multiple long non coding RNAs which orchestrate and control transcription of muscle dystrophin mRNA isoforms. These lncRNAs are tissue-specific and highly expressed during myogenesis, suggesting a possible role in tissue-specific expression of DMD gene isoforms. Their forced ectopic expression in human muscle and neuronal cells leads to a specific and negative regulation of endogenous dystrophin full lenght isoforms. An intriguing aspect regarding the transcription of the DMD locus is the gene size (2.4Mb). The mechanism that ensures the complete synthesis of the primary transcript and the coordinated splicing of 79 exons is still completely unknown. By ChIP-on-chip analyses, we discovered novel regions never been involved before in the transcription regulation of the DMD locus. Specifically, we observed enrichments for Pol II, P-Ser2, P-Ser5, Ac-H3 and 2Me-H3K4 in an intronic region of 3Kb (approximately 21Kb) downstream of the end of DMD exon 52 and in a region of 4Kb spanning the DMD exon 62. Interestingly, this latter region and the TSS of Dp71 are strongly marked by 3Me-H3K36, an histone modification associated with the regulation of splicing process. Furthermore, we also observed strong presence of open chromatin marks (Ac-H3 and 2Me-H3K4) around intron 34 and the exon 45 without presence of RNA pol II. We speculate that these two regions may exert an enhancer-like function on Dp427m promoter, although further investigations are necessary. Finally, we investigated the nuclear-cytoplasmic compartmentalization of the muscular dystrophin mRNA and, specifically, we verified whether the exon skipping therapy could influence its cellular distribution.