Duchenne muscular dystrophy is a progressive muscle disease that is still incurable. The disease affects all systems in the body and is therefore a need for a comprehensive approach. It manifests itself in childhood muscle weakness. Over time, there is a postural and respiratory changes affecting posture and the respiratory system. Depending on the changes of these functions leads to certain complications. Among these complications rank poorly stereotype walk, spinal deformities such as scoliosis, bad stereotype affect breathing, leading to vital lung function and many more. These complications are present in a particular time sequence and can be assigned to a specific patient age. This thesis is focused on the monitoring of postural and respiratory function in these patients. The work is the evaluation of these changes when they occur and in which the patient's age. Patients are rehabilitated life and physiotherapy is an integral part of treatment. It focuses possibilities of surgical treatment of scoliosis. The work also includes a questionnaire aimed at rehabilitation and physical therapy patients. Powered by TCPDF (www.tcpdf.org)

A distrofina é uma das proteínas que formam o complexo glicoproteico necessário para a integridade da fibra muscular e sua disfunção causa uma doença genética letal para os seres humanos, a distrofia muscular de Duchenne (DMD). Além do papel fundamental no tecido muscular, a distrofina é necessária para a fisiologia da retina e, portanto, para o processamento da informação visual. Estudos anteriores mostraram prejuízo assimétrico no eletrorretinograma (ERG), maior para aumento da luminância (via ON) que para diminuição (via OFF). Além disso, prejuízos na visão de cores e contrastes eram mais frequentes e severos em pacientes com alterações genéticas que comprometem a expressão da isoforma Dp260. O objetivo do presente estudo foi verificar através de protocolos eletrofisiológicos e psicofísicos se existiam diferenças nas respostas mediadas pelas vias visuais ON e OFF em jovens com DMD e como estas se relacionavam com o genótipo. Foram avaliados 19 jovens com DMD (idade média = 15,2 ± 3,4 anos) cujos resultados foram comparados com os de sujeitos controles pareados por idade. Os métodos utilizados foram o ERG de campo total e medidas psicofísicas de sensibilidade ao contraste (SC) espacial e temporal de luminância. Protocolos tradicionalmente empregados foram associados a protocolos cujos estímulos visuais ativam, preferencialmente, a via ON ou a via OFF. Para o ERG de campo total foram utilizados seis protocolos: 1. ERG escotópico, 2. ERG fotópico, 3 e 4. ERG mesópico ON e OFF, 5 e 6. ERG fotópico ON e OFF. Para os quatro últimos foram utilizados estímulos intermitentes com modulação da luminância em dente de serra, com aumento rápido de luminância e diminuição gradual (ON) e o contrário (OFF). Para a avaliação psicofísica foi determinada: 1. SC para grades senoidais e SC temporal, e 2. SC a estímulos de tabuleiro de xadrez com aumento (ON) ou diminuição (OFF) da luminância média relativa ao fundo, apresentados com duração curta (sistema magnocelular) ou longa (sistema parvocelular). Os resultados mostraram redução da amplitude da onda-b dos ERGs escotópico e fotópico e prejuízos na SC espacial e temporal de luminância, concordando com a literatura. A contribuição inédita do presente estudo foi mostrar alteração nos ERGs ON e OFF para atividade dos bastonetes e no ERG ON para atividade exclusiva dos cones. Na avaliação psicofísica, houve redução da SC para os protocolos ON sem diferença entre magnocelular e parvocelular. Em conclusão, as alterações encontradas estão principalmente relacionadas com a atividade ON da retina. A alteração psicofísica da SC espacial de luminância de jovens com DMD deve estar relacionada, ao menos em parte, com prejuízos retinianos devidos à ausência da Dp260 ou da própria distrofina total (Dp427). Estudos futuros devem aprofundar a investigação utilizando protocolos do ERG que estimulam, preferencialmente, as vias magnocelular e parvocelular, e ampliar o número de pacientes avaliados para se obter as correlações entre as alterações genéticas e os prejuízos visuais / The dystrophin is one of the proteins that form the glycoprotein complex necessary for the integrity of the muscular fibers. Its dysfunction causes a genetic disease called the Duchenne Muscular Dystrophy (DMD) which is lethal for humans. Besides its fundamental role in the muscle tissues the dystrophin is also necessary in the physiology of the retina, in the processing of visual information. Previous studies have demonstrated asymmetric deviations in the electroretinogram (ERG) of DMDs with bigger changes to stimuli with increasing (ON pathway) than to decreasing (OFF pathway) luminance. Moreover deficiencies in color vision and contrast sensitivity have been more frequent and severe in patients having genetic alterations related to the expression of the Dp260 isoform. The aim of the present study was to apply electrophysiological and psychophysical protocols to verify the suspected alterations in DMD patients regarding the ON and OFF visual pathways and relate the results to their genotypes. 19 DMD patients (mean age = 15.2 ± 3.4 years) were tested and their results were compared to that of an age-matched control group. Fullfield ERG and spatial and temporal luminance contrast sensitivity tests were used during the examinations. Classical protocols were applied together with the ones preferentially stimulating the ON and the OFF visual pathways. The full-field ERG test consisted of six protocols: 1. Scotopic ERG, 2. Photopic ERG, 3. and 4. Mesopic ON and OFF ERG, 5. and 6. Photopic ON and OFF ERG. For the latter four protocols flicker stimuli were used with sawtooth modulation of rapid increase and slower decrease in luminance (ON) and rapid decrease and slower increase in luminance (OFF). The psychophysical evaluation comprised 1. Spatial contrast sensitivity test with sinusoidal gratings and temporal contrast sensitivity test, and 2. Contrast sensitivity tests with checkerboard stimuli with increasing (ON) and decreasing (OFF) luminance relative to the background. These latter were presented for both short (magnocellular system) and long (parvocellular system) durations. In agreement with the literature the results show reduced amplitudes in the ERGs scotopic and photopic b-waves and also impairment in the spatial and temporal contrast sensitivities. This studys novel contribution was the presentation of the alterations in both rod driven ON and OFF ERGs and solely in the cone driven ON ERG. The psychophysical analysis showed reduced contrast sensitivity in the ON protocol similar for both magno- and parvocellular oriented stimuli. In summary the encountered alterations suggest damages in the ON mechanism of the retina. The changes in spatial luminance contrast sensitivity of DMD patients are related, at least partially, to the lack of Dp260 or to the loss of the entire dystrophin (Dp427). Future studies shall investigate this in more details applying ERG protocols to stimulate magno- and parvocellular activities, and increase the number of patients to be able to determine correlations between visual dysfunctions and genetic mutations

