Introdução: Distrofia muscular progressiva nas formas de Duchenne (DMD) e Becker (DMB) são doenças caracterizadas por progressiva degeneração musculoesquelética e substituição por tecido fibrogorduroso. O envolvimento cardíaco está presente em 80% dos pacientes, apresenta curso clínico silencioso e é diagnosticado tardiamente pelos métodos tradicionais. Objetivos: 1. Investigar a progressão da fibrose miocárdica pela ressonância magnética cardíaca (RMC), em ensaio clínico randomizado para tratamento ou não com IECA, de pacientes com DMD e DMB e fração de ejeção ventricular esquerda (FEVE) preservada, por um período de 02 anos. 2. Investigar se há mutações genéticas específicas que sejam preditoras do acometimento miocárdico diagnosticado pela RMC. 3. Comparar os achados do ECG, radiografia de tórax e ecocardiograma com os da RMC. Métodos: Entre 1/6/2009 e 1/6/2012 foram incluídos 76 pacientes com diagnóstico de DMD e DMB. Todos os pacientes realizaram duas RMCs com intervalo médio de 2,05±0,11 anos, com técnicas de cine ressonância para avaliação da função ventricular e realce tardio miocárdico para avaliação da fibrose miocárdica. A fibrose miocárdica foi quantificada por software específico para obtenção do percentual da massa de fibrose do VE com análise semi automática, utilizando os desvios padrões da média dos valores de intensidade do sinal do miocárdio normal. Os valores acima de 5 desvios padrões da média do miocárdio normal foram considerados como fibrose miocárdica. Os 42 pacientes com fibrose miocárdica e FEVE normal foram randomizado em 2 grupos, com 21 deles recebendo tratamento com IECA e 21 sem qualquer tratamento para cardiomiopatia. Após 2 anos, novas RMCs foram realizadas para avaliar a evolução da fibrose e a FEVE. Resultados: Notou-se fibrose miocárdica em 72,3% dos pacientes, sendo que 55,6 % não apresentavam disfunção sistólica. Verificou-se uma correlação positiva significativa entre idade e percentual de fibrose na RMC basal (r=0,338, p=0,014) e seguimento (r=0,315, p=0,006). Os pacientes randomizados e tratados com IECA apresentaram menor evolução do percentual de fibrose do que os randomizados não tratados (3,1±7,4% versus 10,0±6,2% respectivamente, p=0,001). Na análise linear multivariada, verificamos que pertencer ao grupo tratado diminui a progressão do percentual de fibrose (y=-4,51x+29,63 ajustado por idade, CK e percentual de fibrose basal, p=0,039) e indica uma tendência de menor probabilidade de apresentar fração de ejeção do VE < 50% na RMC seguimento (OR= 3,18, p= 0,102, por regressão logística). Os pacientes com mutação nos exons menores que 45 do gene da distrofina apresentaram maior percentual de fibrose que os com mutação dos exons maiores ou iguais ao 45 na RMC basal (27,9±18,4% versus 12,1±13,4%, respectivamente, p=0,006) e seguimento (33,1±21,1% versus 18,8±16,9%, respectivamente, p=0,024). A avaliação conjunta por métodos tradicionais (radiografia de tórax, ECG e ecocardiografia) apresentou baixa sensibilidade de 47,3% e valor preditivo negativo de 34,1% para o diagnóstico do envolvimento cardíaco na DMD e DMB, em pacientes com FEVE normal e fibrose miocárdica na RMC. Conclusões: O ensaio clínico randomizado, por um período de 2 anos, em pacientes com DMD e DMB, com fibrose miocárdica diagnosticada pela RMC e FEVE preservada, demonstrou significativa maior progressão da fibrose miocárdica nos pacientes que não fizerem uso de IECA. Existe uma correlação significativa entre o local de mutação no gene da distrofina e o acometimento cardíaco. O ECG, o eco e radiografia de tórax apresentaram baixa sensibilidade e baixo valor preditivo negativo para detecção do envolvimento cardíaco precoce nos pacientes com DMD e DMB / Introduction: Duchenne and Becker muscular dystrophies (DMD and BMD) are diseases characterized by progressive skeletal muscle degeneration and replacement by fibro fatty tissue. Cardiac involvement is frequent, as high as 70 - 80% of patients, and often develops clinically silent, without any evident early clinical signs. Traditional diagnostic methods (ECG, chest x-ray and echocardiography) are only able to diagnose cardiac involvement at a later stage. Objectives: 1. To investigate the progression of myocardial fibrosis by cardiac magnetic resonance (CMR), in a randomized clinical trial for treatment with ACE inhibitors, in patients with DMD or BMD and preserved left ventricular ejection fraction (LVEF), for a period of 02 years. 