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BMI-z scores of boys with DMD already begin to increase before losing ambulation: a longitudinal exploration of BMI, corticosteroids and caloric intake. Neuromuscul Disord 2022; 32:236-244. [DOI: 10.1016/j.nmd.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 01/22/2023]
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Niba ETE, Awano H, Lee T, Takeshima Y, Shinohara M, Nishio H, Matsuo M. Dystrophin Dp71 Subisoforms Localize to the Mitochondria of Human Cells. Life (Basel) 2021; 11:life11090978. [PMID: 34575126 PMCID: PMC8468555 DOI: 10.3390/life11090978] [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: 06/21/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/26/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is a fatal muscle wasting disease caused by deficiency in dystrophin, a protein product encoded by the DMD gene. Mitochondrial dysfunction is now attracting much attention as a central player in DMD pathology. However, dystrophin has never been explored in human mitochondria. Here, we analyzed dystrophin in cDNAs and mitochondrial fractions of human cells. Mitochondrial fraction was obtained using a magnetic-associated cell sorting (MACS) technology. Dystrophin was analyzed by reverse transcription (RT)-PCR and western blotting using an antibody against the dystrophin C-terminal. In isolated mitochondrial fraction from HEK293 cells, dystrophin was revealed as a band corresponding to Dp71b and Dp71ab subisoforms. Additionally, in mitochondria from HeLa, SH-SY5Y, CCL-136 and HepG2 cells, signals for Dp71b and Dp71ab were revealed as well. Concomitantly, dystrophin mRNAs encoding Dp71b and Dp71ab were disclosed by RT-PCR in these cells. Primary cultured myocytes from three dystrophinopathy patients showed various levels of mitochondrial Dp71 expression. Coherently, levels of mRNA were different in all cells reflecting the protein content, which indicated predominant accumulation of Dp71. Dystrophin was demonstrated to be localized to human mitochondrial fraction, specifically as Dp71 subisoforms. Myocytes derived from dystrophinopathy patients manifested different levels of mitochondrial Dp71, with higher expression revealed in myocytes from Becker muscular dystrophy (BMD) patient-derived myocytes.
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Affiliation(s)
- Emma Tabe Eko Niba
- Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
- Correspondence: ; Tel.: +81-78-382-5543
| | - Hiroyuki Awano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Tomoko Lee
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya 663-8501, Japan; (T.L.); (Y.T.)
| | - Yasuhiro Takeshima
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya 663-8501, Japan; (T.L.); (Y.T.)
| | - Masakazu Shinohara
- Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Hisahide Nishio
- Department of Occupational Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe 651-2180, Japan;
| | - Masafumi Matsuo
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe 651-2180, Japan;
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Alayi T, Tawalbeh SM, Ogundele M, Smith HR, Samsel AM, Barbieri ML, Hathout Y. Tandem Mass Tag-Based Serum Proteome Profiling for Biomarker Discovery in Young Duchenne Muscular Dystrophy Boys. ACS OMEGA 2020; 5:26504-26517. [PMID: 33110978 PMCID: PMC7581259 DOI: 10.1021/acsomega.0c03206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
Blood-accessible molecular biomarkers are becoming highly attractive tools to assess disease progression and response to therapies in Duchenne muscular dystrophy (DMD) especially in very young patients for whom other outcome measures remain subjective and challenging. In this study, we have standardized a highly specific and reproducible multiplexing mass spectrometry method using the tandem mass tag (TMT) strategy in combination with depletion of abundant proteins from serum and high-pH reversed-phase peptide fractionation. Differential proteome profiling of 4 year-old DMD boys (n = 9) and age-matched healthy controls (n = 9) identified 38 elevated and 50 decreased serum proteins (adjusted P < 0.05, FDR <0.05) in the DMD group relative to the healthy control group. As expected, we confirmed previously reported biomarkers but also identified novel biomarkers. These included novel muscle injury-associated biomarkers such as telethonin, smoothelin-like protein 1, cofilin-1, and plectin, additional muscle-specific enzymes such as UTP-glucose-1-phosphate uridylyltransferase, aspartate aminotransferase, pyruvate kinase PKM, lactotransferrin, tissue alpha-l-fucosidase, pantetheinase, and ficolin-1, and some pro-inflammatory and cell adhesion-associated biomarkers such as leukosialin, macrophage receptor MARCO, vitronectin, galectin-3-binding protein, and ProSAAS. The workflow including serum depletion, sample processing, and mass spectrometry analysis was found to be reproducible and stable over time with CV < 20%. Furthermore, the method was found to be superior in terms of specificity compared to other multiplexing affinity-based methods. These findings demonstrate the specificity and reliability of TMT-based mass spectrometry methods in detection and identification of serum biomarkers in presymptomatic young DMD patients.