Duchenne Muscular Dystrophy (DMD) is a fatal condition occurring in approximately 1 in 3500 male births and is due to the lack of a protein called dystrophin. Initially DMD was considered a skeletal myopathy, but the pathology and consequences of cardiomyopathy are being increasingly recognised. Fibrosis, resulting from continual cycles of degeneration of the muscle tissues followed by inadequate regeneration of the muscles, is progressive in both cardiac and skeletal dystrophic muscle. In the heart fibrosis interferes with contractility and rhythm whereas it affects contractile function and causes contractures in skeletal muscles. This study utilised the mdx mouse which exhibits a pathological loss of muscle fibres and fibrosis characteristic of DMD, to examine a range of mechanisms that can influence muscle function and fibrosis. Ageing and workload both appear to contribute to the development of dystrophic features in cardiac and skeletal muscle of the mdx mouse. Therefore the effect of eccentric exercise on cardiac and skeletal muscle was examined in older mdx mice. Mice ran in 30 minute sessions for five months, 5 days per week. Downhill treadmill running did not exacerbate the contractile function or fibrosis of the mdx heart or the EDL, SOL or diaphragm muscles suggesting that cytokines influence function and fibrosis to a greater extent than workload alone. The role of the cytokine TGF-beta was examined by treating mdx mice with the TGF-beta antagonist pirfenidone at 0.4, 0.8 or 1.2 per cent in drinking water for six months. Pirfenidone improved cardiac contractility (P<0.01) and coronary flow (P<0.05), to levels comparable to control mice, despite no reduction in cardiac fibrosis. Pirfenidone did not reduce fibrosis or improve function in skeletal muscle. A deficiency of neuronal nitric oxide synthase (nNOS) in DMD and mdx mice causes a lowered production of nitric oxide indicating that the substrate of nNOS, l-arginine, may be beneficial to cardiac and skeletal muscle function in mdx mice. Oral l-arginine (5 mg/g bw) improved cardiac contractility, coronary flow and reduced cardiac fibrosis (P<0.05) without improving skeletal muscle function or fibrosis. In contrast, 10 mg/g bw l-arginine improved cardiac function and coronary flow (P<0.01), despite also elevating cardiac collagen. This increment in collagen was prevented by co-administration of prednisone. The experiments described in this dissertation reveal for the first time that pharmacological treatments in mdx mice can improve cardiac structure and function. Further elucidation of the optimum time and doses of such treatments may result in future pharmacological treatments to improve cardiac function and fibrosis in DMD.