2. To investigate whether there are specific genetic mutations that are predictive of myocardial involvement detected by CMR. 3. To compare the findings of ECG, chest radiography and echocardiography with those found by CMR. Methods: Between 01/06/2009 and 01/06/2012 76 patients with DMD and BMD were included. All patients underwent two CMRs with a mean interval of 2.05±0.11 years, using cine resonance for function evaluation and myocardial delayed enhancement technique for myocardial fibrosis detection. Myocardial fibrosis was quantified by specific software for obtaining fibrosis mass, as percentage of LV mass, using semi-automatic fibrosis analysis and standard deviations of the mean values of signal intensity of the normal myocardium. A value of five standard deviations above the mean of a normal myocardium were considered myocardial fibrosis. The 42 patients with myocardial fibrosis and normal LVEF were randomized into 2 groups, with 21 of them receiving ACE inhibitor treatment and 21 no treatment for cardiomyopathy. After 2 years, new CMRs were performed to evaluate fibrosis extent and LVEF. Results: Myocardial fibrosis was noted in 72.3% of the patients, 55.6% showed no systolic dysfunction. There was a significant positive correlation between age and myocardial fibrosis at the CMR baseline (r=0.338, p=0.014) and follow-up (r=0.315, p=0.006). Patients randomized and treated with ACE inhibitors had lower evolution of myocardial fibrosis than those who were randomized and untreated (3.1±7.4% vs.10.0±6.2%, respectively, p=0.001). Using multivariate regression analysis, we found that belonging to the treated group decreases the progression of myocardial fibrosis (y=-4.51x+29.63 adjusted for age, CK and baseline myocardial fibrosis, p=0.039) and indicated a trend for lower probability of presenting LVEF<50% at follow-up CMR (OR= 3.18, p= 0.102, by logistic regression). Patients with mutations in exons less than 45 had greater extent of myocardial fibrosis than patients with mutations in exons greater than or equal to 45 in CMR at baseline (27.9±18.4% vs. 12.1±13.4%, respectively, p=0.006) and at follow-up (33.1±21.1% vs. 18.8±16.9%, respectively, p=0.024). Conclusions: In this 2-year follow-up randomized clinical trial in patients with DMD and BMD with preserved LVEF, myocardial fibrosis diagnosed by CMR, showed significantly greater progression in patients not receiving ACE inhibitors therapy. There was a significant correlation between the site of mutation in the dystrophin gene and cardiac involvement. ECG, echocardiography and chest radiography showed low sensitivity and low negative predictive value for early detection of cardiac involvement (myocardial fibrosis by CMR) in patients with DMD and BMD

Orientador: Humberto Santo Neto / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-04T04:11:41Z (GMT). No. of bitstreams: 1 Luz_MarcusAlexandreMendes_D.pdf: 10697442 bytes, checksum: 222db13a72b848e524a1daccb1c17b92 (MD5) Previous issue date: 2005 / Resumo: A distrofia muscular de Duchenne (DMD) é uma miopatia ligada ao cromossomo X, provocada pela ausência de distrofina, uma proteína da membrana da fibra muscular esquelética, cuja função está relacionada à manutenção da estab11idade do sarcolema. A ausência de distrofina, abera a integridade estrutural do sarcolema fazendo com que a fibra muscular sofra necrose e posterior regeneração. Com o surgimento de uma linhagem de camundongos mutantes (mdx) cujas fibras musculares à semelhança dos pacientes humanos são deficientes em distrofina, diversos trabalhos vêm sendo desenvolvidos com estes animais. Até o início da senilidade, os camundongos não apresentam fraqueza muscular e não vão a