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Affiliation(s)
- Tchilabalo
D. Alayi
- Department
of Pharmaceutical Science, School of Pharmacy and Pharmaceutical Sciences, Binghamton University−SUNY, Johnson City, New York 13790, United States
| | - Shefa M. Tawalbeh
- Department
of Pharmaceutical Science, School of Pharmacy and Pharmaceutical Sciences, Binghamton University−SUNY, Johnson City, New York 13790, United States
- Department
of Biomedical Engineering, Binghamton University−SUNY, 4400 Vestal Pkwy E, Binghamton, New York 13902, United States
| | - Michael Ogundele
- Department
of Pharmaceutical Science, School of Pharmacy and Pharmaceutical Sciences, Binghamton University−SUNY, Johnson City, New York 13790, United States
- Department
of Biomedical Engineering, Binghamton University−SUNY, 4400 Vestal Pkwy E, Binghamton, New York 13902, United States
| | - Holly R. Smith
- Department
of Pharmaceutical Science, School of Pharmacy and Pharmaceutical Sciences, Binghamton University−SUNY, Johnson City, New York 13790, United States
- Department
of Biochemistry, Binghamton University−SUNY, 4400 Vestal Pkwy E, Binghamton, New York 13902, United States
| | - Alison M. Samsel
- Department
of Pharmaceutical Science, School of Pharmacy and Pharmaceutical Sciences, Binghamton University−SUNY, Johnson City, New York 13790, United States
| | - Marissa L. Barbieri
- Department
of Pharmaceutical Science, School of Pharmacy and Pharmaceutical Sciences, Binghamton University−SUNY, Johnson City, New York 13790, United States
| | - Yetrib Hathout
- Department
of Pharmaceutical Science, School of Pharmacy and Pharmaceutical Sciences, Binghamton University−SUNY, Johnson City, New York 13790, United States
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Wasilewska E, Małgorzewicz S, Sobierajska-Rek A, Jabłońska-Brudło J, Górska L, Śledzińska K, Bautembach-Minkowska J, Wierzba J. Transition from Childhood to Adulthood in Patients with Duchenne Muscular Dystrophy. ACTA ACUST UNITED AC 2020; 56:medicina56090426. [PMID: 32846887 PMCID: PMC7557675 DOI: 10.3390/medicina56090426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 01/14/2023]
Abstract
Recently, progress has been observed in the knowledge about Duchenne Muscular Dystrophy (DMD), which is a severe and commonly diagnosed genetic myopathy in childhood, historically resulting in early death. Currently, there are a lot of methods available to improve the clinical course of DMD and extend patients’ life expectancy to more than 30 years of age. The key issue for DMD patients is the period between 16–18 years of age, which is described as a transition from pediatric- to adult-oriented healthcare. Adolescents and adults with DMD have highly complex healthcare needs associated with long-term steroid usage, orthopedic, ventilation, cardiac, and gastrointestinal problems. The current paper provides a comprehensive overview of special healthcare needs related to the transfer of a patient with DMD from child-oriented to adult-oriented care. Additionally, the need to organize effective care for adults with DMD is presented.
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Affiliation(s)
- Eliza Wasilewska
- Department of Allergology and Pulmonology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (E.W.); (L.G.)
| | - Sylwia Małgorzewicz
- Department of Clinical Nutrition, Medical University of Gdansk, 80-211 Gdańsk, Poland
- Correspondence: ; Tel./Fax: +48-583-492-724
| | - Agnieszka Sobierajska-Rek
- Department of Rehabilitation Medicine, Medical University of Gdansk, 80-211 Gdańsk, Poland; (A.S.-R.); (J.J.-B.)
| | - Joanna Jabłońska-Brudło
- Department of Rehabilitation Medicine, Medical University of Gdansk, 80-211 Gdańsk, Poland; (A.S.-R.); (J.J.-B.)
| | - Lucyna Górska
- Department of Allergology and Pulmonology, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (E.W.); (L.G.)
| | - Karolina Śledzińska
- Department of Internal and Pediatric Nursing, Institute of Nursing and Midwifery, Medical University of Gdansk, 80-211 Gdańsk, Poland; (K.Ś.); (J.W.)
| | - Joanna Bautembach-Minkowska
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Jolanta Wierzba
- Department of Internal and Pediatric Nursing, Institute of Nursing and Midwifery, Medical University of Gdansk, 80-211 Gdańsk, Poland; (K.Ś.); (J.W.)
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Hofmann I, Kemter E, Theobalt N, Fiedler S, Bidlingmaier M, Hinrichs A, Aichler M, Burkhardt K, Klymiuk N, Wolf E, Wanke R, Blutke A. Linkage between growth retardation and pituitary cell morphology in a dystrophin-deficient pig model of Duchenne muscular dystrophy. Growth Horm IGF Res 2020; 51:6-16. [PMID: 31926372 DOI: 10.1016/j.ghir.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Human patients with Duchenne muscular dystrophy (DMD) commonly exhibit a short stature, but the pathogenesis of this growth retardation is not completely understood. Due to the suspected involvement of the growth hormone/insulin-like growth factor 1 (GH/IGF1) system, controversial therapeutic approaches have been developed, including both GH- administration, as well as GH-inhibition. In the present study, we examined relevant histomorphological and ultrastructural features of adenohypophyseal GH-producing somatotroph cells in a porcine DMD model. METHODS The numbers and volumes of immunohistochemically labelled somatotroph cells were determined in consecutive semi-thin sections of plastic resin embedded adenohypophyseal tissue samples using unbiased state-of-the-art quantitative stereological analysis methods. RESULTS DMD pigs displayed a significant growth retardation, accounting for a 55% reduction of body weight, accompanied by a significant 50% reduction of the number of somatotroph cells, as compared to controls. However, the mean volumes of somatotroph cells and the volume of GH-granules per cell were not altered. Western blot analyses of the adenohypophyseal protein samples showed no differences in the relative adenohypophyseal GH-abundance between DMD pigs and controls. CONCLUSION The findings of this study do not provide evidence for involvement of somatotroph cells in the pathogenesis of growth retardation of DMD pigs. These results are in contrast with previous findings in other dystrophin-deficient animal models, such as the golden retriever model of Duchenne muscular dystrophy, where increased mean somatotroph cell volumes and elevated volumes of intracellular GH-granules were reported and associated with DMD-related growth retardation. Possible reasons for the differences of somatotroph morphology observed in different DMD models are discussed.
