Influência do bloqueador de receptor de angiotensina (Losartana potássica) na função renal e pressão arterial em cães GRMD

A distrofia muscular de Duchenne (DMD) é uma alteração neuromuscular caracterizada por contínua necrose muscular e degeneração, com eventual fibrose e infiltração por tecido adiposo. O aumento progressivo da fibrose intersticial no músculo impede a migração das células miogênicas, necessárias para a formação muscular. O modelo canino constitui-se nas melhores fenocópias da doença em humanos, quando comparados com outros modelos animais com distrofia. O tratamento antifibrose de pacientes DMD, tendo como alvo os mediadores da citocina, TGF-beta, e o tratamento com antiinflamatórios, podem limitar a degeneração muscular e contribuir para a melhora do curso da doença. O presente estudo teve como objetivo observar os possíveis efeitos adversos na fisiologia renal, por meio de avaliação bioquímica sanguínea e da pressão arterial, verificando a viabilidade do uso do Losartan (um inibidor de TGF-beta) nos cães afetados pela distrofia muscular. Foram utilizados quatro cães adultos, sendo dois machos e duas fêmeas. Utilizou-se a dose de 50mg de Losartan, administrada via oral, uma vez ao dia. Os exames clínicos, bem como alterações na função renal, o nível do potássio sérico e a pressão arterial não evidenciaram reação adversa durante todo o período do experimento. O uso de Losartan, por um período de 9 semanas, mostrou-se como uma terapia segura para o tratamento antifibrótico em cães adultos, não afetando a função renal ou pressão arterial dos animais.

Alterações do trato digestório de cães da raça Golden Retriever afetados pela distrofia muscular

O modelo experimental canino Golden Retriever portador da Distrofia Muscular (GRMD) é o melhor substituto entre os modelos animais para estudar a Distrofia Muscular de Duchenne. Além da musculatura estriada, a doença pode afetar a musculatura estriada cardíaca e a musculatura lisa, e desta forma, o funcionamento do trato digestório, já que o músculo liso é o elemento primário dos órgãos tubulares. Através de estudo morfológico descritivo, o objetivo deste trabalho foi verificar se a distrofia muscular afeta a arquitetura geral do trato digestório e como se dispõe sua estrutura muscular em animais afetados. Foram realizadas avaliações descritivas macro e microscópicas com colorações de Hematoxilina-Eosina, Tricrômio de Masson e Picrosirius. Entre os resultados apresentados, verificou-se que o esôfago e o fígado dos animais afetados encontraram-se alterados, assim como o estômago não ocupava seu lugar habitual. O músculo diafragma apresentava-se atrofiado e diferenças histológicas foram encontradas na camada muscular do sistema gastrointestinal, em geral. Outras estruturas do tubo digestório de GRMDs apresentaram-se de maneira similar a de um animal normal.

Padronização de parâmetros eletrocardiográficos de cães da raça Golden Retriever clinicamente sadios

A distrofia muscular de Duchenne (DMD) em humanos é uma alteração neuromuscular hereditária, de caráter recessivo, ligada ao cromossomo X e causada pela ausência ou disfunção da distrofina. Clinicamente, caracteriza-se por grave alteração na musculatura esquelética, resultando em morte precoce do indivíduo acometido. Em cães da raça Golden Retriever, a mutação que leva à distrofia muscular ocorre espontaneamente e a extensa homologia entre a patogênese da DMD e da distrofia muscular do Golden Retriever permite qualificar o cão como o principal substituto de humanos nos testes clínicos de novas terapias. O miocárdio deficiente em distrofina é mais vulnerável à sobrecarga de pressão e os pacientes com DMD podem desenvolver cardiomiopatia dilatada, hipertensão arterial e o eletrocardiograma pode se apresentar distintamente anormal. No presente estudo, foram avaliados exames eletrocardiográficos de 38 cães da raça Golden Retriever clinicamente sadios (20 animais de até 12 meses de idade e 18 animais entre 12 e 36 meses de idade), com a finalidade de se obter parâmetros para a padronização do eletrocardiograma nessa referida raça, o que futuramente poderá servir de referência na identificação de cães portadores ou afetados pela distrofia muscular. Os valores eletrocardiográficos obtidos encontraram-se dentro dos valores de normalidade e referência para as diferentes raças de cães; e as variáveis peso e idade alteraram significativamente a freqüência cardíaca e a amplitude do complexo QRS.

