Beneficial effects of penicillamine treatment on hereditary avian muscular dystrophy

Oxidative stress and the pathogenesis of muscular dystrophies

The muscular dystrophies represent a diverse group of diseases differing in underlying genetic basis, age of onset, mode of inheritance, and severity of progression, but they share certain common pathologic features. Most prominent among these features is the necrotic degeneration of muscle fibers. Although the genetic basis of many of the dystrophies has been known for over a decade and new disease genes continue to be discovered, the pathogenetic mechanisms leading to muscle cell death in the dystrophies remain a mystery. This review focuses on the oxidative stress theory, which states that the final common pathway of muscle cell death in these diseases involves oxidative damage.

Monocyte function in chickens with hereditary muscular dystrophy

Monocyte functions of Storrs strain muscular dystrophic (MD) chickens and Storrs control strain were compared. After short-term in vitro culture of monocytes, cells taken from Storrs MD chickens had a significantly lower incidence of cells capable of phagocytizing sheep red blood cells than did cells cultured from the control strain. In contrast, no difference was found in the ability of MD vs. control strain blood mononuclear cells to undergo in vitro chemotaxis in response to a bacterial culture supernatant. The study also revealed a distinct peripheral blood leukocyte profile of young MD chickens: elevated percentages and absolute numbers of granulocytes. The total leukocyte count in MD chickens was not significantly different from that of normal chickens. These findings extend previous observations concerning altered reticuloendothelial system function in MD strain chickens.

Pathogenesis of progressive muscular dystrophy: studies on free radical metabolism in an animal model

Evidence to suggest the presence of abnormal metabolism of oxygen free radicals in progressive muscular dystrophy is presented using an animal model. In the superficial pectoral muscles of dystrophic chickens, enzyme activities regulating the metabolism of oxygen free radicals, i.e., catalase, superoxide dismutases and glutathione peroxidase, were significantly elevated within 1 week of hatching. Activities of related enzymes, i.e., glutathione reductase, glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase were also elevated. In contrast, the specific activity of phosphofructokinase, the rate-limiting enzyme of the glycolytic pathway, was normal during the first 4-week period. These results suggest that there is an increased turnover of oxygen free radicals in the dystrophic muscle. This concept appears important in a further investigation of the pathogenesis and treatment of progressive muscular dystrophies.

Interactions of vitamin E and penicillamine in the treatment of hereditary avian muscular dystrophy

Our prior work demonstrated that penicillamine treatment of dystrophic chickens delayed the onset of symptoms, partially alleviated contractures, improved muscle function, and lowered serum creatine kinase. Penicillamine, a sulfhydryl compound with reducing properties, also prevented inactivation of glycolytic enzymes by protecting thiol groups. The present study shows that vitamin E enhances the therapeutic effects of penicillamine. Interaction of these two reductants is dose related. With vitamin E as adjunct therapy, the dosage level of penicillamine could be lowered by 50%, thereby minimizing side effects. The therapeutic rationale for two antioxidants is that penicillamine may act primarily in the cytoplasm to prevent oxidative damage, whereas the more hydrophobic vitamin E may protect membrane bilayers. Additionally, penicillamine may prevent collagen cross-linking and, deposition of insoluble collagen in muscle and thus decrease contracture formation. General applications of combined penicillamine and vitamin E therapy are discussed regarding prevention of free radical and oxidative damage in Duchenne dystrophy and a wide range of human diseases.

Free radicals: a potential pathogenic mechanism in inherited muscular dystrophy

Despite years of intensive work, the biochemical defect responsible for the pathogenesis of inherited muscular dystrophy has not been identified either in humans or animal models. This review examines evidence in support of the hypothesis that free radicals may be responsible for muscle degeneration in this disorder. A variety of cellular abnormalities noted in dystrophic muscles can be accounted for by free radical mediated damage. In addition, chemical by-products associated with free radical damage are found in dystrophic muscle tissue from humans and animals with this disease. Various enzymatic antioxidant systems can be enhanced as a normal cellular response to oxidative stress, and such changes are seen both in dystrophic muscle cells and certain other tissues of dystrophic animals. An increased level of free radical damage would follow from either: enhanced production of free radical species, or a deficient component of the cellular antioxidant system, such as vitamin E. The free radical hypothesis of muscular dystrophy can account for data supporting several alternative theories of the pathogenesis of this disease, as well as other observations which have not previously been explained.

Glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase and glyceraldehyde-3-phosphate dehydrogenase activities in early stages of development in dystrophic chickens

Glucose-6-phosphate dehydrogenase (G6PDH), 6-phosphogluconate dehydrogenase (6PGDH) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) activities were assayed in superficial pectoral muscles of hereditary dystrophic chickens, 1 week, 2 weeks, 4 weeks and 4 months after hatching. In control chickens, activities of G6PDH and 6PGDH were very low at 4 months of age; however, at 1 week of age, they were much higher than those at 4 months of age. Activities of G6PDH and 6PGDH were significantly higher in dystrophic chickens compared with those in the controls at all the stages of development studied. These findings suggest that considerable activities of G6PDH and 6PGDH are present within the pectoral muscle cells at early stages of development, at least in dystrophic chickens. GAPDH activity was significantly lower in dystrophic chickens at 2 weeks, 4 weeks and 4 months of age compared with those in control chicken. These findings together with our previous studies (Mizuno 1984a,b) in which increased activities of superoxide dismutases, catalase, glutathione peroxidase and glutathione reductase were reported in dystrophic chickens, indicate the presence of an increased capacity for the turnover of oxygen-free radicals within muscle cells in dystrophic chickens, and that oxygen-free radicals and the related activated oxygen species may be playing a role in inducing cellular damage.

In vivo effects of three calcium blockers on chickens with inherited muscular dystrophy

Genetically homozygous Line 413 dystrophic chickens were given in separate trials daily i.p. injections of aqueous solutions of the calcium blocker drugs, diltiazem, verapamil, or nifedipine. At a dosage of 20 mg/kg/day, drug therapy in each case significantly prolonged the functional ability of the dystrophic chickens as quantitated regularly by a standardized test for righting ability. Enhanced functional ability, however, was not generally accompanied by a decrease in the usually high plasma creatine kinase activity. In addition, there was no change in the pectoralis muscle mass or protein with any of the drug treatments. Moreover, no significant reduction in the abnormally high total muscle calcium was found with calcium blocker treatment. Also, there was no marked change in the histopathology of muscle from the drug-treated dystrophic chickens. We concluded that drugs with calcium entry blocker activity offer only limited benefit in retarding dystrophic symptoms expressed in the chicken (viz., short-term enhancement in righting ability).

Changes in superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase activities and thiobarbituric acid-reactive products levels in early stages of development in dystrophic chickens

Cu-Zn superoxide dismutase, Mn superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase activities and thiobarbituric acid-reactive products were assayed in the superficial pectoral muscles of genetically dystrophic chickens (line 413) and their controls (line 412) 1, 2, and 4 weeks, and 4 months after hatching. In control chickens, all these enzyme activities declined as they grew older. In dystrophic chickens, all these enzyme activities were significantly elevated at all stages of development studied, and their developmental time courses were quite different from those in the controls. Thiobarbituric acid-reactive products were also significantly elevated in dystrophic chickens after 2 weeks of age. Invasion of macrophages and lipid cells were not manifest until 4 weeks after hatching in the dystrophic chickens studied. Therefore, observed abnormalities were considered to represent biochemical pathologies within muscle cells. Increased activities of the enzymes which are responsible for the regulation of active oxygen species and the elevated thiobarbituric acid-reactive products would indicate the presence of increased turnover of those active oxygen species. These findings indicated that active oxygen species were playing a significant role in the pathogenesis of muscular dystrophies. The possible mechanisms of cellular damage by active oxygen species are discussed.

Drugs in muscular dystrophy of the chicken: corticosterone-21-acetate

In a previous series of 22-day evaluations of 31 compounds, only corticosterone-21-acetate (C-21-A) increased righting ability of genetically dystrophic chickens to a greater extent than the standard of comparison, methysergide maleate. In the present study, C-21-A was subjected to longer-term trials of up to 48 days, and additional signs of the myopathy were examined. The highest doses of C-21-A increased righting ability for the duration of the trials, decreased the typically elevated plasma levels of creatine kinase (CK) activity by more than 80%, and improved morphology of the dystrophic pectoralis major muscle at the light microscopic level. The major adverse effect of C-21-A, reduction of body weight, was consistently observed at the relatively high doses needed to increase righting ability. That alone, however, could not account for increased righting ability, and plasma CK activity was decreased even at doses that did not reduce body weight. The results show that C-21-A is the most effective compound yet tested in this system and, perhaps more significantly, provides the first evidence that it is possible to identify compounds that improve muscle morphology in a hereditary myopathy using a short-term, step-wise system.