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Affiliation(s)
- I Hofmann
- Institute of Veterinary Pathology at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - E Kemter
- Chair for Molecular Animal Breeding and Biotechnology, Gene Centre and Department of Veterinary Sciences, Ludwig-Maximilians-Universität München, Munich, Germany; Centre for Innovative Medical Models (CiMM), Ludwig-Maximilians-Universität München, Oberschleißheim, Germany
| | - N Theobalt
- Institute of Veterinary Pathology at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - S Fiedler
- Institute of Veterinary Pathology at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - M Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - A Hinrichs
- Chair for Molecular Animal Breeding and Biotechnology, Gene Centre and Department of Veterinary Sciences, Ludwig-Maximilians-Universität München, Munich, Germany; Centre for Innovative Medical Models (CiMM), Ludwig-Maximilians-Universität München, Oberschleißheim, Germany
| | - M Aichler
- Research Unit Analytical Pathology, Helmholtz Zentrum München, Neuherberg, Germany
| | - K Burkhardt
- Chair for Molecular Animal Breeding and Biotechnology, Gene Centre and Department of Veterinary Sciences, Ludwig-Maximilians-Universität München, Munich, Germany; Centre for Innovative Medical Models (CiMM), Ludwig-Maximilians-Universität München, Oberschleißheim, Germany
| | - N Klymiuk
- Chair for Molecular Animal Breeding and Biotechnology, Gene Centre and Department of Veterinary Sciences, Ludwig-Maximilians-Universität München, Munich, Germany; Centre for Innovative Medical Models (CiMM), Ludwig-Maximilians-Universität München, Oberschleißheim, Germany
| | - E Wolf
- Chair for Molecular Animal Breeding and Biotechnology, Gene Centre and Department of Veterinary Sciences, Ludwig-Maximilians-Universität München, Munich, Germany; Centre for Innovative Medical Models (CiMM), Ludwig-Maximilians-Universität München, Oberschleißheim, Germany; Laboratory for Functional Genome Analysis (LAFUGA), Gene Centre, Ludwig-Maximilians-Universität München, Munich, Germany
| | - R Wanke
- Institute of Veterinary Pathology at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - A Blutke
- Research Unit Analytical Pathology, Helmholtz Zentrum München, Neuherberg, Germany.
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Ward LM, Weber DR. Growth, pubertal development, and skeletal health in boys with Duchenne Muscular Dystrophy. Curr Opin Endocrinol Diabetes Obes 2019; 26:39-48. [PMID: 30507696 PMCID: PMC6402320 DOI: 10.1097/med.0000000000000456] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Glucocorticoid therapy is currently the most widely used treatment for Duchenne muscular dystrophy (DMD), having consistently shown to prolong ambulation by 2 years, reduce the frequency of scoliosis, and improve cardiorespiratory function. Among the most frequent side effects of glucocorticoids are fractures due to osteoporosis, linear growth retardation or arrest, and pubertal delay, the subjects of this review. RECENT FINDINGS The diagnosis of osteoporosis has shifted in recent years away from a bone mineral density-centric to a fracture-focused approach, with particular emphasis on early vertebral fracture identification (one of the key triggers for osteoporosis intervention). Delayed puberty should be addressed in an age-appropriate manner, with numerous options available for sex steroid replacement. Growth impairment, however, is a more challenging complication of glucocorticoid-treated DMD, one that is most likely best addressed through growth-sparing therapies that target the dystrophinopathy. SUMMARY With glucocorticoid prescription an increasingly prevalent component of DMD care, early attention to management of osteoporosis and delayed puberty are important components of multidisciplinary and anticipatory care. The treatment of short stature remains controversial, with no accepted therapy currently available to over-ride the toxic effects of glucocorticoids on the growth axis.
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Affiliation(s)
- Leanne M. Ward
- Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - David R. Weber
- Division of Endocrinology and Diabetes, Golisano Children’s Hospital, University of Rochester Medical Centre, Rochester, New York, USA
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Cabrera-Salcedo C, Hawkes CP, Tyzinski L, Andrew M, Labilloy G, Campos D, Feld A, Deodati A, Hwa V, Hirschhorn JN, Grimberg A, Dauber A. Targeted Searches of the Electronic Health Record and Genomics Identify an Etiology in Three Patients with Short Stature and High IGF-I Levels. Horm Res Paediatr 2019; 92:186-195. [PMID: 31865343 PMCID: PMC7173346 DOI: 10.1159/000504884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Short stature is one of the most common reasons for referral to a pediatric endocrinologist and can result from many etiologies. However, many patients with short stature do not receive a definitive diagnosis. OBJECTIVE To ascertain whether integrating targeted bioinformatics searches of electronic health records (EHRs) combined with genomic studies could identify patients with previously undiagnosed rare genetic etiologies of short stature. We focused on a specific rare phenotypic subgroup: patients with short stature and elevated IGF-I levels. METHODS We performed a cross-sectional cohort study at three large academic pediatric healthcare networks. Eligible subjects included children with heights below -2 SD, IGF-I levels >90th percentile, and no known etiology for short stature. We performed a search of the EHRs to identify eligible patients. Patients were then recruited for phenotyping followed by exome sequencing and in vitro assays of IGF1R function. RESULTS A total of 234 patients were identified by the bioinformatics algorithm with 39 deemed eligible after manual review (17%). Of those, 9 were successfully recruited. A genetic etiology was identified in 3 of the 9 patients including 2 novel variants in IGF1R and a de novo variant in CHD2. In vitro studies supported the pathogenicity of the IGF1R variants. CONCLUSIONS This study provides proof of principle that patients with rare phenotypic subgroups can be identified based on discrete data elements in the EHRs. Although limitations exist to fully automating this approach, these searches may help find patients with previously unidentified rare genetic disorders.
