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Schiava M, Lofra RM, Bourke JP, Díaz-Manera J, James MK, Elseed MA, Malinova M, Michel-Sodhi J, Moat D, Ghimenton E, Mccallum M, Díaz CFB, Mayhew A, Wong K, Richardson M, Tasca G, Eglon G, Eagle M, Turner C, Heslop E, Straub V, Bettolo CM, Guglieri M. Functional abilities, respiratory and cardiac function in a large cohort of adults with Duchenne muscular dystrophy treated with glucocorticoids. Eur J Neurol 2024; 31:e16267. [PMID: 38556893 DOI: 10.1111/ene.16267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/18/2024] [Accepted: 02/14/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND PURPOSE The transition to adult services, and subsequent glucocorticoid management, is critical in adults with Duchenne muscular dystrophy. This study aims (1) to describe treatment, functional abilities, respiratory and cardiac status during transition to adulthood and adult stages; and (2) to explore the association between glucocorticoid treatment after loss of ambulation (LOA) and late-stage clinical outcomes. METHODS This was a retrospective single-centre study on individuals with Duchenne muscular dystrophy (≥16 years old) between 1986 and 2022. Logistic regression, Cox proportional hazards models and survival analyses were conducted utilizing data from clinical records. RESULTS In all, 112 individuals were included. Mean age was 23.4 ± 5.2 years and mean follow-up was 18.5 ± 5.5 years. At last assessment, 47.2% were on glucocorticoids; the mean dose of prednisone was 0.38 ± 0.13 mg/kg/day and of deflazacort 0.43 ± 0.16 mg/kg/day. At age 16 years, motor function limitations included using a manual wheelchair (89.7%), standing (87.9%), transferring from a wheelchair (86.2%) and turning in bed (53.4%); 77.5% had a peak cough flow <270 L/min, 53.3% a forced vital capacity percentage of predicted <50% and 40.3% a left ventricular ejection fraction <50%. Glucocorticoids after LOA reduced the risk and delayed the time to difficulties balancing in the wheelchair, loss of hand to mouth function, forced vital capacity percentage of predicted <30% and forced vital capacity <1 L and were associated with lower frequency of left ventricular ejection fraction <50%, without differences between prednisone and deflazacort. Glucocorticoid dose did not differ by functional, respiratory or cardiac status. CONCLUSION Glucocorticoids after LOA preserve late-stage functional abilities, respiratory and cardiac function. It is suggested using functional abilities, respiratory and cardiac status at transition stages for adult services planning.
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Affiliation(s)
- Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Robert Muni Lofra
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - John P Bourke
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Jordi Díaz-Manera
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Meredith K James
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Maha A Elseed
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Monika Malinova
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Jassi Michel-Sodhi
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Dionne Moat
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Elisabetta Ghimenton
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Michelle Mccallum
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Carla Florencia Bolaño Díaz
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Anna Mayhew
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Karen Wong
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Mark Richardson
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Giorgio Tasca
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Gail Eglon
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | | | - Cathy Turner
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Emma Heslop
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Chiara Marini Bettolo
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
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Schiava M, McDermott MP, Broomfield J, Abrams KR, Mayhew AG, McDonald CM, Martens WB, Gregory SJ, Griggs RC, Guglieri M. Factors Associated With Early Motor Function Trajectories in DMD After Glucocorticoid Initiation: Post Hoc Analysis of the FOR-DMD Trial. Neurology 2024; 102:e209206. [PMID: 38710006 DOI: 10.1212/wnl.0000000000209206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical trials in Duchenne muscular dystrophy (DMD) require 3-6 months of stable glucocorticoids, and the primary outcome is explored at 48-52 weeks. The factors that influence the clinical outcome assessment (COA) trajectories soon after glucocorticoid initiation are relevant for the design and analysis of clinical trials of novel drugs. We describe early COA trajectories, associated factors, and the time from glucocorticoid initiation to COA peak. METHODS This was a prospective 18-month analysis of the Finding the Optimum Corticosteroid Regimen for Duchenne Muscular Dystrophy study. Four COAs were investigated: rise from supine velocity (RFV), 10-meter walk/run velocity (10MWRV), North Star Ambulatory Assessment (NSAA) total score, and 6-minute walk test distance (6MWT). The relationships of baseline age (4-5 vs 6-7 years), COA baseline performance, genotype, and glucocorticoid regimen (daily vs intermittent) with the COA trajectories were evaluated using linear mixed-effects models. RESULTS One hundred ninety-six glucocorticoid-naïve boys with DMD aged 4-7 years were enrolled. The mean age at baseline was 5.9 ± 1.0 years, 66% (n = 130) were on daily regimens, 55% (n = 107) showed a 6MWT distance >330 metres; 41% (n = 78) showed RFV >0.2 rise/s; 76% (n = 149) showed 10MWRV >0.142 10m/s, and 41.0% (n = 79) showed NSAA total score >22 points. Mean COA trajectories differed by age at glucocorticoid initiation (p < 0.01 for RFV, 10MWRV, and NSAA; p < 0.05 for 6MWT) and regimen (p < 0.01 for RFV, 10MWRV, and NSAA). Boys younger than 6 years reached their peak performance 12-18 months after glucocorticoid initiation. Boys aged 6 years or older on a daily regimen peaked between months 9 and 12 and those on an intermittent regimen by 9 months. The baseline COA performance was associated with the NSAA (p < 0.01) and the 6MWT trajectory in boys younger than 6 years on a daily regimen (p < 0.01). Differences in the mean trajectories by genotype were not significant. DISCUSSION Glucocorticoid regimen, age, duration of glucocorticoid exposure, and baseline COA performance need to be considered in the design and analysis of clinical trials in young boys with DMD.