Sex differences in the phenotypic expression of avian dystrophy

Although the gene for muscular dystrophy in chickens is not sex-linked, results from clinical tests suggest that it is expressed differently in males and females. As measurement of muscle contractile responses provides a quantitative index for the severity of the disease, the contractile properties of the extensor digitorum communis muscle were examined in normal and dystrophic chickens with respect to sex. Furthermore, these differences were examined in young (6 to 9 weeks) and old (greater than 6 months) chickens. Results showed that age-related sex differences were apparent for those mechanical parameters of the muscle (in particular the posttetanic potentiation and posttetanic contracture) known to distinguish normal and dystrophic birds. The sex differences observed in the younger group indicate that the female birds were more severely affected by the disease than were the male. In the older group, the male were affected by the disease more severely than age-matched female birds. If the inheritance pattern is truly autosomal then it is likely that one or more developmental factors interact with the dystrophic genotype and alter the dystrophic phenotype.

Prevention of doxorubicin cardiac toxicity in the mouse by N-acetylcysteine

This study was undertaken to investigate the effect of exogenous sulfhydryl compound administration on the toxicity of doxorubicin in mice. Pretreatment of CDF1 mice with a pharmacologic dose (2,000 mg/kg) of n-acetyl-l-cysteine 1 h before doxorubicin (20 mg/kg, i.p.) decreased lethality from 100% (n = 44) to 37.7% (n = 53), P less than 0.001. Variation in the timing and dose of n-acetylcysteine significantly diminished its protective activity. Pretreatment with n-acetylcysteine also significantly reduced long-term mortality in animals receiving multiple doses of doxorubicin; 10 wk after the third of three doxorubicin doses (5 mg/kg, i.p.) administered at 2-wk intervals, survival in the n-acetylcysteine pretreated group was 51.4% (n = 35) compared with 16.7% (n = 30) for animals receiving saline before doxorubicin, P less than 0.01. In this experiment, n-acetylcysteine pretreatment also diminished doxorubicin-related losses in total body weight and heart wet weight by 55.2% (P less than 0.05), and 60.9% (P less than 0.02), respectively, compared with animals pretreated with saline. N-acetylcysteine pretreatment also ablated electron microscopic evidence of doxorubicin cardiomyopathy without alleviating morphological features of its toxic effects on the liver or small intestinal mucosa. The cardioprotective action of n-acetylcysteine may be partially explained by the 429 +/- 60% increase in cardiac nonprotein sulfhydryl content (P less than 0.01) that was measured one hour after n-acetylcysteine administration; nonprotein sulfhydryl concentration in the liver at the same time was insignificantly different from control levels. Treatment with n-acetylcysteine also increased the nonprotein sulfhydryl content of P388 leukemia cells nearly threefold; however, it did not after the chemotherapeutic activity of doxorubicin against this murine tumor. Whereas n-acetylcysteine blocked doxorubicin cardiac toxicity, it did not affect the uptake or metabolism of doxorubicin in the heart or liver. These results suggest that the concentration of free sulfhydryl groups in the heart may play a role in the development of doxorubicin cardiac toxicity and that augmenting cardiac nonprotein sulfhydryl group content with n-acetylcysteine may provide a means to enhance the chemotherapeutic index of doxorubicin.

In vivo effects of protease inhibitors on chickens with hereditary muscular dystrophy