Estudo morfofuncional dos rins de cães da raça Golden Retriever afetados pela distrofia muscular (GRMD)

A Distrofia Muscular de Duchenne (DMD) é uma miopatia severa de caráter recessivo ligada ao cromossomo X e o modelo animal de estudo mais relevante é o Golden Retriever Muscular Dystrophy (GRMD). Além das severas alterações que ocorrem na musculatura estriada, muitos estudos mostram que outras estruturas, inclusive viscerais, podem se mostrar alteradas nesta patologia. Desta forma, este trabalho objetivou análisar e comparar possíveis alterações estruturais e funcionais do rim em cães GRMD. Neste modelo de estudo, foi possível observar a presença das faces convexa e côncava, do hilo renal e dos pólos craniais e caudais dos rins. O órgão mostrou-se envolto por uma cápsula fibrosa. Em um corte sagital do órgão, notou-se a presença das regiões cortical e medular e da pelve renal. Na análise microscópica foi possível identificar a zona medular e cortical com suas estruturas: os corpúsculos renais formados pelo glomérulo e pela cápsula de Bowman, os túbulos contorcidos proximais e distais, os ductos coletores, vasos sanguíneos e os segmentos das Alças de Henle. As dosagens séricas de creatinina e uréia encontram-se dentro dos limites de normalidade. Desta forma, de acordo com os nossos resultados, podemos concluir que os animais afetados estudados, não apresentaram alterações estruturais ou funcionais dos rins, o que nos permitir sugerir que apesar da ingestão hídrica comprometida, a estrutura renal, mantem- se preservada nos animais GRMD.

Alterações morfofuncionais renais em cães Golden Retriever Distróficos (GRMD)

A Golden Retriever Muscular Dystrophy (GRMD) é geneticamente homóloga à distrofia muscular de Duchenne (DMD) que acomete seres humanos. É uma doença genética que gera degeneração progressiva da musculatura esquelética. Considerando-se as intensas alterações musculares, é natural pensar em uma possível lesão renal decorrente da intensa lesão muscular. Foram avaliados seis cães machos da raça Golden Retriever afetados pela distrofia muscular (GRMD) e três cães machos clinicamente sadios. A concentração de creatinina foi determinada e as proteínas urinárias foram avaliadas por eletroforese em gel de poliacrilamida. Os resultados mostraram que a proteinúria patológica não está diretamente associada à Distrofia Muscular de Duchenne, porém diversos parâmetros apresentaram concentrações aumentadas para animais afetados, como a razão proteína/albumina, que foi maior em cães distróficos, podendo ser indício de microalbuminúria e conseqüente lesão renal precoce. Estes resultados visam embasar avaliações clínicas e futuros estudos considerando-se as patologias decorrentes ou associadas a esta doença genética.

Impaired regeneration of dystrophin-deficient muscle fibers is caused by exhaustion of myogenic cells