Reproduction de : Habilitation à diriger des recherches : Sciences naturelles : Lille 1 : 2005. / Synthèse des travaux en français. Articles en anglais non reproduits dans la version électronique. N° d'ordre (Lille 1) : 491. Curriculum vitae. Titre provenant de la page de titre du document numérisé. Bibliogr. p. 99-111. Liste des publications et des communications.

Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 141-160). Also issued on the Internet.

Duchenne Muscular Dystrophy (DMD) is an x-linked neuromuscular disease that is caused by an absence of dystrophin protein, rendering skeletal muscle more susceptible to contraction-induced damage. One therapeutic strategy focuses on increasing the expression of endogenous utrophin A, a dystrophin homologue. Interestingly, slow muscle is more resistant to the dystrophic pathology and has increased utrophin A expression (Webster 1998; Gramolini 2001b). These observations led researchers to explore the therapeutic potential of stimulating the slow, oxidative myogenic program (SOMP) in the mdx context. Beneficial adaptations were seen with pharmacological activation of PPARδ and AMPK. We treated mdx mice with resveratrol (~100mg/kg/day), a putative SIRT1 activator, for 6-7 weeks and evaluated the activity of phenotypic modifiers that are known to influence the SOMP. SIRT1 activity and protein levels increased significantly, as well as downstream PGC-1α activity. There was evidence of a fibre type conversion as the treated mice had a higher proportion of the slow myosin heavy chain isoforms in both the EDL and Soleus skeletal muscles. Utrophin A protein levels showed modest, but consistent increases with resveratrol treatment. Finally, histological analysis revealed improvements in central nucleation and fibre size variability. These findings were promising, but raised the question of whether modifying the treatment regimen may result in greater therapeutic benefits. Surprisingly, we discovered that an elevated dose of 500mg/kg/day was ineffective in its promotion of the SOMP. SIRT1 was not activated and there was no change in utrophin A levels with resveratrol treatment. Taken together, this study demonstrates that resveratrol has the ability to promote the SOMP through SIRT1 and PGC-1α activation. It also highlights the importance of selecting an appropriate dose of resveratrol to maximize its effectiveness.

Duchenne Muscular Dystrophy (DMD) is an X-linked recessive genetic disease, caused by a frame-shift mutation in the dystrophin gene. Current gene therapies for DMD target dystrophin transcripts in existing skeletal and cardiac muscle, rather than adipose and fibrotic tissues. These approaches may be unable to repair muscle functionality in DMD patients who have already undergone extensive muscle damage and wasting. Thus, successful DMD therapies must consider the underlying genetic cause and pathology. Inhibition of the gene myostatin, a negative regulator of muscle growth, has been shown to ameliorate muscle loss. Here, the CRISPR-Cas9 gene-editing platform is proposed to restore dystrophin expression and inhibit myostatin as a novel gene therapy in DMD patient derived induced pluripotent stem cells. Successful CRISPR-Cas9 mediated gene editing would be determined using PCR amplification, western blot analysis, immunofluorescence staining, and off target sequence analysis in differentiated skeletal muscle cells.

