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Abaji M, Gorokhova S, Da Silva N, Busa T, Grelet M, Missirian C, Sigaudy S, Philip N, Leturcq F, Lévy N, Krahn M, Bartoli M. Novel Exon-Skipping Therapeutic Approach for the DMD Gene Based on Asymptomatic Deletions of Exon 49. Genes (Basel) 2022; 13:genes13071277. [PMID: 35886062 PMCID: PMC9323532 DOI: 10.3390/genes13071277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
Exon skipping is a promising therapeutic approach. One important condition for this approach is that the exon-skipped form of the gene can at least partially perform the required function and lead to improvement of the phenotype. It is therefore critical to identify the exons that can be skipped without a significant deleterious effect on the protein function. Pathogenic variants in the DMD gene are responsible for Duchenne muscular dystrophy (DMD). We report for the first time a deletion of the in-frame exon 49 associated with a strikingly normal muscular phenotype. Based on this observation, and on previously known therapeutic approaches using exon skipping in DMD for other single exons, we aimed to extend the clinical use of exon skipping for patients carrying truncating mutations in exon 49. We first determined the precise genomic position of the exon 49 deletion in our patients. We then demonstrated the feasibility of skipping exon 49 using an in vitro AON (antisense oligonucleotide) approach in human myotubes carrying a truncating pathogenic variant as well as in healthy ones. This work is a proof of concept aiming to expand exon-skipping approaches for DMD exon 49.
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Affiliation(s)
- Mario Abaji
- Medical Genetics Department, Assistance Publique Hôpitaux de Marseille, La Timone Children’s Hospital, 13005 Marseille, France; (M.A.); (S.G.); (T.B.); (C.M.); (S.S.); (N.P.); (N.L.); (M.K.)
- MMG, INSERM, Aix Marseille University, 13385 Marseille, France;
| | - Svetlana Gorokhova
- Medical Genetics Department, Assistance Publique Hôpitaux de Marseille, La Timone Children’s Hospital, 13005 Marseille, France; (M.A.); (S.G.); (T.B.); (C.M.); (S.S.); (N.P.); (N.L.); (M.K.)
- MMG, INSERM, Aix Marseille University, 13385 Marseille, France;
| | | | - Tiffany Busa
- Medical Genetics Department, Assistance Publique Hôpitaux de Marseille, La Timone Children’s Hospital, 13005 Marseille, France; (M.A.); (S.G.); (T.B.); (C.M.); (S.S.); (N.P.); (N.L.); (M.K.)
- MMG, INSERM, Aix Marseille University, 13385 Marseille, France;
| | - Maude Grelet
- Centre Hospitalier Inter-Communal Toulon-La Seyne, Medical Genetics Unit, Sainte Musse Hospital, 83100 Toulon, France;
| | - Chantal Missirian
- Medical Genetics Department, Assistance Publique Hôpitaux de Marseille, La Timone Children’s Hospital, 13005 Marseille, France; (M.A.); (S.G.); (T.B.); (C.M.); (S.S.); (N.P.); (N.L.); (M.K.)
- MMG, INSERM, Aix Marseille University, 13385 Marseille, France;
| | - Sabine Sigaudy
- Medical Genetics Department, Assistance Publique Hôpitaux de Marseille, La Timone Children’s Hospital, 13005 Marseille, France; (M.A.); (S.G.); (T.B.); (C.M.); (S.S.); (N.P.); (N.L.); (M.K.)
- MMG, INSERM, Aix Marseille University, 13385 Marseille, France;
| | - Nicole Philip
- Medical Genetics Department, Assistance Publique Hôpitaux de Marseille, La Timone Children’s Hospital, 13005 Marseille, France; (M.A.); (S.G.); (T.B.); (C.M.); (S.S.); (N.P.); (N.L.); (M.K.)
- MMG, INSERM, Aix Marseille University, 13385 Marseille, France;
| | - France Leturcq
- Department of Medical Genetics, APHP Centre Université Paris Cité Cochin Hospital, 75014 Paris, France;
| | - Nicolas Lévy
- Medical Genetics Department, Assistance Publique Hôpitaux de Marseille, La Timone Children’s Hospital, 13005 Marseille, France; (M.A.); (S.G.); (T.B.); (C.M.); (S.S.); (N.P.); (N.L.); (M.K.)
- MMG, INSERM, Aix Marseille University, 13385 Marseille, France;
| | - Martin Krahn
- Medical Genetics Department, Assistance Publique Hôpitaux de Marseille, La Timone Children’s Hospital, 13005 Marseille, France; (M.A.); (S.G.); (T.B.); (C.M.); (S.S.); (N.P.); (N.L.); (M.K.)