Duchenne muscular dystrophy is one of the most devastating myopathies. Muscle fibers undergo necrosis and lose their ability to regenerate, and this may be related to increased interstitial fibrosis or the exhaustion of satellite cells. In this study, we used mdx mice, an animal model of Duchenne muscular dystrophy, to assess whether muscle fibers lose their ability to regenerate after repeated cycles of degeneration-regeneration and to establish the role of interstitial fibrosis or exhaustion of satellite cells in this process. Repeated degenerative-regenerative cycles were induced by the injection of bupivacaine (33 mg/kg), a myotoxic agent. Bupivacaine was injected weekly into the right tibialis anterior muscle of male, 8-week-old mdx (N = 20) and C57Bl/10 (control, N = 10) mice for 20 and 50 weeks. Three weeks after the last injection, the mice were killed and the proportion of regenerated fibers was counted and reported as a fibrosis index. Twenty weekly bupivacaine injections did not change the ability of mdx muscle to regenerate. However, after 50 weekly bupivacaine injections, there was a significant decrease in the regenerative response. There was no correlation between the inability to regenerate and the increase in interstitial fibrosis. These results show that after prolonged repeated cycles of degeneration-regeneration, mdx muscle loses its ability to regenerate because of the exhaustion of satellite cells, rather than because of an increase in interstitial fibrosis. This finding may be relevant to cell and gene therapy in the treatment of Duchenne muscular dystrophy.

Erythropoietin reduces the expression of myostatin in mdx dystrophic mice

Erythropoietin (EPO) has been well characterized as a renal glycoprotein hormone regulating red blood cell production by inhibiting apoptosis of erythrocyte progenitors in hematopoietic tissues. EPO exerts regulatory effects in cardiac and skeletal muscles. Duchenne muscular dystrophy is a lethal degenerative disorder of skeletal and cardiac muscle. In this study, we tested the possible therapeutic beneficial effect of recombinant EPO (rhEPO) in dystrophic muscles in mdx mice. Total strength was measured using a force transducer coupled to a computer. Gene expression for myostatin, transforming growth factor-β1 (TGF-β1), and tumor necrosis factor-α (TNF-α) was determined by quantitative real time polymerase chain reaction. Myostatin expression was significantly decreased in quadriceps from mdx mice treated with rhEPO (rhEPO=0.60±0.11, control=1.07±0.11). On the other hand, rhEPO had no significant effect on the expression of TGF-β1 (rhEPO=0.95±0.14, control=1.05±0.16) and TNF-α (rhEPO=0.73±0.20, control=1.01±0.09). These results may help to clarify some of the direct actions of EPO on skeletal muscle.

Lihasperäiselle kreatiinikinaasille spesifinen immunomääritys Duchennen lihasdystrofian seulontaa varten

Duchennen lihasdystrofia (engl. Duchenne muscular dystrophy, DMD) on lähes pelkästään pojilla ilmenevä perinnöllinen lihasrappeumatauti, joka johtaa kuolemaan noin 25 vuoden iässä. Noin yksi 3500–6000 pojasta sairastaa DMD:tä. Taudin aiheuttaa X-kromosomissa sijaitsevan dystrofiinigeenin mutaatio, jonka seurauksena toimivaa, lihaksia koossapitävää dystrofiinia ei tuotu. Kliinisissä testeissä on lupaavia hoitoja, joten DMD:n vastasyntyneiden seulonnan aloittamista harkitaan. DMD:n seulonnassa analyyttina olisi mahdollista käyttää lihasperäistä kreatiinikinaasia (engl. muscle-type creatine kinase tai creatine kinase MM isoform, CK-MM), jota päätyy vereen lihassolujen vaurioituessa. DMD:tä sairastavilla vastasyntyneillä CK-MM:n määrä veressä on moninkertainen terveisiin vastasyntyneisiin verrattuna lihasten rappeutumisesta johtuen. Perinteisesti kreatiinikinaasia on mitattu entsyymiaktiivisuusmäärityksillä, jotka mittaavat kaikkia kreatiinikinaasimuotoja eli myös sydänperäistä ja aivoperäistä kreatiinikinaasia (CK-MB ja CK-BB). Työn tarkoituksena oli kehittää kuivatuista veritäplistä tehtävä CK-MM:lle spesifinen kaksipuoleinen immunomääritys, joka olisi siirrettävissä PerkinElmerin automaattiselle GSP® Genetic Screening Processor -analysaattorille. Työ suoritettiin kolmessa vaiheessa. Ensimmäiseksi vertailtiin kaupallisesti saatavilla olevien CK-MM-vasta-aineiden affiniteetteja biosensorilla. Seuraavassa vaiheessa pystytettiin manuaalinen kaksipuoleinen immunomääritys käyttäen ensimmäisessä vaiheessa valittuja vasta-aineita ja optimoitiin immunomäärityksen parametreja. Lopuksi immunomääritys sovitettiin GSP-laitteelle. Biosensorimittausten ja manuaalisten immunomääritysten tulosten perusteella valittiin kaksi potentiaalista leimavasta-ainetta ja yksi sitojavasta-aineeksi sopiva vasta-aine. Niitä käytettäessä määritys on melko spesifinen CK-MM:lle, sillä CK-BB ei tuottanut lainkaan signaalia ja CK-MB:n ristireaktiivisuus oli noin 7 %. GSP-laitteella mitattaessa DMD:tä sairastavien (n = 10) CK-MM-pitoisuuksien mediaani (vaihteluväli) oli 7590 ng/ml (1490–13400 ng/ml) ja terveiden vastasyntyneiden (n = 8) 165 ng/ml (108–263 ng/ml). Määrityksen dynaamista mittausaluetta ei vielä selvitetty, mutta alustavien mittausten perusteella se kattaa terveiden vastasyntyneiden pitoisuudet ja sairaiden pitoisuudet ainakin 8770 ng/ml asti, mikä mahdollistaa sairaiden erottumisen. Työssä kehitetty määritys vaikuttaa siis sopivalta DMD:n seulontaan vastasyntyneiltä.