óbito. Outra diferença fenotipica fundamenta} entre a DMD humana e a dos camundongos é o fato de que, nestes últimos, as fibras musculares mantém a capacidade de regeneração. É certo que a ausência de distrofina seja a responsável direta pela necrose das fibras musculares, entretanto, é possível que a perda da capacidade regenerativa esteja relacionada a outros fatores. Um desses fatores, fundamental no presente trabalho, refere-se às células satélites das fibras musculares precursoras dos mioMastos e que originam novas fibras musculares. Estudos in vitro com células satélites de pacientes com DMD, demonstram que elas perdem, com o avançar da idade, a capacidade de se dividir. Dessa forma o presente traba1ho procura demonstrar experimenta1mente a capacidade regenerativa das fibras do músculo tibial anterior através de uma série de injeções de doridrato de lidocaína 2%. Os animaís de ambos os grupos (Grupo A - mdx; Grupo B -Black 10) foram submetidos a 20 e 55 aplicações de cloridrato de lidocaína, induzindo-se ciclos de degeneração e regeneração das fibras musculares. Os músculos coletados foram incluídos em historresina e corados pelos métodos da Hematoxilina-Eosina e Picrosirius-hematoxilina (para análise de tecido conjuntivo). Após a quantificação das populações das fibras musculares, os resu1tados mostraram que ao final 55 aplicações, a população de fibras regeneradas nos animais mdx sofreu uma redução de 48% em relação ao grupo controle, sendo que, ao final de 20 aplicações a redução da população de fibras foi de 0.2%. Não foi constatado o desenvolvimento de fibrose, o que exclui a tese sustentada por a1guns pesquisadores, de que este fator 100... seria o responsáve{ pe{a redução da capacidade regenerativa das fibras. De acordo com nossos resultados, podemos concluir que a redução da capacidade regenerativa das fibras está diretamente ligada a exaustão da capacidade miogênica das células satélites, não se encontrando qualquer evidência de que a redução desta atividade esteja associada ao aparecimento de fibrose intersticial / Abstract: The Duchenne (Dl / Doutorado / Histologia / Doutor em Biologia Celular e Estrutural

Adult skeletal muscles have remarkable regenerative capacity. Muscle regeneration occurs when muscle tissue experiences injury, causing a population of normally quiescent muscle-resident stem cells, called satellite cells, to become activated. The CCAAT/enhancer binding proteins known as C/EBPs are transcription factors belonging to the bZIP family. Previous work from our lab has identified C/EBPβ as an important negative regulator of myogenesis. C/EBPβ expression is localized to muscle satellite cells and is downregulated upon induction to differentiate, mirroring the loss of Pax7 expression in early myogenesis. C/EBPβ expression also negatively regulates MyoD protein expression. Leaky ribosomal scanning of the Cebpb mRNA produces three C/EBPβ isoforms: LAP*, LAP and LIP, though the individual role of each of these isoforms has not been investigated in myoblasts. This thesis focuses on determining the role of each of the C/EBPβ isoforms during skeletal muscle differentiation. Forced expression of the C/EBPβ-LIP isoform in myoblasts led to a decrease in Myf5, MyoD, and myogenin expression under differentiation conditions when compared to empty vector controls. Further, the fusion of cells was greatly reduced following differentiation. C/EBPβ-LIP expressing cells also demonstrated a growth defect, with pronounced G1 arrest and features of senescence. In contrast, myoblasts expressing the C/EBPβ-LAP isoform has impaired differentiation, though this was not as pronounced as in C/EBPβ-LIP expressing cells and proliferated normally. While LIP is not normally expressed in primary myoblasts from healthy muscle, the ratio of LIP:LAP was increased in primary myoblasts isolated from mdx mice, an animal model for Duchenne muscular dystrophy. These findings suggest that the regulation of C/EBPβ isoform expression could regulate stem cell stamina and may contribute to defects in muscle regeneration in disease.