- MMG, INSERM, Aix Marseille University, 13385 Marseille, France;
| | - Marc Bartoli
- MMG, INSERM, Aix Marseille University, 13385 Marseille, France;
- Correspondence: ; Tel.: +33-491-32-49-06
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Zamani G, Hosseinpour S, Ashrafi MR, Mohammadi M, Badv RS, Tavasoli AR, Akbari MG, Bereshneh AH, Malamiri RA, Heidari M. Characteristics of disease progression and genetic correlation in ambulatory Iranian boys with Duchenne muscular dystrophy. BMC Neurol 2022; 22:162. [PMID: 35501714 PMCID: PMC9059913 DOI: 10.1186/s12883-022-02687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy in the pediatric population. The manifestations of this disease include progressive muscle weakness, gait dysfunction, and motor impairment, leading to a loss of ambulation by the age of 13 years. Molecular diagnosis is the standard diagnostic tool for DMD. This study aimed to investigate disease progression and genetic patterns in Iranian ambulant boys and to find the correlation between genotypes and motor function phenotypes. METHODS This study was performed on 152 DMD patients. Clinical history, including the disease phenotype, steroid therapy, and the North Star Ambulatory Assessment (NSAA) score, was taken for all the patients. Molecular diagnoses were confirmed by multiplex ligation-dependent probe amplification and next-generation sequencing tests. RESULTS A total of 152 Iranian DMD patients were examined in this study. The mean age at the time of disease onset was 4.04 ± 2.00 years, and the mean age at diagnosis was 5.05 ± 2.08 years. The mean age of ambulation loss was 10.9 years. Contracture was reported in 38.9% of cases. In terms of age, the mean total NSAA score showed a peak at 4 years of age, with a mean NSAA score of 24. Annual changes in the NSAA score were determined for all cases, based on the mutation type and exon site. Deletion mutation was found in 79.1% of cases, duplication in 6.8%, nonsense in 12.8%, and splice site in 1.4%. The most common single exon deletion was exon 44 (5.3%), and the most common multiexon deletions were attributed to exons 45-50 and exons 45-52 (4.6%). The results did not indicate any correlation between the mutation type and age at the time of disease onset, loss of ambulation age, and wheelchair dependence; however, a significant association was found between contracture and mutation type. The results showed a significant difference in the NSAA score between the deletion and nonsense groups at the age of 3 years (P = 0.04). No significant correlation was found between the phenotype and exon site. Overall, 91.1% of the study population had a history of corticosteroid use, and 54.1% showed compliance with rehabilitation therapy. CONCLUSION This study demonstrated the phenotypes and mutational features of Iranian DMD boys and provided information regarding the natural motor history of the disease, disease progression, diagnosis, and status of DMD management in Iran. The present findings can promote the development of clinical trials and future advanced molecular therapies in Iran.
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Affiliation(s)
- Gholamreza Zamani
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sareh Hosseinpour
- Department of Pediatric Neurology, Vali-e-Asr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Ashrafi
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Mohammadi
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Tavasoli
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masood Ghahvechi Akbari
- Physical Medicine and Rehabilitation Department, Children's Medical Center , Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseini Bereshneh
- Prenatal Diagnosis and Genetic Research Center, Dastgheib Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Reza Azizi Malamiri
- Department of Pediatric Neurology, Golestan Medical, Educational, and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Morteza Heidari
- Pediatrics Center of Excellence, Department of Pediatric Neurology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Wang JZ, Wu P, Shi ZM, Xu YL, Liu ZJ. The AAV-mediated and RNA-guided CRISPR/Cas9 system for gene therapy of DMD and BMD. Brain Dev 2017; 39:547-556. [PMID: 28390761 DOI: 10.1016/j.braindev.2017.03.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/13/2017] [Accepted: 03/19/2017] [Indexed: 12/26/2022]
Abstract
Mutations in the dystrophin gene (Dmd) result in Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD), which afflict many newborn boys. In 2016, Brain and Development published several interesting articles on DMD treatment with antisense oligonucleotide, kinase inhibitor, and prednisolone. Even more strikingly, three articles in the issue 6271 of Science in 2016 provide new insights into gene therapy of DMD and BMD via the clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9). In brief, adeno-associated virus (AAV) vectors transport guided RNAs (gRNAs) and Cas9 into mdx mouse model, gRNAs recognize the mutated Dmd exon 23 (having a stop codon), and Cas9 cut the mutated exon 23 off the Dmd gene. These manipulations restored expression of truncated but partially functional dystrophin, improved skeletal and cardiac muscle function, and increased survival of mdx mice significantly. This review concisely summarized the related advancements and discussed their primary implications in the future gene therapy of DMD, including AAV-vector selection, gRNA designing, Cas9 optimization, dystrophin-restoration efficiency, administration routes, and systemic and long-term therapeutic efficacy. Future orientations, including off-target effects, safety concerns, immune responses, precision medicine, and Dmd-editing in the brain (potentially blocked by the blood-brain barrier) were also elucidated briefly. Collectively, the AAV-mediated and RNA-guided CRISPR/Cas9 system has major superiorities compared with traditional gene therapy, and might contribute to the treatment of DMD and BMD substantially in the near future.
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Affiliation(s)
- Jing-Zhang Wang
- College of Medicine, Affiliated Hospital, Hebei University of Engineering, Handan 056002, PR China.
| | - Peng Wu
- Department of Social Science, Hebei University of Engineering, Handan 056038, PR China
| | - Zhi-Min Shi
- College of Medicine, Affiliated Hospital, Hebei University of Engineering, Handan 056002, PR China
| | - Yan-Li Xu
- College of Medicine, Affiliated Hospital, Hebei University of Engineering, Handan 056002, PR China
| | - Zhi-Jun Liu
- College of Medicine, Affiliated Hospital, Hebei University of Engineering, Handan 056002, PR China.
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