Vulnérabilité cardiaque au stress au cours du remodelage ventriculaire pathologique : rôle de la mitochondrie et du pore de perméabilité transitionnelle (PTP)

L’objectif central de cette thèse de Doctorat était d’investiguer les dysfonctions mitochondriales qui surviennent précocement au cours de la phase compensée du remodelage ventriculaire pathologique et qui pourraient jouer un rôle causal dans la progression vers l’insuffisance cardiaque. Nos travaux antérieurs, réalisés à l’aide d’un modèle de surcharge volumique chronique induite par une fistule aorto-cavale (ACF) chez le Rat WKHA, ont montré qu’au cours du remodelage ventriculaire, les mitochondries développaient une vulnérabilité à l’ouverture du pore de perméabilité transitionnelle (PTP : un élément clé de la signalisation de la mort cellulaire) [1]. Ceci était observable au stade compensé du remodelage en absence des dysfonctions mitochondriales majeures typiquement observées dans le cœur insuffisant. Ces résultats nous ont amenés à suggérer que la vulnérabilité à l’ouverture du PTP pourrait constituer un mécanisme précoce favorisant la progression de la cardiopathie. Dans l’étude 1 de cette thèse, nous avons tenté de tester cette hypothèse en induisant une ACF chez deux souches de rats affichant de très nettes différences au niveau de la propension à développer l’insuffisance cardiaque : les souches WKHA et Sprague Dawley (SD). Nos études in vitro sur organelles isolées et in situ sur l’organe entier ont permis de confirmer que, dans le cœur ACF, les mitochondries développent une vulnérabilité à l’ouverture du PTP et à l’activation de la voie mitochondriale de la mort cellulaire lorsqu’exposées à des stress pertinents à la pathologie (surcharge calcique, ischémie-reperfusion [I-R]). Cependant, bien que comparativement aux animaux WKHA, les animaux SD démontraient un remodelage ventriculaire plus rapide et prononcé et une progression précoce vers l’insuffisance cardiaque, aucune différence n’était observable entre les deux groupes au niveau des dysfonctions mitochondriales, suggérant quelles ne sont pas à l’origine de la progression plus rapide de la pathologie chez la souche SD, à tout le moins en réponse à la surcharge volumique. Nous avons par la suite déterminé, à l’aide des mêmes approches expérimentales, si cette vulnérabilité mitochondriale était observable dans une cardiopathie d’étiologie différente, plus spécifiquement celle qui est associée à la dystrophie musculaire de Duchenne (DMD), une maladie génétique causée par une mutation de la protéine dystrophine. Nos études menées (études 2-4) sur de jeunes souris mdx (le modèle murin de la DMD) exemptes de tout signe clinique de cardiopathie n’ont révélé aucune différence au niveau des fonctions mitochondriales de base. Cependant, tout comme dans le modèle d’ACF, les mitochondries dans le cœur de souris mdx étaient significativement plus vulnérables à l’ouverture du PTP lorsque soumises à une I-R (étude 2). Par ailleurs, nous avons démontré que l’administration aiguë de sildénafil aux souris mdx induisait une abolition de l’ouverture du PTP et de ses conséquences signalétiques, une diminution marquée du dommage tissulaire et une meilleure récupération fonctionnelle à la suite de l’I-R (étude 3). Nous avons ensuite testé chez la souris mdx l’administration aiguë de SS31, un peptide anti-oxydant ciblé aux mitochondries, cependant aucun effet protecteur n’a été observé, suggérant que le tamponnement des radicaux libres est d’une utilité limitée si les perturbations de l’homéostasie calcique typiques à cette pathologie ne sont pas traitées simultanément (étude 4). Globalement, les travaux effectués au cours de cette thèse démontrent que la vulnérabilité à l’ouverture du PTP constitue une dysfonction précoce et commune qui survient au cours de remodelages ventriculaires pathologiques d’étiologies différentes. Par ailleurs, ces travaux suggèrent des stratégies d’intervention pharmacologiques ciblant ce processus, dont l’efficacité pour la prévention de l’insuffisance cardiaque demande à être établie.