A distrofina é uma das proteínas que formam o complexo glicoproteico necessário para a integridade da fibra muscular e sua disfunção causa uma doença genética letal para os seres humanos, a distrofia muscular de Duchenne (DMD). Além do papel fundamental no tecido muscular, a distrofina é necessária para a fisiologia da retina e, portanto, para o processamento da informação visual. Estudos anteriores mostraram prejuízo assimétrico no eletrorretinograma (ERG), maior para aumento da luminância (via ON) que para diminuição (via OFF). Além disso, prejuízos na visão de cores e contrastes eram mais frequentes e severos em pacientes com alterações genéticas que comprometem a expressão da isoforma Dp260. O objetivo do presente estudo foi verificar através de protocolos eletrofisiológicos e psicofísicos se existiam diferenças nas respostas mediadas pelas vias visuais ON e OFF em jovens com DMD e como estas se relacionavam com o genótipo. Foram avaliados 19 jovens com DMD (idade média = 15,2 ± 3,4 anos) cujos resultados foram comparados com os de sujeitos controles pareados por idade. Os métodos utilizados foram o ERG de campo total e medidas psicofísicas de sensibilidade ao contraste (SC) espacial e temporal de luminância. Protocolos tradicionalmente empregados foram associados a protocolos cujos estímulos visuais ativam, preferencialmente, a via ON ou a via OFF. Para o ERG de campo total foram utilizados seis protocolos: 1. ERG escotópico, 2. ERG fotópico, 3 e 4. ERG mesópico ON e OFF, 5 e 6. ERG fotópico ON e OFF. Para os quatro últimos foram utilizados estímulos intermitentes com modulação da luminância em dente de serra, com aumento rápido de luminância e diminuição gradual (ON) e o contrário (OFF). Para a avaliação psicofísica foi determinada: 1. SC para grades senoidais e SC temporal, e 2. SC a estímulos de tabuleiro de xadrez com aumento (ON) ou diminuição (OFF) da luminância média relativa ao fundo, apresentados com duração curta (sistema magnocelular) ou longa (sistema parvocelular). Os resultados mostraram redução da amplitude da onda-b dos ERGs escotópico e fotópico e prejuízos na SC espacial e temporal de luminância, concordando com a literatura. A contribuição inédita do presente estudo foi mostrar alteração nos ERGs ON e OFF para atividade dos bastonetes e no ERG ON para atividade exclusiva dos cones. Na avaliação psicofísica, houve redução da SC para os protocolos ON sem diferença entre magnocelular e parvocelular. Em conclusão, as alterações encontradas estão principalmente relacionadas com a atividade ON da retina. A alteração psicofísica da SC espacial de luminância de jovens com DMD deve estar relacionada, ao menos em parte, com prejuízos retinianos devidos à ausência da Dp260 ou da própria distrofina total (Dp427). Estudos futuros devem aprofundar a investigação utilizando protocolos do ERG que estimulam, preferencialmente, as vias magnocelular e parvocelular, e ampliar o número de pacientes avaliados para se obter as correlações entre as alterações genéticas e os prejuízos visuais / The dystrophin is one of the proteins that form the glycoprotein complex necessary for the integrity of the muscular fibers. Its dysfunction causes a genetic disease called the Duchenne Muscular Dystrophy (DMD) which is lethal for humans. Besides its fundamental role in the muscle tissues the dystrophin is also necessary in the physiology of the retina, in the processing of visual information. Previous studies have demonstrated asymmetric deviations in the electroretinogram (ERG) of DMDs with bigger changes to stimuli with increasing (ON pathway) than to decreasing (OFF pathway) luminance. Moreover deficiencies in color vision and contrast sensitivity have been more frequent and severe in patients having genetic alterations related to the expression of the Dp260 isoform. The aim of the present study was to apply electrophysiological and psychophysical protocols to verify the suspected alterations in DMD patients regarding the ON and OFF visual pathways and relate the results to their genotypes. 19 DMD patients (mean age = 15.2 ± 3.4 years) were tested and their results were compared to that of an age-matched control group. Fullfield ERG and spatial and temporal luminance contrast sensitivity tests were used during the examinations. Classical protocols were applied together with the ones preferentially stimulating the ON and the OFF visual pathways. The full-field ERG test consisted of six protocols: 1. Scotopic ERG, 2. Photopic ERG, 3. and 4. Mesopic ON and OFF ERG, 5. and 6. Photopic ON and OFF ERG. For the latter four protocols flicker stimuli were used with sawtooth modulation of rapid increase and slower decrease in luminance (ON) and rapid decrease and slower increase in luminance (OFF). The psychophysical evaluation comprised 1. Spatial contrast sensitivity test with sinusoidal gratings and temporal contrast sensitivity test, and 2. Contrast sensitivity tests with checkerboard stimuli with increasing (ON) and decreasing (OFF) luminance relative to the background. These latter were presented for both short (magnocellular system) and long (parvocellular system) durations. In agreement with the literature the results show reduced amplitudes in the ERGs scotopic and photopic b-waves and also impairment in the spatial and temporal contrast sensitivities. This studys novel contribution was the presentation of the alterations in both rod driven ON and OFF ERGs and solely in the cone driven ON ERG. The psychophysical analysis showed reduced contrast sensitivity in the ON protocol similar for both magno- and parvocellular oriented stimuli. In summary the encountered alterations suggest damages in the ON mechanism of the retina. The changes in spatial luminance contrast sensitivity of DMD patients are related, at least partially, to the lack of Dp260 or to the loss of the entire dystrophin (Dp427). Future studies shall investigate this in more details applying ERG protocols to stimulate magno- and parvocellular activities, and increase the number of patients to be able to determine correlations between visual dysfunctions and genetic mutations