La myostatine, un facteur de croissance de la famille des TGF-β dont la voie de signalisation agit via l'Activine récepteur de type IIB (ActRIIB), a été identifié comme un régulateur négatif important de la croissance du muscle squelettique. Toutefois, son effet sur le métabolisme énergétique musculaire et sur la fonction du muscle reste largement inexploré. Dans mes travaux de thèse, j'ai étudié la conséquence de l'inhibition de la voie de signalisation ActRIIB sur le métabolisme musculaire, et ceci dans deux modèles expérimentaux, i) les souris constitutives knock-out myostatine et ii) après l'administration pharmacologique de l'ActRIIB soluble chez les souris adultes. Nos résultats démontrent que les souris knock-out myostatine développent une forte fatigabilité, une diminution de la respiration mitochondriale et une signature moléculaire qui tend vers un métabolisme glycolytique. Comme ces résultats peuvent s'expliquer par une conversion congénitale vers des fibres musculaires glycolytiques rapides chez ces souris, j'ai étudié l'effet de l'inhibition de la voie de signalisation ActRIIB chez la souris adulte. J'ai fourni des preuves, notamment pour la souris mdx, modèle animal de la myopathie de Duchenne, que l'inhibition de l'ActRIIB, malgré une distribution de typage de fibres qui reste normale, conduit à une intolérance extrême à l'exercice. Cela a été associé à une augmentation pathologique des taux de lactate sérique ainsi que des caractéristiques prononcées de la myopathie. Plus en détail, l'analyse biochimique et moléculaire montre que l'inhibition de la voie de signalisation ActRIIB diminue l'expression de la protéine porine, réduit la capillarisation musculaire et provoque une déficience de la phosphorylation oxydative. Je montre aussi que l’ActRIIB régule les composants clés du métabolisme musculaire, comme PPARß, Pgc1α, et PDK4, optimisant ainsi les différentes composantes du métabolisme énergétique musculaire. En somme, mes résultats démontrent que l’inhibition de l’ActRIIB provoque une myopathie métabolique, en particulier dans le contexte d’un muscle dystrophique, chez lequel un stress métabolique sous-jacent existe déjà. En conclusion, je ne peux pas recommander l'utilisation de l’inhibition de la voie de signalisation de l’ActRIIB comme stratégie thérapeutique pour les maladies musculaires. / Myostatin, a growth factor of the TGF-β family that signals through the activin receptor-IIB (ActRIIB), has been identified as an important negative regulator of skeletal muscle growth. However, its effect on muscle energy metabolism and energy dependent muscle function remains largely unexplored. I here investigated the consequence of impaired ActRIIB signaling for muscle metabolism in two experimental models, i) the constitutive myostatin knockout mice and ii) following pharmacological administration of soluble ActRIIB in adult mice. Our results demonstrate that myostatin knockout mice develop a strong fatigability, a decrease in mitochondrial respiration and a molecular signature towards a glycolytic metabolism. As these findings may be explained by the congenital shift towards fast glycolytic muscle fibers in these mice, I investigated the effect of inhibition of ActRIIB signaling in adult mice. I provide evidence, notably for the mdx mouse, model for Duchenne muscular dystrophy, that ActRIIB blockade, despite an unchanged fiber type distribution, leads to extreme exercise intolerance. This was associated with pathologically increased serum lactate levels and myopathic features. In-depth biochemical and molecular analysis demonstrates that blockade of ActRIIB signaling down-regulates the ATP channel porin, reduces muscle capillarization and leads to a consecutive deficiency in oxidative phosphorylation. I also show that ActRIIB regulates key determinants of muscle metabolism, such as Pparβ, Pgc1α, and Pdk4, thereby optimizing different components of muscle energy metabolism. Taken together, my results demonstrate that ActRIIB blockade provokes a metabolic myopathy, especially in the context of dystrophic muscle, in which an underlying metabolic stress already exists. In conclusion, I cannot recommend the use of ActRIIB signaling blockade as a therapeutic strategy for muscle diseases.

Orientador: Marcos Nogueira Eberlin / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Química / Made available in DSpace on 2018-08-27T06:43:33Z (GMT). No. of bitstreams: 1 MartinsJunior_HelioAlves_D.pdf: 12398214 bytes, checksum: f76ac9572671aeed993f82ac2167745d (MD5) Previous issue date: 2014 / Resumo: A Espectrometria de Massas (MS) é uma das técnicas mais empregadas em aplicações bioanalíticas para detecção e quantificação inequívoca de compostos de interesse biológico, provendo informações de extrema relevância para o entendimento dos sistemas biológicos em geral. Neste trabalho, foram realizados estudos de quantificação de hormônios esteroidais por espectrometria de massas no campo da produção animal, por se tratar de uma técnica pouco difundida atualmente na área veterinária. A primeira parte do trabalho consistiu no estudo quantitativo do perfil de quatro hormônios esteroidais em soro de cães da raça Golden Retriever, portadores do gene da distrofia