A mitochondrial perspective on striated muscle physiopathology: insights from sepsis, denervation, and dystrophinopathies.

La mitochondrie est de plus en plus reconnue pour sa contribution à la dégénerescence musculaire. Les dysfonctions mitochondriales, en plus de causer une défaillance énergétique, contribuent à la signalisation apoptotique, stimule la production de ROS et peuvent induire une surcharge calcique. Ces caractéristiques sont tous reliées à certains types de myopathies. Cette thèse met en lumières comment certaines dysfonctions mitochondriales peuvent intervenir dans la pathogenèse de diverses myopathies. Nous démontrons que les dysfonctions mitochondriales sont impliqués dans l’atrophie dû à la perte d’innervation. Par contre, la désensabilisation de l’ouverture du pore mitochondrial de transition de perméabilité, via ablation génétique de cyclophiline-D, ne prévient ni la signalisation apoptotique mitochondrial ni l’atrophie. Nous avons aussi observé des dysfonctions mitochondriales dans le muscle atteint de dystrophie musculaire de Duchenne qui furent améliorés suite à une transfection de PGC1-α, laquelle résulta aussi en une amélioration de la pathologie. Finalement, nous démontrons que le recyclage de mitochondrie par les voies de mitophagies et de contrôles de la qualité impliquant Parkin et possiblement d’autres voies de signalisation inconnues sont cruciales au recouvrement cardiaqe lors d’un choc septique.