Beginning on day 4 ex ovo, and every 3 d thereafter, genetically dystrophic Line 413 chickens were given intraperitoneal injections (4 mg/kg body wt) of a protease inhibitor, leupeptin, pepstatin, or antipain. Experimental chickens received protease inhibitors dissolved in a water:ethanol:dimethyl sulfoxide solution (50:40:10, vol:vol:vol). Control untreated animals received diluent injections. Untreated dystrophic chickens typically reach around day 30 ex ovo a maximum ability to right from the supine position in a standardized functional test for muscle weakness. After day 30 ex ovo, the dystrophic chickens are found to decline progressively in their ability to right, compared with normal, nondystrophic controls, which have an unimpaired ability to right. Concomitantly, dystrophic chickens exhibit characteristically high levels of plasma creatine phosphokinase enzyme activity. In addition, an increased frequency of degenerating, regenerating, and vacuolated myofibers, and inflammatory cells appear in the affected pectoralis major muscles from the dystrophic chicken. Throughout the duration of the trial, there was no major enhancement in the functional righting ability of dystrophic chickens receiving any one of the protease inhibitors tested. However, there was a significant reduction in the abnormally high levels of plasma creatine phosphokinase in the treated chickens. Also, there was an apparent reduction in the mean number of vacuolated fibers in the pectoralis muscle from the protease inhibitor-treated birds. No significant reductions were observed in the relative frequency of degenerating and regenerating myofibers or inflammatory cells. In addition to the plasma creatine phosphokinase decrease, however, therapeutic benefit was seen in 31.0, 30.5, and 14.8% increases in the wet weight (and total noncollagen protein) of pectoralis muscle from dystrophic chickens receiving leupeptin, pepstatin or antipain, respectively.

Enhancement of free radical reduction by elevated concentrations of ascorbic acid in avian dystrophic muscle

It has been postulated that the degenerative process in dystrophic muscle results from increased concentrations of free radicals, peroxides, or lipid hydroperoxides. Therefore, the reduction of the free radical tanol (2,2,6,6-tetramethyl-4-piperidinol-1-oxyl) by extracts of muscles of dystrophic and normal chickens was studied. Pectoral (white) and thigh (red) muscles were used. For initial rate measurements, the various muscle extracts were added to an equal volume of 0.2 mM tanol. Reaction mixtures were introduced into the EPR cavity in a standard aqueous flat cell. Rates were measured by continuously monitoring the decrease in signal amplitude of the center (MI = 0) solution tanol EPR resonance line (in-phase first harmonic absorption signal). With extracts from dystrophic white muscle, the reduction rate was 75% faster than normal, whereas in dystrophic red muscle extracts the rate was normal. This agreed with previous observations that white muscle is more severely affected than red in dystrophic chickens. The primary reductant was identified as reduced ascorbic acid, and the rate of reduction of tanol correlated directly with the concentrations of ascorbic acid in the various muscle extracts as shown by chemical analysis. The results suggest an involvement of the intracellular redox status in the pathogenesis of avian muscular dystrophy.

Suppression of myotonia in dystrophic chicken muscle by phenytoin

We describe myotonic electromyographic activity in muscles of genetically dystrophic chickens and show that this activity is antagonized in vivo by doses of phenytoin (DPH) that improve righting ability. To test the possibility that the in vivo effects of DPH can be accounted for by a direct action on skeletal muscle we studied posterior latissimus dorsi fibers in vitro at 23 degrees C with intracellular microelectrodes. Compared to normal fibers, fibers from untreated dystrophic chicks had larger diameters, increased membrane capacitance, longer latencies at rheobase, and a greater tendency to fire repetitively in response to direct stimulation. DPH (10 or 50 micrograms/ml in the bath solution) decreased latencies at rheobase and repetitive firing in fibers from untreated chicks. In DPH-free solution fibers from dystrophic chicks treated chronically with DPH were still abnormal with respect to latencies at rheobase and ease of repetitive firing. The data support the hypothesis that abnormalities of membrane electrical properties are major features of dystrophic chicken muscles and furthermore, show that DPH suppresses, but does not abolish, these abnormalities.

New muscle transplant method produces normal twitch tension in dystrophic muscle

Grafting newborn muscle is an innovative method of muscle transplant. This method overcomes hypoxia in the deeper fibers and facilitates reinnervation and revascularization of the grafted muscle fibers, thus promoting the survival and development of the characteristics of the donor muscle. The result achieved is superior to that obtained from mature muscle grafts or from minced muscle transplants. When an intact soleus from a 1-day-old normal mouse was grafted into a recipient soleus of a 20-day-old dystrophic C57BL/6J-dy2J mouse, the actively developing normal graft helped to improve the structure and function of the dystrophic muscle. When compared to the intact dystrophic solei, the test dystrophic muscles five to six months after operation showed increases in cross-sectional area, in wet weight, in twitch and tetanic tension, and in the number of muscle fibers with high resting membrane potentials. This is the first procedure to have raised the muscle twitch tension in an adult dystrophic mouse to the normal level.

