In this retrospective cohort study, we characterize the health profile of preterm males with Duchenne muscular dystrophy. Major clinical milestones (ambulation cessation, assisted ventilation use, and onset of left ventricular dysfunction) and corticosteroids use in males with Duchenne muscular dystrophy identified through a population-based surveillance system were analyzed using Kaplan-Meier survival curves and Cox proportional hazards modeling. The adjusted risk of receiving any respiratory intervention among preterm males with Duchenne muscular dystrophy was 87% higher than among the corresponding full-term males with Duchenne muscular dystrophy. The adjusted risks for ambulation cessation and left ventricular dysfunction were modestly elevated among preterm compared to full-term males, but the 95% confidence intervals contained the null. No difference in the start of corticosteroid use between preterm and full-term Duchenne muscular dystrophy males was observed. Overall, the disease course seems to be similar between preterm and full-term males with Duchenne muscular dystrophy; however, pulmonary function seems to be affected earlier among preterm males with Duchenne muscular dystrophy.

Introduction/Aims Duchenne and Becker muscular dystrophies (DBMD) are X-linked neuromuscular disorders characterized by progressive muscle weakness, leading to decreased mobility and multisystem complications. We estimate productivity costs attributable to time spent by a parent caring for a male child under the age of 18 y with DBMD, with particular focus on female caregivers of boys with Duchenne muscular dystrophy (DMD) who have already lost ambulation. Methods Primary caregivers of males with DBMD in the Muscular Dystrophy Surveillance and Research Tracking Network (MD STARnet) were surveyed during 2011–2012 on family quality of life measures, including labor market outcomes. Of 211 respondents, 96 female caregivers of boys with DBMD were matched on state, year of survey, respondent's age, child's age, and number of minor children with controls constructed from Current Population Survey extracts. Regression analysis was used to estimate labor market outcomes and productivity costs. Results Caregivers of boys with DBMD worked 296 h less per year on average than caregivers of unaffected children, translating to a $8816 earnings loss in 2020 U.S. dollars. Caregivers of boys with DMD with ≥4 y of ambulation loss had a predicted loss in annualized earnings of $23,995, whereas caregivers of boys with DBMD of the same ages who remained ambulatory had no loss of earnings. Discussion Female caregivers of non-ambulatory boys with DMD face additional household budget constraints through income loss. Failure to include informal care costs in economic studies could understate the societal cost-effectiveness of strategies for managing DMD that might prolong ambulation.

The objective of this study was to investigate whether males who were born preterm took longer to receive a Duchenne muscular dystrophy diagnosis than term males. Data for males with Duchenne muscular dystrophy identified through a population-based surveillance system were analyzed using a Kaplan-Meier estimator. The first signs and symptoms were noted at a median age of 2 years in both groups. Median age when first signs and symptoms prompted medical evaluation was 2.59 years among preterm and 4.01 years among term males. Median age at definitive diagnosis was 4.25 years and 4.92 years for preterm and term males, respectively. Neither difference was statistically significant. Preterm males tended to be seen for their initial medical evaluation earlier than term males, though they were not diagnosed significantly earlier. It may take clinicians longer after the initial evaluation of preterm males to arrive at a Duchenne muscular dystrophy diagnosis.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18870号 / 医博第3981号 / 新制||医||1008(附属図書館) / 31821 / 京都大学大学院医学研究科医学専攻 / (主査)教授 萩原 正敏, 教授 瀬原 淳子, 教授 中畑 龍俊 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Current study demonstrated the impact of heat therapy on skeletal muscle function in a model of Duchenne muscular dystrophy (DMD). The aim of this study was to: (1) examine the impact of treatment temperature on the skeletal muscle adaptation in DBA/2J mice; and (2) determine the impact of repeated HT for 3 consecutive weeks on body composition and skeletal muscle function in D2.mdx, a model of DMD. From study 1, we revealed that HT at 39℃ for 3 weeks significantly promoted relative muscle mass of both EDL and soleus muscle in DBA/2J mice. However, from study 2, HT at 39℃ for 3 weeks does not improve muscle function or increase muscle mass in a mouse model of DMD.