Back muscles activity and scoliosis in ataxic and dystrophic patients

To investigate the role of muscles in the development of adolescent idiopathic scoliosis (AIS), our group was initially interested in Duchenne muscular dystrophy (DMD) diseases where a muscular degeneration often leads to scoliosis. Few years ago the studies with those patients provided interesting results but were obtained only from few patients. To increase that number, the present project was initiated but recruitment of new DMD patients from Marie-Enfant hospital was found impossible. As an alternative, patients with Friedreich’s ataxia (FA) were recruited since they also suffer from a muscular deficiency which often induces a scoliosis. So, 4 FA patients and 4 healthy controls have been chosen to closely match the age, weight and body mass indexes (BMI) of the patients were enrolled in our experiments. As in the previous study, electromyography (EMG) activity of paraspinal muscles were recorded on each side of the spine during three types of contraction at 2 different maximum voluntary contractions (MVC). Moreover, the volume and skinfold thickness of these muscles were determined from ultrasound images (US) in order to facilitate the interpretation of EMG signals recorded on the skin surface. For the 3 FA right scoliotic patients, EMG activity was most of the time larger on the concave side of the deviation. The opposite was found for the 4th one (P4, left scoliosis, 32°) for whom EMG activity was larger on the convex side; it should however be noted that all his signals were of small amplitude. This was associated to a muscle weakness and a large skinfold thickness (12 mm) vs 7 mm for the 3 others. As for the paraspinal muscle volume, it was present on the convex side of P1, P3 and P4 and on the concave side for P2. As for skinfold thickness over this muscle, it was larger on the concave side for P1 and P2 and the opposite for P3 and P4. At the apex of each curve, the volume and skinfold thickness differences were the largest. Although the study covers only a small number of FA patients, the presence of larger EMG signals on the concave side of a spinal deformation is similar to pre-scoliotic DMD patients for whom the deformation is in its initial stage. It thus seems that our FA patients with more EMG activity on their concave side could see progression of their spinal deformation in the coming months in spite of their already important Cobb angle.

Chronic systemic therapy with low-dose morpholino oligomers ameliorates the pathology and normalizes locomotor behavior in mdx Mice

The administration of antisense oligonucleotides (AOs) to skip one or more exons in mutated forms of the DMD gene and so restore the reading frame of the transcript is one of the most promising approaches to treat Duchenne muscular dystrophy (DMD). At present, preclinical studies demonstrating the efficacy and safety of long-term AO administration have not been conducted. Furthermore, it is essential to determine the minimal effective dose and frequency of administration. In this study, two different low doses (LDs) of phosphorodiamidate morpholino oligomer (PMO) designed to skip the mutated exon 23 in the mdx dystrophic mouse were administered for up to 12 months. Mice treated for 50 weeks showed a substantial dose-related amelioration of the pathology, particularly in the diaphragm. Moreover, the generalized physical activity was profoundly enhanced compared to untreated mdx mice showing that widespread, albeit partial, dystrophin expression restores the normal activity in mdx mice. Our results show for the first time that a chronic long-term administration of LDs of unmodified PMO, equivalent to doses in use in DMD boys, is safe, significantly ameliorates the muscular dystrophic phenotype and improves the activity of dystrophin-deficient mice, thus encouraging the further clinical translation of this approach in humans.

Codon and mRNA sequence optimization of microdystrophin transgenes improves expression and physiological outcome in dystrophic mdx mice following AAV2/8 gene transfer

Duchenne muscular dystrophy is a fatal muscle-wasting disorder. Lack of dystrophin compromises the integrity of the sarcolemma and results in myofibers that are highly prone to contraction-induced injury. Recombinant adenoassociated virus (rAAV)-mediated dystrophin gene transfer strategies to muscle for the treatment of Duchenne muscular dystrophy (DMD) have been limited by the small cloning capacity of rAAV vectors and high titers necessary to achieve efficient systemic gene transfer. In this study, we assess the impact of codon optimization on microdystrophin (ΔAB/R3-R18/ΔCT) expression and function in the mdx mouse and compare the function of two different configurations of codon-optimized microdystrophin genes (ΔAB/R3-R18/ΔCT and ΔR4-R23/ΔCT) under the control of a muscle-restrictive promoter (Spc5-12). Codon optimization of microdystrophin significantly increases levels of microdystrophin mRNA and protein after intramuscular and systemic administration of plasmid DNA or rAAV2/8. Physiological assessment demonstrates that codon optimization of ΔAB/R3-R18/ΔCT results in significant improvement in specific force, but does not improve resistance to eccentric contractions compared with noncodon-optimized ΔAB/ R3-R18/ΔCT. However, codon-optimized microdystrophin ΔR4-R23/ΔCT completely restored specific force generation and provided substantial protection from contraction-induced injury. These results demonstrate that codon optimization of microdystrophin under the control of a muscle-specific promoter can significantly improve expression levels such that reduced titers of rAAV vectors will be required for efficient systemic administration.