Mechanism of action of penicillamine in the treatment of avian muscular dystrophy

Penicillamine, a cysteine analog with a reduced sulfhydryl group, has been used in this laboratory for the treatment of hereditary avian dystrophy. The drug delays the onset of symptoms and alleviates the debilitating aspects of the disease. To study the mechanism of drug action, the effects of penicillamine on white and red muscles of dystrophic chickens were examined with regard to the specific activities of the soluble enzymes glyceraldehyde-3-phosphate dehydrogenase, acetylphosphatase, glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase, glutathione reductase, glutathione preoxidase, superoxide dismutase, and catalase. The sulfhydryl contents of the soluble proteins and the concentration of myoglobin were also determined. In white dystrophic muscle (pectoral), there were large alterations in the various enzymatic activities compared to normal levels. In the DISCUSSION, these changes are related to the pathogenesis of the disease and to the adaptive response for protection of the severely affected fast fibers. Red dystrophic muscles (thigh) were minimally involved, in accordance with the known sparing action of the slow fiber type. The results suggested that the disease process in dystrophic muscle may be due to oxidation of the essential sulfhydryl groups of proteins. Penicillamine may produce therapeutic effects by altering the intracellular redox status, thereby promoting better regulation of enzymatic activity, membrane stability, and improved muscle function.

Delayed functional disability in dystrophic chickens receiving chemotherapy

Line 413 early-onset, genetically homozygous dystrophic chickens were given twice-daily intraperitoneal injections of the antiserotoninergic drug cinanserin, alone or in combination with methysergide. Other trials consisted of penicillamine treatment in combination with either methysergide or cyproheptadine. Chemotherapy significantly prolonged the righting ability of treated dystrophic chickens, as measured by a periodic standardized flip-test procedure. Plasma creatine kinase activities were not affected by any of the various drug treatments. However, the blood serotonin levels of the dystrophic chickens (grand mean 1.47 microgram serotonin/ml blood) were found to be significantly higher (p less than 0.001) than those in the corresponding normal chickens (0.99 microgram/ml). This finding may partially account for the antiserotoninergic drug enhancement in righting ability that was demonstrated in the drug-treated dystrophic chickens.

Role of intracellular calcium in promoting muscle damage: a strategy for controlling the dystrophic condition

It is suggested that various muscle diseases and examples of experimentally-induced muscle damage arise because of a high calcium level in the myoplasm. When [Ca2+]i is raised experimentally in amphibian or mammaliam muscle by treatment with A23187 or caffeine, myofilament degradation follows quickly. Such a rapid action suggests the involvement of a sequence of proteolytic activity that is stimulated by a rise in [Ca2+]i. Ca2+ might either trigger protease activity directly or indirectly, or promote the release of lysosomal enzymes. A high [Ca2+]i in dystrophic muscle is believed to be the resultant of a sequence of events that is summarized in the figure. Suggestions are presented for different ways in which the steady-state position of [Ca2+]i might ultimately be controlled for the clinical amelioration of some dystrophic conditions.

Muscular dystrophy: inhibition of degeneration in vivo with protease inhibitors

The protease inhibitors leupeptin and pepstatin were used in vivo in genetically dystrophic chickens to determine their effects on the histological and biochemical changes observed in this disease. These compounds appear to delay the degeneration of muscle tissue which is characteristic of this disorder and thus may have potential therapeutic value in the treatment of muscular dystrophy.

Avian muscular dystrophy: functional and biochemical improvement with diphenylhydantoin

Chicks affected with hereditary muscular dystrophy were injected twice daily with 20 milligrams of diphenylhydantoin per kilogram of body weight on days 1 to 40 after hatching. The righting ability of dystrophic chicks treated with diphenylhydantoin was improved compared to that of untreated dystrophic chicks, and acetylcholinesterase activity was reduced to normal levels in the posterior latissimus dorsi muscles.

Penicillamine treatment of hereditary avian muscular dystrophy

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Mitochondrial calcium overload: A general mechanism for cell-necrosis in muscle diseases

It is suggested that the mechanism of muscle-cell necrosis in various muscle diseases is explained by an increased net influx of calcium into cells which triggers a "vicious cycle" of mitochondrial calcium overloading and energy depletion. If correct, this hypothesis may offer the basis of a more rational treatment of some muscle diseases even before their primary aetiology is known.