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Affiliation(s)
- Catalina Cabrera-Salcedo
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, Kentucky, USA
| | - Colin P. Hawkes
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leah Tyzinski
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Melissa Andrew
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Division of Endocrinology and Center for Genetic Medicine Research, Children’s National Hospital, Washington, District of Columbia, USA
| | - Guillaume Labilloy
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Diego Campos
- Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amalia Feld
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Annalisa Deodati
- Division of Endocrinology and Center for Genetic Medicine Research, Children’s National Hospital, Washington, District of Columbia, USA,Dipartimento Pediatrico Universitario Ospedaliero “Bambino Gesù” Children’s Hospital-Tor Vergata University, Rome, Italy
| | | | - Vivian Hwa
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joel N. Hirschhorn
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, USA,Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Adda Grimberg
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Dauber
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA, .,Division of Endocrinology and Center for Genetic Medicine Research, Children's National Hospital, Washington, District of Columbia, USA, .,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA,
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Skeletal disproportion in glucocorticoid-treated boys with Duchenne muscular dystrophy. Eur J Pediatr 2019; 178:633-640. [PMID: 30762116 PMCID: PMC6459782 DOI: 10.1007/s00431-019-03336-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/13/2019] [Accepted: 01/30/2019] [Indexed: 12/30/2022]
Abstract
We aimed to compare body segment and bone lengths in glucocorticoid-treated boys with Duchenne muscular dystrophy (DMD) with healthy controls using dual-energy absorptiometry (DXA) images. Total height (Ht), sitting height (SH), leg length (LL) and bone lengths (femur, tibia) in boys with DMD and age-matched control boys were measured using DXA. Thirty boys with DMD (median age 10.0 years (6.1, 16.8)) were compared with 30 controls. SH in DMD was 3.3 cm lower (95% CI - 6.1, - 0.66; p = 0.016). LL in DMD was 7.3 cm lower (95% CI - 11.2, - 3.4; p < 0.0001). SH:LL of boys with DMD was higher by 0.08 (95% CI 0.04, 0.12; p < 0.0001). Femur length in DMD was 2.4 cm lower (95% CI - 4.6, - 0.12; p = 0.04), whereas tibial length in DMD was 4.8 cm lower (95% CI - 6.7, - 2.9; p < 0.0001). SH:LL was not associated with duration of glucocorticoid use (SH:LL β = 0.003, 95% CI - 0.01 to 0.002, p = 0.72).Conclusion: Glucocorticoid-treated boys with DMD exhibit skeletal disproportion with relatively shorter leg length and more marked reduction of distal long bones. As glucocorticoid excess is not associated with such disproportion, our findings raise the possibility of an intrinsic disorder of growth in DMD. What is Known • Severe growth impairment and short stature are commonly observed in boys with Duchenne muscular dystrophy (DMD), especially those treated with long-term glucocorticoids (GC). • In other groups of children with chronic conditions and/or disorders of puberty, skeletal disproportion with lower spinal length has been reported. What is New • Growth impairment in GC-treated boys with DMD was associated with skeletal disproportion in relation to age, with lower limbs and distal long bones affected to a greater degree.
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9
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Weber DR, Thomas S, Erickson SW, Fox D, Oleszek J, Pandya S, Venkatesh Y, Westfield C, Ciafaloni E. Bone Health and Endocrine Care of Boys with Duchenne Muscular Dystrophy: Data from the MD STARnet. J Neuromuscul Dis 2018; 5:497-507. [PMID: 30149461 PMCID: PMC6277257 DOI: 10.3233/jnd-180317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with Duchenne muscular dystrophy (DMD) are at high risk of endocrine and bone health complications resulting from the high glucocorticoid (GC) doses used to treat this condition. There are limited data characterizing the clinical management of these complications. OBJECTIVE To determine the frequency of bone health screening, endocrinologist evaluation, and use of endocrine and bone health pharmacotherapy in the clinical care of males with DMD. METHODS A population based cohort study using data from the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet) was conducted. Clinical data was abstracted from the medical records of 683 males with DMD at five surveillance sites across the US. RESULTS A DXA scan had been documented in 24% of cases; the percentage of cases with DXA varied across surveillance sites from 13% to 43%, p < 0.001. History of fracture and greater disease duration were associated with greater odds of having a DXA. Only 4.7% of cases had documentation of an endocrinologist evaluation. The frequency of documented endocrine and bone health pharmacotherapy use included calcium (42.8%), vitamin D (36.6%), bisphosphonates (13.3%), growth hormone (1.9%), testosterone (1.7%), insulin (1.2%), and metformin (0.3%)Conclusions:A low percentage of DMD males had record of DXA scan, endocrinologist evaluation, or treatment with endocrine or bone health pharmacotherapy. Endocrine and bone health care may represent an unmet need in the DMD population.
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Affiliation(s)
- David R. Weber
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Shiny Thomas
- New York State Department of Health, Albany, NY, USA
| | | | - Deborah Fox
- New York State Department of Health, Albany, NY, USA
| | | | - Shree Pandya
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | | | | | - Emma Ciafaloni
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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10
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Patients with Duchenne muscular dystrophy are significantly shorter than those with Becker muscular dystrophy, with the higher incidence of short stature in Dp71 mutated subgroup. Neuromuscul Disord 2017; 27:1023-1028. [DOI: 10.1016/j.nmd.2017.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/31/2017] [Accepted: 06/14/2017] [Indexed: 01/06/2023]
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Corticosteroid Treatment and Growth Patterns in Ambulatory Males with Duchenne Muscular Dystrophy. J Pediatr 2016; 173:207-213.e3. [PMID: 27039228 PMCID: PMC5100357 DOI: 10.1016/j.jpeds.2016.02.067] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 01/14/2016] [Accepted: 02/24/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate growth patterns of ambulatory males with Duchenne muscular dystrophy (DMD) treated with corticosteroids compared with ambulatory, steroid-naïve males with DMD and age-matched unaffected general-population males and to test associations between growth and steroid treatment patterns among treated males. STUDY DESIGN Using data from the Muscular Dystrophy Surveillance, Tracking, and Research Network, we identified a total of 1768 height, 2246 weight, and 1755 body mass index (BMI) measurements between age 2 and 12 years for 324 ambulatory males who were treated with corticosteroids for at least 6 months. Growth curve comparisons and linear mixed-effects modeling, adjusted for race/ethnicity and birth year, were used to evaluate growth and steroid treatment patterns (age at initiation, dosing interval, duration, cumulative dose). RESULTS Growth curves for ambulatory males treated with corticosteroids showed significantly shorter stature, heavier weight, and greater BMI compared with ambulatory, steroid-naïve males with DMD and general-population US males. Adjusted linear mixed-effects models for ambulatory males treated with corticosteroids showed that earlier initiation, daily dosing, longer duration, and greater dosages predicted shorter stature with prednisone. Longer duration and greater dosages predicted shorter stature for deflazacort. Daily prednisone dosing predicted lighter weight, but longer duration, and greater dosages predicted heavier weight. Early initiation, less than daily dosing, longer duration, and greater doses predicted greater BMIs. Deflazacort predicted shorter stature, but lighter weight, compared with prednisone. CONCLUSION Prolonged steroid use is significantly associated with short stature and heavier weight. Growth alterations associated with steroid treatment should be considered when making treatment decisions for males with DMD.