Muscle stem cells self-renew to maintain the long-term capacity for skeletal muscles to regenerate. However, the homeostatic regulation of muscle stem cell self-renewal is poorly understood. By utilizing high-throughput screening and transcriptomic approaches, we identify the critical function of dystrophin, the epidermal growth factor receptor (EGFR), and fibronectin in the establishment of cell polarity and in determining symmetric and asymmetric modes of muscle stem cell self-renewal. These findings reveal an orchestrated network of paracrine signaling that regulate muscle stem cell homeostasis during regeneration and have profound implications for the pathogenesis and development of therapies for Duchenne muscular dystrophy.

Duchenne Muscular Dystrophy (DMD) is an x-linked neuromuscular disease that is caused by an absence of dystrophin protein, rendering skeletal muscle more susceptible to contraction-induced damage. One therapeutic strategy focuses on increasing the expression of endogenous utrophin A, a dystrophin homologue. Interestingly, slow muscle is more resistant to the dystrophic pathology and has increased utrophin A expression (Webster 1998; Gramolini 2001b). These observations led researchers to explore the therapeutic potential of stimulating the slow, oxidative myogenic program (SOMP) in the mdx context. Beneficial adaptations were seen with pharmacological activation of PPARδ and AMPK. We treated mdx mice with resveratrol (~100mg/kg/day), a putative SIRT1 activator, for 6-7 weeks and evaluated the activity of phenotypic modifiers that are known to influence the SOMP. SIRT1 activity and protein levels increased significantly, as well as downstream PGC-1α activity. There was evidence of a fibre type conversion as the treated mice had a higher proportion of the slow myosin heavy chain isoforms in both the EDL and Soleus skeletal muscles. Utrophin A protein levels showed modest, but consistent increases with resveratrol treatment. Finally, histological analysis revealed improvements in central nucleation and fibre size variability. These findings were promising, but raised the question of whether modifying the treatment regimen may result in greater therapeutic benefits. Surprisingly, we discovered that an elevated dose of 500mg/kg/day was ineffective in its promotion of the SOMP. SIRT1 was not activated and there was no change in utrophin A levels with resveratrol treatment. Taken together, this study demonstrates that resveratrol has the ability to promote the SOMP through SIRT1 and PGC-1α activation. It also highlights the importance of selecting an appropriate dose of resveratrol to maximize its effectiveness.