muscular de Duchenne (GRMD). Os animais foram acompanhados durante todas as fases do ciclo estral e os hormônios foram dosados para o entendimento da dinâmica destes compostos ao longo do ciclo. Os resultados comparativos dos níveis hormonais entre os grupos de estudo e o grupo controle apresentaram, pela primeira vez analisados por espectrometria de massas, informações relevantes sobre os níveis destes hormônios. Nossas observações impulsionaram uma importante discussão sobre a correlação das concentrações dos hormônios analisados frente aos sinais clínicos e desenvolvimento da patologia destes animais. A segunda parte deste trabalho consistiu no emprego da espectrometria de massas de alta resolução e exatidão para quantificação de dez hormônios esteroidais em plasma bovino. A metodologia desenvolvida foi aplicada ao estudo dos níveis plasmáticos dos hormônios em vacas clonadas por transferência nuclear de células somáticas (TNCS). Realizou-se um estudos comparativo da cinética dos níveis em plasma dos hormônios no ultimo mês de gestação dos animais clonados, em relação a animais inseminados por fertilização in vitro (FIV) e ao grupo controle, composto por animais de gestação natural. Os resultados mostraram haver alterações na esteroidogênese das vacas portadoras de embriões derivados de técnicas artificiais de gestação e biotecnologia. Foram observadas alterações significativas das rotas de biosíntese e concentrações de hormônios sexuais e corticóides no ultimo mês de gestação dos animais. Estas diferenças e desregulação do processo de biosíntese dos hormônios analisados, promovem alterações das concentrações de hormônios associados ao processo de sinalização de parto, ineficiente em animais clonados por TNCS / Abstract: Mass spectrometry (MS) is one of the most used techniques in bioanalytical applications for detection and unambiguous quantitation of biological compounds, providing information of greatest relevance for the understanding of biological systems. In this thesis, the tandem mass spectrometry has been applied for quantitation of steroid hormones in the field of animal production, as this technique still remains unusual in the veterinary science. The first part of this work consisted in the quantitative profiling study of four steroids in serum of X-linked Golden Retriever Muscular Dystrophy (GRMD) dogs. The animals were followed during all estrous cycle phases and the hormones were measured to understand the dynamics of these compounds over the estrous cycle. The results comparison among the studied carrier and affected groups versus the control group presented, for the first time by mass spectrometry, relevant information about the levels of these hormones. Our findings stimulated an important discussion about the correlation of the hormones concentrations against clinical signs and development of the pathology of these animals. In the second part of this thesis, the high resolution mass spectrometry was applied for quantification of ten steroid hormones in bovine plasma. The methodology was applied to investigate the steroid plasma levels in cloned-derived catlle by nuclear transfer of somatic cells (SCNT). A comparative study of the plasma steroid dynamics of naturally and artificially conceived bovine pregnancies approaching parturition was carried out. The results revealed changes in the steroidogenesis of recipient cows carrying artificially-derived (ART) conceptuses from biotechnology techniques. Significant changes in the steroids pathway as well as in the concentrations of corticosteroids and sex steroids over the last month of gestation were observed. The steroids pathway dysregulation considerably altered the steroids plasma steroid concentrations in the prior month of parturition contributing to the lack of partutition signaling observed in SCNT-derived pregnant cattle / Doutorado / Quimica Inorganica / Doutor em Ciências

The CRISPR-Cas9 gene editing system gives researchers the ability to manipulate and edit DNA with unprecedented ease and precision. It was discovered in bacteria as part of their adaptive immune system, but has been reengineered to target any double stranded DNA. This burgeoning molecular tool has created great excitement as scientists are rapidly adopting it to study fields including human gene therapy, disease modeling, agriculture, gene drive in mosquitos, and many others. This paper will explore the potential impact of CRISPR-Cas9 in human therapeutics. Specifically, the potential of CRISPR-Cas9 to treat Duchenne Muscular Dystrophy will be examined. In several ways, this debilitating degenerative disease is an ideal candidate for gene-editing with CRISPR-Cas9. Recent progress in the lab has demonstrated the gene editing system’s ability to rescue dystrophin protein levels in vivo. Although CRISPR-Cas9 holds great promise for previously incurable diseases, there are still many limitations that must be overcome before the gene editing system can be used in patients. This paper will discuss these barriers as well as recent advancements to overcome them.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13354号 / 論医博第2200号 / 新制||医||1044(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 木村 剛, 教授 羽賀 博典 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