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Wood CL, Straub V, Guglieri M, Bushby K, Cheetham T. Short stature and pubertal delay in Duchenne muscular dystrophy. Arch Dis Child 2016; 101:101-6. [PMID: 26141541 DOI: 10.1136/archdischild-2015-308654] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/16/2015] [Indexed: 11/04/2022]
Abstract
Children with Duchenne muscular dystrophy (DMD) are shorter than their healthy peers. The introduction of corticosteroid (CS) has beneficial effects on muscle function but slows growth further and is associated with pubertal delay. In contrast to CS usage in most children and adolescents, weaning glucocorticoid is not a key objective of management in DMD. As the outlook for these young people improves, one of the main challenges is to reduce or offset the detrimental effects of CS on growth and development. This is a review of the aetiology and prevalence of short stature and delayed puberty in DMD, a summary of the treatments available and suggestions for areas of further research.
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Affiliation(s)
- Claire L Wood
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle upon Tyne, UK
| | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle upon Tyne, UK
| | - Michela Guglieri
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle upon Tyne, UK
| | - Kate Bushby
- The John Walton Muscular Dystrophy Research Centre and MRC Centre for Neuromuscular Diseases, Institute of Genetic Medicine, Newcastle upon Tyne, UK
| | - Tim Cheetham
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK Institute of Genetic Medicine, Newcastle upon Tyne, UK
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Servais L, Montus M, Guiner CL, Ben Yaou R, Annoussamy M, Moraux A, Hogrel JY, Seferian AM, Zehrouni K, Le Moing AG, Gidaro T, Vanhulle C, Laugel V, Butoianu N, Cuisset JM, Sabouraud P, Cances C, Klein A, Leturcq F, Moullier P, Voit T. Non-Ambulant Duchenne Patients Theoretically Treatable by Exon 53 Skipping have Severe Phenotype. J Neuromuscul Dis 2015; 2:269-279. [PMID: 27858743 PMCID: PMC5240539 DOI: 10.3233/jnd-150100] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Exon skipping therapy is an emerging approach in Duchenne Muscular Dystrophy (DMD). Antisense oligonucleotides that induce skipping of exon 51, 44, 45, or 53 are currently being evaluated in clinical trials. These trials were designed on the basis of data available in general DMD population. OBJECTIVES Our objective was to compare the clinical and functional statuses of non-ambulant DMD patients theoretically treatable by exon 53 skipping and of DMD patients with other mutations. METHODS We first compared fifteen non-ambulant DMD patients carrying deletions theoretically treatable by exon 53 skipping (DMD-53) with fifteen closely age-matched DMD patients with mutations not treatable by exon 53 skipping (DMD-all-non-53) then with fifteen DMD patients carrying deletions not treatable by exon 53 skipping (DMD-del-non-53). RESULTS We found that DMD-53 patients had a lower left ventricular ejection fraction, more contractures and they tend to have weaker grips and pinch strengths than other DMD patients. DMD-53 patients lost ambulation significantly younger than other DMD patients. This result was confirmed by comparing ages at loss of ambulation in all non-ambulant DMD patients of the DMD cohort identified in a molecular diagnostic lab. CONCLUSIONS These prospective and retrospective data demonstrate that DMD-53 patients have clinically more severe phenotypes than other DMD patients.
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Affiliation(s)
- Laurent Servais
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
| | | | - Caroline Le Guiner
- Généthon, Evry, France
- Atlantic Gene Therapies, INSERM UMR, Nantes, France
| | - Rabah Ben Yaou
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
- Laboratoire de biochimie et génétique moléculaire, Hôpital Cochin, APHP, Paris, France
| | - Mélanie Annoussamy
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
| | - Amélie Moraux
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
| | - Jean-Yves Hogrel
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
| | - Andreea M. Seferian
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
| | - Karima Zehrouni
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
| | - Anne-Gaëlle Le Moing
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
| | - Teresa Gidaro
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
| | - Catherine Vanhulle
- Service de Pédiatrie, Centre Hospitalier Universitaire (CHU), Rouen, France
| | - Vincent Laugel
- Service de Pédiatrie, Centre Hospitalier Universitaire (CHU), Strasbourg, France
| | - Nina Butoianu
- Pediatric Neurology Clinic, Alexandru Obregia Hospital, Bucharest, Romania
| | - Jean-Marie Cuisset
- Service de Neuropédiatrie, Centre hospitalier régional universitaire et faculté de médecine, Lille, France
| | - Pascal Sabouraud
- Service de Pédiatrie A, Hôpital Américain, CHU de Reims, Reims, France
| | - Claude Cances
- Service de Neurologie Pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Andrea Klein
- Department of pediatric neurology, University Children’s Hospital, Zurich, Switzerland
| | - France Leturcq
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
- Laboratoire de biochimie et génétique moléculaire, Hôpital Cochin, APHP, Paris, France
| | - Philippe Moullier
- Généthon, Evry, France
- Atlantic Gene Therapies, INSERM UMR, Nantes, France
| | - Thomas Voit
- Institut de Myologie, Groupe hospitalier La Pitié Salpêtrière, AP-HP, Paris, France
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Davis J, Samuels E, Mullins L. Nutrition Considerations in Duchenne Muscular Dystrophy. Nutr Clin Pract 2015; 30:511-21. [PMID: 25977513 DOI: 10.1177/0884533615586202] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is a serious degenerative muscular disease affecting males. Diagnosis usually occurs in childhood and is confirmed through genetic testing and/or muscle biopsy. Accompanying the disease are several nutrition-related concerns: growth, body composition, energy and protein requirements, constipation, swallowing difficulties, bone health, and complementary medicine. This review article addresses the nutrition aspects of DMD.