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La dystrophie musculaire de Duchenne est une maladie génétique qui résulte de diverses mutations dans le gène DMD, codant pour la protéine dystrophine. 70% des patients ont une délétion d'exons ou de parties d'exons provoquant un changement dans le cadre de lecture, résultant en l'apparition d'un codon stop et en l'absence de la protéine dystrophine. Plusieurs traitements potentiels ont été explorés dans les dernières années pour cette maladie, dont le système CRISPR-Cas9, un outil génétique permettant d'éliminer un segment d'ADN à l'aide de la protéine nucléase Cas9 et de deux guides d'ARN ciblant des séquences précises d'ADN. Le plus grand défi avec l'utilisation de cette technologie est sa livraison in vivo. Les vésicules extracellulaires sont des particules membranaires lipidiques qui jouent un rôle dans la communication intercellulaire et sont retrouvées dans tous les biofluides chez les mammifères. Elles pourraient donc être une alternative intéressante pour la livraison du système CRISPR-Cas9. J'ai participé à des travaux de purification de vésicules extracellulaires de sérum par chromatographie par exclusion de taille. Ces vésicules extracellulaires ont été chargées avec la protéine Cas9 et des guides ARN, puis, des injections intramusculaires ont été effectuées dans le Tibialis anterior de trois lignées de souris (Ai9, RAG-mdx et mdx/hDMD) pour établir l'efficacité du traitement. Les résultats ont montré que les vésicules extracellulaires chargées avec la Cas9 et des guides d'ARN provoquent une édition de l'ADN efficace dans le Tibialis anterior des trois lignées de souris utilisées et la restauration de l'expression de la protéine dystrophine dans les fibres musculaires du Tibialis anterior des souris RAG-mdx, modèle pour la dystrophie musculaire de Duchenne. Le traitement a ensuite été modifié pour permettre le ciblage des vésicules extracellulaires aux organes affectés par la dystrophie musculaire de Duchenne, soit le cœur et les muscles squelettiques. Des peptides de ciblage ont été sélectionnés dans la littérature et insérés dans la membrane des vésicules extracellulaires marquées de façon fluorescente à l'aide d'un segment lipidique stéaryl. Les résultats de l'expérience effectuée avec les vésicules extracellulaires ciblées n'ont pas été concluants en raison d'un marquage mal adapté des vésicules injectées, mais de futures expériences permettront d'élucider leur efficacité. L'ajustement du traitement pour permettre une injection systémique rejoignant le cœur et les muscles squelettiques est indispensable à l'application de celui-ci à la clinique. / Duchenne muscular dystrophy is a genetic disease that affects one in 3500 boys and results from mutations in the DMD gene, which codes for dystrophin protein. 70% of patients have an exon deletion, which results in a shift in the reading frame, the apparition of a stop codon, and the absence of the dystrophin protein. Many different potential treatments have been explored for Duchenne muscular dystrophy, including the CRISPRCas9 system. This technology allows for the modification of genomic DNA through a Cas9 nuclease and two guide RNAs designed to target a specific DNA sequence. The biggest challenge with using the CRISPR system is delivery. The classic vectors for CRISPR, such as AAV, can cause many adverse effects like immunological responses. Extracellular vesicles are membranous particles that play a role in intercellular communication and are found in all mammalian biofluids. They are thus an interesting alternative for the delivery of the Cas9 protein and its guide RNAs. I have participated in a research project aiming to purify serum extracellular vesicles by size-exclusion chromatography and to load them with Cas9 and two guide RNAs. These extracellular vesicles were then injected intramuscularly into the Tibialis anterior muscles of three mouse strains (Ai9, RAG-mdx and mdx/hDMD) to assess treatment efficiency. The injection of Cas9 and guide RNA-loaded extracellular vesicles produced efficient gene editing as well as dystrophin expression restauration. To modify the treatment for systemic injection, targeting peptides were added to EV membrane through a lipid stearyl segment. This was done to target the extracellular vesicles to Duchenne muscular dystrophy-affected organs: heart and skeletal muscles. Results of the targeted-extracellular vesicle experiment were inconclusive, however, with more experiments, the efficacy of the targeting peptides should be determinable. It is essential to adjust this treatment to allow for targeted systemic delivery for it to be applicable to the clinic.

Previous work from our laboratory in the mdx mouse model of Duchenne muscular dystrophy (DMD) demonstrated that a fraction of muscle stem cells (i.e., satellite cells) (MuSCs) progressively lose the expression of myogenic markers during the progression of the disease. In the process of characterizing this aberrant behaviour, we serendipitously discovered that MuSCs might be separated into two distinct subpopulations based on the expression of the GPI-anchored surface protein CD90. Crucially, this separation does not correlate with a divergence from the myogenic lineage; instead, it separates the pool of MuSCs into two subpopulations, both maintaining myogenic properties in healthy muscles. These two newly identified subpopulations do not overlap with any previously reported subpopulation and may be prospectively isolated; present a different response in terms of kinetics of activation and differentiation during the regenerative process induced by acute muscle damage; show a different propensity to enter in GAlert state upon distal injury; display dissimilar pAMPK activity and contain a different amount of mitochondria; are present in different proportions in distinct muscle groups; differentially express ECM encoding genes during quiescence. Moreover, one of the two subpopulations can give rise to the other and therefore appears to be upstream in the lineage hierarchy. Notably, loss of function experiments, in which CD90 was downregulated in MuSCs, diminish the difference in activation displayed by the two subpopulations. This demonstrates that CD90 is a molecular determinant of MuSCs functional diversification. Importantly, although the two subpopulations of MuSCs are numerically similar in healthy limb muscles, one of the two subpopulations is lost with time in dystrophic mdx mice. Based on these data, we are hypothesizing that an imbalance between the two newly identified subpopulations may impair regeneration in the dystrophic muscles. These observations not only increase our knowledge of the molecular and cellular dynamics that are controlling normal and pathological muscle homeostasis but also open the possibility that restoring the proper functional equilibrium between subpopulations of MuSCs may counteract the progression of the dystrophic disease.