In the heart, sodium (Na+) influx via NaV1.5 channels initiates the action potential, and calcium (Ca2+) influx via CaV1.2 channels has a key role in excitation-contraction coupling and determining the plateau phase of the action potential. Mutations in the genes that encode these ion channels or in proteins that modulate them are linked to arrhythmias and cardiomyopathy, underscoring the need for characterizing mechanisms of regulation. The work presented in this thesis is subdivided into three different chapters, each with a distinct focus on ion channel modulation. The first chapter details our investigation of the functional PKA phosphorylation target for β-adrenergic regulation of CaV1.2. Physiologic β-adrenergic activation of PKA during the sympathetic “fight or flight” response increases Ca2+ influx through CaV1.2 in cardiomyocytes, leading to increased cardiac contractility. The molecular mechanisms of β-adrenergic regulation of CaV1.2 in cardiomyocytes are incompletely known, but activation of PKA is required for this process. Recent data suggest that β-adrenergic regulation of CaV1.2 does not require any combination of PKA phosphorylation sites conserved in human, guinea pig, rabbit, rat, and mouse α1C subunits. To test if any non-conserved sites are required for regulation, we generated mice with inducible cardiac-specific expression of α1C with mutations at both conserved and non- conserved predicted PKA phosphorylation sites (35-mutant α1C). Additionally, we createdanother mouse with inducible cardiac-specific expression of β2 with mutations at predicted PKA phosphorylation sites (28-mutant β2B). In each of these mice, β-adrenergic stimulation of Ca²⁺ current was unperturbed. Finally, to test the hypothesis that redundant functional PKA phosphorylation sites exist on the α1C subunit and β2 subunit or that several sites confer incremental regulation, we crossed the 35-mutant α1C mice with the 28-mutant β2B mice to generate offspring expressing both mutant subunits. In these offspring, intact regulation was observed. These results provide the definitive answer that phosphorylation of the α1C subunit or β2 subunit is not required for β-adrenergic regulation of CaV1.2 in the heart. In the second chapter, we study the influence of calmodulin and fibroblast growth homologous factor (FHF) FGF13 on late Na+ current. Studies in heterologous expression systems show that the Ca²⁺-binding protein calmodulin plays a key role in decreasing late Na⁺ current. The effect of loss of calmodulin binding to NaV1.5 on late Na+ current has yet to be resolved in native cardiomyocytes. We created transgenic mice with cardiac-specific expression of human NaV1.5 channels with alanine substitutions for the IQ motif (IQ/AA), disrupting calmodulin binding to the C-terminus. Surprisingly, we found that the IQ/AA mutation did not cause an increase late Na⁺ current in cardiomyocytes. These findings suggest the existence of endogenous protective mechanisms that counteract the increase in late Na+ current that occurs with loss of calmodulin binding. We reasoned that FGF13, a known modulator of late Na+ current that is endogenously expressed in cardiomyocytes but not HEK cells, might play a protective role in limiting late Na+ current. Finally, we coexpressed the IQ/AA mutant NaV1.5 channel in HEK293 cells with FGF13 and found that FGF13 diminished the late Na⁺ currentcompared to cells without FGF13, suggesting that endogenous FHFs may serve to prevent late Na⁺ current in mouse cardiomyocytes. The third chapter of this thesis focuses on the use of proximity labeling and multiplexed quantitative proteomics to define changes in the NaV1.5 macromolecular complex in Duchenne muscular dystrophy (DMD), in which the absence of dystrophin predisposes affected individuals to arrhythmias and cardiac dysfunction.. Standard methods to characterize macromolecular complexes have relied on candidate immunoprecipitation or immunocytochemistry techniques that fall short of providing a comprehensive view of the numbers and types of interactors, as well as the potential dynamic nature of the interactions that may be perturbed by disease states. To provide an inclusive understanding of NaV1.5 macromolecular complexes, we utilize live-cell APEX2 proximity labeling in cardiomyocytes. We identify several proximal changes that align with the electrophysiological NaV1.5 phenotype of young dystrophin-deficient mice, including a decrease in Ptpn3 and Gdp1l and an increase in proteasomal machinery. Whole-cell protein expression fold-change results were used to reveal the altered global expression profile and to place context behind NaV1.5-proximal changes. Finally, we leveraged the neighborhood- specificity of proteins at the lateral membrane, intercalated disc, and transverse tubules of cardiomyocytes to demonstrate that NaV1.5 channels can traffic to all three membrane compartments even in the absence of dystrophin. Thus, the approach of proximity labeling in cardiomyocytes from an animal model of human disease offers new insights into molecular mechanisms of NaV1.5 dysfunction in DMD and provides a template for similar investigations in other cardiac diseases.