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Davidson ZE, Ryan MM, Kornberg AJ, Sinclair K, Cairns A, Walker KZ, Truby H. Observations of body mass index in Duchenne muscular dystrophy: a longitudinal study. Eur J Clin Nutr 2014; 68:892-7. [PMID: 24824013 DOI: 10.1038/ejcn.2014.93] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 03/06/2014] [Accepted: 04/06/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Nutritional issues that are associated with Duchenne muscular dystrophy (DMD) remain poorly understood. The aim of this analysis was to describe and explore longitudinal observations of body mass index (BMI) in a cohort of children with DMD. SUBJECTS/METHODS Anthropometric and clinical characteristics were collected retrospectively and longitudinally for boys with DMD seen in two large neuromuscular clinics. BMI Z-scores were determined using the Centers for Disease Control and Prevention reference values for children (2000). RESULTS Medical records (n=193) were examined from which 75% were included for analysis. The mean age of the cohort at the time of data collection was 11.9 years, with 72% of patients currently or previously using steroids. The highest prevalence of obesity based on the BMI Z-score was 50% at the age of 10 years. Longitudinally, BMI Z-scores from the age of 2 to 12 years plot approximately one s.d. above the mean, after which there is a marked and progressive decline. BMI gainers were identified for whom BMI Z-score increased by 1.65 units compared with the 0.09 units in non-gainers. BMI gainers were younger when they had their first BMI measurement (5.9 vs 7.2 years), and this measure was significantly lower compared with the non-gainers (BMI Z-score: 0.04 vs 1.17). In this cohort, BMI was associated with age, ambulatory status and lung function. CONCLUSIONS This study demonstrates that boys with DMD using steroid therapy experience shifts in BMI. A declining BMI appears to be associated with increasing age. Interpretation of growth patterns is limited here by a lack of normative growth references in DMD.
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Affiliation(s)
- Z E Davidson
- 1] Department Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia [2] Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - M M Ryan
- 1] Murdoch Childrens Research Institute, Melbourne, Victoria, Australia [2] Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - A J Kornberg
- 1] Murdoch Childrens Research Institute, Melbourne, Victoria, Australia [2] Department of Neurology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - K Sinclair
- Neurosciences Department, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - A Cairns
- Neurosciences Department, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - K Z Walker
- Department Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia
| | - H Truby
- Department Nutrition and Dietetics, Monash University, Melbourne, Victoria, Australia
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Abstract
OPINION STATEMENT • Duchenne muscular dystrophy (DMD), the most common and severe type of dystrophinopathy, is a progressive disease affecting primordially skeletal and cardiac muscle. A coordinated multidisciplinary approach is required to address its multisystemic manifestations and secondary problems.• Treatment with glucocorticosteroids (GCS) is accepted as standard of care in ambulant DMD. Daily and intermittent administrations are both in common use with different efficacy and different side effect profile.• There are no established guidelines for age/stage at initiation and treatment duration of GCS. Common practice is initiation of GCS before the child is starting to decline (between age 3 and 6 years) and continuation of monitored treatment after loss of ambulation, aiming at delaying cardiac and respiratory manifestations and preventing the development of scoliosis.• Prevention, monitoring, and treatment of the side effects of long-term chronic GCS use, such as excessive weight gain, hypertension, osteoporosis, impairment of glucose metabolism, delayed puberty, and cataract, should be integrated in the standards of care.• Noninvasive ventilatory support associated with cough assisting techniques has significantly improved the longevity in DMD.• Pharmacologic treatment for cardiac manifestations includes the standard treatments of dilated cardiomyopathy and arrhythmia such as the use of angiotensin converting enzyme (ACE) inhibitors, beta-blockers and diuretics. The lack of robust controlled data hampers clear recommendations about preventive treatment with ACE inhibitors.• DMD is associated with low bone mineral content, which is aggravated by the use of corticosteroids. The use of biphosphonates can be considered in the treatment of painful vertebral fractures. The use of biphosphonates as a preventive treatment should be investigated in randomized controlled studies.• DMD has evolved from a pediatric disease to an adult condition. This underscores the need to prepare adult neurologists for the optimal surveillance and management of patients with a severe chronic disease that have outgrown the pediatric care and that may develop new disease manifestations with improved longevity.
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Sarrazin E, von der Hagen M, Schara U, von Au K, Kaindl AM. Growth and psychomotor development of patients with Duchenne muscular dystrophy. Eur J Paediatr Neurol 2014; 18:38-44. [PMID: 24100172 DOI: 10.1016/j.ejpn.2013.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 07/19/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
Duchenne muscular dystrophy (DMD) is one of the most common hereditary degenerative neuromuscular diseases and caused by mutations in the dystrophin gene. The objective of the retrospective study was to describe growth and psychomotor development of patients with DMD and to detect a possible genotype-phenotype correlation. Data from 263 patients with DMD (mean age 7.1 years) treated at the Departments of Pediatric Neurology in three German University Hospitals was assessed with respect to body measurements (length, weight, body mass index BMI, head circumference OFC), motor and cognitive development as well as genotype (site of mutation). Anthropometric measures and developmental data were compared to those of a reference population and deviations were analyzed for their frequency in the cohort as well as in relation to the genotypes. Corticosteroid therapy was implemented in 29 from 263 patients. Overall 30% of the patients exhibit a short statue (length < 3rd centile) with onset early in development at 2-5 years of age, and this is even more prevalent when steroid therapy is applied (45% of patients with steroid therapy). The BMI shows a rightwards shift (68% > 50th centile) and the OFC a leftwards shift (65% < 50th centile, 5% microcephaly). Gross motor development is delayed in a third of the patients (mean age at walking 18.3 months, 30% > 18 months, 8% > 24 months). Almost half of the patients show cognitive impairment (26% learning disability, 17% intellectual disability). Although there is no strict genotype-phenotype correlation, particularly mutations in the distal part of the dystrophin gene are frequently associated with short stature and a high rate of microcephaly as well as cognitive impairment.