Delivery of AAV2/9-microdystrophin genes incorporating helix 1 of the coiled-coil motif in the C-terminal domain of dystrophin improves muscle pathology and restores the level of α1-syntrophin and α-dystrobrevin in skeletal muscles of mdx mice. Level of α1-Syntrophin and α-Dystrobrevin in Skeletal Muscles of mdx Mice

Duchenne muscular dystrophy is a severe X-linked inherited muscle wasting disorder caused by mutations in the dystrophin gene. Adeno-associated virus (AAV) vectors have been extensively used to deliver genes efficiently for dystrophin expression in skeletal muscles. To overcome limited packaging capacity of AAV vectors (<5 kb), truncated recombinant microdystrophin genes with deletions of most of rod and carboxyl-terminal (CT) domains of dystrophin have been developed. We have previously shown the efficiency of mRNA sequence–optimized microdystrophin (ΔR4-23/ΔCT, called MD1) with deletion of spectrin-like repeat domain 4 to 23 and CT domain in ameliorating the pathology of dystrophic mdx mice. However, the CT domain of dystrophin is thought to recruit part of the dystrophin-associated protein complex, which acts as a mediator of signalling between extracellular matrix and cytoskeleton in muscle fibers. In this study, we extended the ΔR4-23/ΔCT microdystrophin by incorporating helix 1 of the coiled-coil motif in the CT domain of dystrophin (MD2), which contains the α1-syntrophin and α-dystrobrevin binding sites. Intramuscular injection of AAV2/9 expressing CT domain–extended microdystrophin showed efficient dystrophin expression in tibialis anterior muscles of mdx mice. The presence of the CT domain of dystrophin in MD2 increased the recruitment of α1-syntrophin and α-dystrobrevin at the sarcolemma and significantly improved the muscle resistance to lengthening contraction–induced muscle damage in the mdx mice compared with MD1. These results suggest that the incorporation of helix 1 of the coiled-coil motif in the CT domain of dystrophin to the microdystrophins will substantially improve their efficiency in restoring muscle function in patients with Duchenne muscular dystrophy.

Blockade of ActRIIB signaling triggers muscle fatigability and metabolic myopathy

Myostatin regulates skeletal muscle size via the activin receptor IIB (ActRIIB). However, its effect on muscle energy metabolism and energy dependent muscle function remains largely unexplored. This question needs to be solved urgently since various therapies for neuromuscular diseases based on blockade of ActRIIB signaling are being developed. Here we show in mice that four months of pharmacological abrogation of ActRIIB signaling by treatment with soluble ActRIIB-Fc triggers extreme muscle fatigability. This is associated with elevated serum lactate levels and a severe metabolic myopathy in the mdx mouse, an animal model of Duchenne muscular dystrophy. Blockade of ActRIIB signaling down-regulates Porin, a crucial ADP/ATP shuttle between cytosol and mitochondrial matrix leading to a consecutive deficiency of oxidative phosphorylation as measured by in vivo Phophorus Magnetic Resonance Spectroscopy (31P-MRS). Further, ActRIIB blockade reduces muscle capillarization, which further compounds the metabolic stress. We show that ActRIIB regulates key determinants of muscle metabolism, such as Pparβ, Pgc1α, and Pdk4 thereby optimizing different components of muscle energy metabolism. In conclusion, ActRIIB signaling endows skeletal muscle with high oxidative capacity and low fatigability. The severe metabolic side effects following ActRIIB blockade caution against deploying this strategy, at least in isolation, for treatment of neuromuscular disorders.