Sammanfattning  Bakgrund: Duchennes muskeldystrofi (DMD) är en ovanlig genetisk muskelsjukdom som beräknas drabba cirka tio pojkar i Sverige per år. Sjukdomen påverkas av en brist på proteinet dystrofin, vilket leder till en progressiv nedbrytning av skelett- och respiratoriska muskler samt myocardium. Detta leder till en successiv försämring av muskelstyrka samt ledrörlighet. Fysioterapeutiska åtgärder vid arbete med patientgruppen är framförallt inriktade mot att fördröja försämringen av sjukdomsförloppet. Syfte: Syftet med denna studie var att ge ökad förståelse för hur den fysioterapeutiska behandlingen ser ut för patienter med DMD, samt hur fysioterapeuter upplever arbetet med patientgruppen.  Metod: Fyra semistrukturerade intervjuer genomfördes med fysioterapeuter som hade erfarenhet av arbete med patientgruppen. Materialet från intervjuerna analyserades därefter med kvalitativ innehållsanalys enligt Graneheim och Lundman. Resultat: Analysen resulterade i tre huvudkategorier: “Mångfacetterad fysioterapeutisk behandling”, “Samarbete för att bidra till ett normalt liv” och “Komplex diagnos påverkar fysioterapeutens upplevelser”. Slutsats: Fysioterapeuterna uttryckte att huvudmålet för den fysioterapeutiska behandlingen var att ligga steget före med insatser samt att fördröja försämring. Att stötta patienten till ett delaktigt och självständigt liv ansågs som en nyckelkomponent i behandlingen. Arbetet med patientgruppen kunde stundom upplevas som svårt och sorgsamt, men också fridsamt och positivt. Fysioterapeuters upplevelser kan ge en inblick i vårdprocessen och därav bidra till utveckling av en bättre vård.

The extracellular matrix (ECM) of the skeletal muscle provides the framework for the muscle structure and plays a key role in the repair and maintenance of myofibers through the resident fibroblasts and muscle satellite cells. However, excessive production of ECM components, notably collagen, leads to fibrosis which impedes muscle function, impairs the natural repair process, and leads to muscle weakness. Fibrosis is a hallmark of muscular dystrophies, including Duchenne muscular dystrophy (DMD). Duchenne muscular dystrophy is a terminal, x-linked disorder characterized by progressive muscle wasting as muscle fibers are replaced by fibrosis and fat. There are approximately 300,000 DMD patients worldwide, and the few disease modifying treatments are genotype specific, only helping a small percentage of the patient population. Myostatin is a member of the transforming growth factor beta (TGF-β) family of ligands, is a negative regulator of muscle mass, and may also contribute to the fibrotic environment in dystrophic muscle through myofibroblast proliferation and survival. Therefore, myostatin blockade could potentially ameliorate muscle weakness in DMD patients by increasing skeletal mass and function while also reducing the accumulation of fibrosis. A murine anti-myostatin antibody, mRK35, and its humanized analogue, domagrozumab, are specific and potent inhibitors of myostatin. mRK35 was tested in multiple mouse models, from healthy C57Bl/6 and C57Bl/10, mildly dystrophic C57Bl/10.mdx, and severely dystrophic D2.mdx mice, for changes in muscle mass, muscle function, and fibrotic content. Additionally, inflammatory, fibrotic, and myogenic gene expression changes were analyzed in the severely dystrophic animals treated with mRK35. Domagrozumab was tested in non-human primates (NHPs) for changes in skeletal muscle mass. Myostatin blockade with mRK35 resulted in muscle anabolic and functional improvements in healthy murine models and NHPs treated with domagrozumab demonstrated a dose-dependent increase in lean mass and muscle volume. However, as mice age or as the dystrophic severity of the model increases, the anabolic effect of myostatin inhibition is diminished. The extensor digitorum longus (EDL) muscle escapes this trend and is the most responsive to myostatin inhibition across all mouse strains and disease severities. However, analysis of the fibrotic content in the triceps and diaphragms of D2.mdx mice treated with mRK35 for 8 weeks does not reveal any change in fibrotic content. Gene expression changes in the muscles within these mice appear to be tightly tied to their healthy or dystrophic state and myostatin inhibition has minimal effect. In sum, while specific myostatin inhibition with mRK35 increases muscle weight and function in mice, there is no conclusive evidence of reduced muscle fibrosis. / 2023-06-22T00:00:00Z