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Affiliation(s)
- Elisabeth Sarrazin
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; SPZ Pediatric Neurology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Institute of Cell and Neurobiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10115 Berlin, Germany.
| | - Maja von der Hagen
- Department of Pediatric Neurology, Universitätskinderklinik der TU Dresden, Germany
| | - Ulrike Schara
- Department of Pediatric Neurology, Universitätskinderklinik Essen, Germany
| | - Katja von Au
- SPZ Pediatric Neurology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; SPZ Pediatric Neurology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Institute of Cell and Neurobiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10115 Berlin, Germany
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West NA, Yang ML, Weitzenkamp DA, Andrews J, Meaney FJ, Oleszek J, Miller LA, Matthews D, DiGuiseppi C. Patterns of growth in ambulatory males with Duchenne muscular dystrophy. J Pediatr 2013; 163:1759-1763.e1. [PMID: 24103921 DOI: 10.1016/j.jpeds.2013.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 05/31/2013] [Accepted: 08/07/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide weight-for-age, height-for-age, and body mass index-for-age growth reference standards for ambulatory, steroid-naïve males, ages 2-12 years, with Duchenne muscular dystrophy (DMD) and to compare these growth curves to the 2000 Centers for Disease Control and Prevention growth charts for boys, which serve as references of physical size and growth for the general male pediatric population in the US. STUDY DESIGN Through a multi-state population-based surveillance of individuals with muscular dystrophy, a total of 1877 weight and 1544 height measurements ascertained during 1985-2010 from 513 males with DMD were obtained retrospectively from medical record review. Cases were classified as DMD if loss of ambulation occurred before the 12th birthday or, if younger than 12 years and still ambulating, the earliest symptoms of dystrophinopathy occurred before the 6th birthday. Each growth chart was constructed using 5 percentiles: 10th, 25th, 50th, 75th, and 90th. Smoothing procedures were applied in 2 stages to the irregular plots of the empirical percentile values. RESULTS A set of growth curves, derived from a large cohort of male youth with DMD, are presented. These curves demonstrate that DMD males are shorter and tend to the extremes of weight and body mass index compared with the general male pediatric population in the US. CONCLUSION Charts representing the pattern of growth in ambulatory, steroid-naïve males with DMD can facilitate monitoring of growth and early detection of unusual growth patterns. Use of these growth standards also will assist in monitoring responses to corticosteroid treatment.
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Affiliation(s)
- Nancy A West
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO.
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Mcdonald CM, Han JJ, Mah JK, Carter GT. Corticosteroids and duchenne muscular dystrophy: Does earlier treatment really matter? Muscle Nerve 2012; 45:777-9. [DOI: 10.1002/mus.23304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Leung DG, Germain-Lee EL, Denger BE, Wagner KR. Report on the Second Endocrine Aspects Of Duchenne Muscular Dystrophy Conference December 1-2, 2010, Baltimore, Maryland, USA. Neuromuscul Disord 2011; 21:594-601. [PMID: 21763136 DOI: 10.1016/j.nmd.2011.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/07/2011] [Accepted: 04/15/2011] [Indexed: 11/28/2022]
Affiliation(s)
- D G Leung
- Center for Genetic Muscle Disorders, The Kennedy Krieger Institute, USA
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Endocrine Aspects of Duchenne Muscular Dystrophy. Neuromuscul Disord 2011; 21:298-303. [DOI: 10.1016/j.nmd.2011.02.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Revised: 01/24/2011] [Accepted: 02/02/2011] [Indexed: 11/21/2022]
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Banerjee B, Sharma U, Balasubramanian K, Kalaivani M, Kalra V, Jagannathan NR. Effect of creatine monohydrate in improving cellular energetics and muscle strength in ambulatory Duchenne muscular dystrophy patients: a randomized, placebo-controlled 31P MRS study. Magn Reson Imaging 2010; 28:698-707. [PMID: 20395096 DOI: 10.1016/j.mri.2010.03.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 02/24/2010] [Accepted: 03/05/2010] [Indexed: 11/18/2022]
Abstract
Randomized, placebo-controlled single blinded study was carried out to evaluate the effect of oral creatine supplementation on cellular energetics, manual muscle test (MMT) score and functional status in steroid-naive, ambulatory boys suffering with Duchenne muscular dystrophy (DMD; n=33). Eighteen patients received creatine monohydrate (Cr; 5 g/day for 8 weeks), while 15 received placebo (500 mg of vitamin C). Phosphorus metabolite ratios were determined from the right calf muscle of patients using phosphorus magnetic resonance spectroscopy ((31)P MRS) both prior to (baseline) and after supplementation of Cr or placebo. In addition, metabolite ratios were determined in normal calf muscle of age and sex matched controls (n=8). Significant differences in several metabolite ratios were observed between controls and DMD patients indicating a lower energy state in these patients. Analysis using analysis of covariance adjusted for age and stature showed that the mean phosphocreatine (PCr)/inorganic phosphate (Pi) ratio in patients treated with Cr (4.7; 95% CI; 3.9-5.6) was significantly higher (P=.03) compared to the placebo group (3.3; 95% CI; 2.5-4.2). The mean percentage increase in PCr/Pi ratio was also more in patients <7 years of age compared to older patients after Cr supplementation indicating variation in therapeutic effect with the age. In the placebo group, significant reduction in PCr/Pi (P=.0009), PCr/t-ATP (P=.05) and an increase in phosphodiester (PDE)/PCr ratios was observed after supplementation. Further, in the placebo group, patients <7 years showed reduction of PCr/t-ATP and Pi/t-ATP compared to older patients (>7 years), after supplementation. These results imply that the significant difference observed in PCr/Pi ratio between the Cr and the placebo groups after supplementation may be attributed to a decrease of PCr in the placebo group and an increase in PCr in the Cr group. Changes in MMT score between the two groups was significant (P=.04); however, no change in functional scale (P=.19) was observed. Parents reported subjective improvement on Cr supplementation versus worsening in placebo (P=.02). Our results indicated that Cr was well tolerated and oral Cr significantly improved the muscle PCr/Pi ratio and preserved the muscle strength in short term. However, this study provides no evidence that creatine will prove beneficial after long-term treatment, or have any positive effect on patient lifespan.
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Affiliation(s)
- Bidisha Banerjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Söderpalm AC, Magnusson P, Ahlander AC, Karlsson J, Kroksmark AK, Tulinius M, Swolin-Eide D. Low bone mineral density and decreased bone turnover in Duchenne muscular dystrophy. Neuromuscul Disord 2007; 17:919-28. [PMID: 17627820 DOI: 10.1016/j.nmd.2007.05.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 03/27/2007] [Accepted: 05/25/2007] [Indexed: 11/29/2022]
Abstract
This cross-sectional study examined bone mineral density, bone turnover, body composition and calciotropic hormones in 24 boys with Duchenne muscular dystrophy (DMD) (2.3-19.7 years), most of whom were being treated with prednisolone, and 24 age-matched healthy boys. Our study demonstrated lower bone mineral density in the DMD group for total body, spine, hip, heel and forearm measurements. These differences between DMD patients and controls increased with increasing age. Biochemical markers of both bone formation and resorption revealed reduced bone turnover in DMD patients. The fracture rate was not higher in DMD patients. The DMD group had low vitamin D levels but high leptin levels in comparison with the control group. Muscle strength correlated with bone mineral density assessed at the hip and heel in the DMD group. Interventions that increase bone formation should be considered, as DMD patients have reduced bone turnover in addition to their low bone mineral density.
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Affiliation(s)
- Ann-Charlott Söderpalm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital/Ostra, Sahlgrenska Academy at Göteborg University, SE-416 85 Göteborg, Sweden.
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Weiss C, Jakubiczka S, Huebner A, Klopocki E, Kress W, Voit T, Hübner C, Schuelke M. Tandem duplication ofDMD exon 18 associated with epilepsy, macroglossia, and endocrinologic abnormalities. Muscle Nerve 2007; 35:396-401. [PMID: 17143888 DOI: 10.1002/mus.20705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We describe a patient with Duchenne muscular dystrophy (DMD) who additionally suffered from intractable seizures, severe mental retardation, and a marked macroglossia. He also had endocrinologic abnormalities consisting of growth hormone deficiency, delayed puberty, and adrenal hypoplasia. We detected a duplication of DMD exon 18 and flanking introns that caused a frame-shift and was not removed by corrective splicing. A coincident mutation in the FKRP gene was excluded by direct sequencing. Complex DNA rearrangements, deletions, and duplications >100 kb were excluded through microarray-comparative genomic hybridization (CGH), although we were not able to exclude a second coincident mutation with certainty. In conclusion, we present a case of DMD that conflicts with current understanding of genotype-phenotype relations and discuss putative pathogenetic mechanisms for this uncommon phenotype.
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Affiliation(s)
- Claudia Weiss
- Department of Neuropediatrics, Charité University Medical Center, Augustenburger Platz 1, D-13353 Berlin, Germany.
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Merlini L, Cicognani A, Malaspina E, Gennari M, Gnudi S, Talim B, Franzoni E. Early prednisone treatment in Duchenne muscular dystrophy. Muscle Nerve 2003; 27:222-7. [PMID: 12548530 DOI: 10.1002/mus.10319] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this long-term, open parallel-group, double-consent study of alternate-day, low-dose prednisone in 2-4-year-old patients with Duchenne muscular dystrophy (DMD) was to determine whether prednisone produces a beneficial effect when given earlier than usual. Muscle function was evaluated by timed tests, and muscle strength with a hand-held myometer. After 55 months of treatment, the five patients (mean age 8.3 years) in the prednisone group were still able to get up from the floor, whereas two of the three in the control group had lost this ability. Side effects included a decline in growth rate in the prednisone-treated patients and excessive weight gain in one control and three treated patients. Because steroids are effective in prolonging function, but not in recovering lost function, we propose that treatment be started with low-dose prednisone in DMD patients as soon as the diagnosis is definite.
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Affiliation(s)
- Luciano Merlini
- Neuromuscular Unit, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
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Abstract
Dysphagia and aspiration seem to be rare in Duchenne muscular dystrophy, but cachexia can be associated with early death. Commonly, weight loss can be attributed to inadequate caloric intake caused by loss of ability to self-feed and/or fatigue. Our objective was to determine whether scoliosis repair is associated with malnutrition. A retrospective chart review was undertaken of patients with Duchenne muscular dystrophy, including those who underwent operative repair of scoliosis. We identified nine boys who lost > 5% body weight within 12 months of surgery. Eight patients who gained weight after surgery and eight patients of comparable age who had no surgery served as control subjects. All patients had no change in biceps strength after surgery, but those who lost weight were unable to self-feed. We found that weight loss after surgery was associated with loss of self-feeding. We conclude that pre- and postoperative management of patients with Duchenne muscular dystrophy should include feeding evaluation and determination of postural changes.
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Affiliation(s)
- Susan T Iannaccone
- Department of Neurology, Texas Scottish Rite Hospital for Children, Dallas TX, USA.
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Al-Shekhlee A, Katirji B. Sensory Mononeuropathy Multiplex in Chronic Graft versus Host Disease. J Clin Neuromuscul Dis 2001; 2:184-186. [PMID: 19078633 DOI: 10.1097/00131402-200106000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Graft versus host disease (GVHD) is a frequent complication of bone marrow transplantation (BMT). Peripheral neuropathies in association with chronic GVHD are uncommon. We report a patient with BHT for chronic myeloid leukemia, and chronic GVHD with severe sclerodermatitis resulting in bilateral medial antebrachial and saphenous sensory mononeuropathies.
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Affiliation(s)
- A Al-Shekhlee
- From the Department of Neurology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
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