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Affiliation(s)
- Marianela Schiava
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.G.M., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, United Kingdom; Department of Biostatistics and Computational Biology (M.P.M.); Department of Neurology, University of Rochester Medical Centre, NY; Department of Health Sciences (J.B., K.R.A.), University of Leicester, United Kingdom; Department of Physical Medicine and Rehabilitation (C.M.M.), University of California, Davis, Sacramento; and Department of Neurology (W.B.M., S.J.G., R.C.G.), University of Rochester Medical Centre, NY
| | - Michael P McDermott
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.G.M., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, United Kingdom; Department of Biostatistics and Computational Biology (M.P.M.); Department of Neurology, University of Rochester Medical Centre, NY; Department of Health Sciences (J.B., K.R.A.), University of Leicester, United Kingdom; Department of Physical Medicine and Rehabilitation (C.M.M.), University of California, Davis, Sacramento; and Department of Neurology (W.B.M., S.J.G., R.C.G.), University of Rochester Medical Centre, NY
| | - Jonathan Broomfield
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.G.M., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, United Kingdom; Department of Biostatistics and Computational Biology (M.P.M.); Department of Neurology, University of Rochester Medical Centre, NY; Department of Health Sciences (J.B., K.R.A.), University of Leicester, United Kingdom; Department of Physical Medicine and Rehabilitation (C.M.M.), University of California, Davis, Sacramento; and Department of Neurology (W.B.M., S.J.G., R.C.G.), University of Rochester Medical Centre, NY
| | - Keith R Abrams
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.G.M., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, United Kingdom; Department of Biostatistics and Computational Biology (M.P.M.); Department of Neurology, University of Rochester Medical Centre, NY; Department of Health Sciences (J.B., K.R.A.), University of Leicester, United Kingdom; Department of Physical Medicine and Rehabilitation (C.M.M.), University of California, Davis, Sacramento; and Department of Neurology (W.B.M., S.J.G., R.C.G.), University of Rochester Medical Centre, NY
| | - Anna G Mayhew
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.G.M., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, United Kingdom; Department of Biostatistics and Computational Biology (M.P.M.); Department of Neurology, University of Rochester Medical Centre, NY; Department of Health Sciences (J.B., K.R.A.), University of Leicester, United Kingdom; Department of Physical Medicine and Rehabilitation (C.M.M.), University of California, Davis, Sacramento; and Department of Neurology (W.B.M., S.J.G., R.C.G.), University of Rochester Medical Centre, NY
| | - Craig M McDonald
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.G.M., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, United Kingdom; Department of Biostatistics and Computational Biology (M.P.M.); Department of Neurology, University of Rochester Medical Centre, NY; Department of Health Sciences (J.B., K.R.A.), University of Leicester, United Kingdom; Department of Physical Medicine and Rehabilitation (C.M.M.), University of California, Davis, Sacramento; and Department of Neurology (W.B.M., S.J.G., R.C.G.), University of Rochester Medical Centre, NY
| | - William B Martens
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.G.M., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, United Kingdom; Department of Biostatistics and Computational Biology (M.P.M.); Department of Neurology, University of Rochester Medical Centre, NY; Department of Health Sciences (J.B., K.R.A.), University of Leicester, United Kingdom; Department of Physical Medicine and Rehabilitation (C.M.M.), University of California, Davis, Sacramento; and Department of Neurology (W.B.M., S.J.G., R.C.G.), University of Rochester Medical Centre, NY
| | - Stephanie J Gregory
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.G.M., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, United Kingdom; Department of Biostatistics and Computational Biology (M.P.M.); Department of Neurology, University of Rochester Medical Centre, NY; Department of Health Sciences (J.B., K.R.A.), University of Leicester, United Kingdom; Department of Physical Medicine and Rehabilitation (C.M.M.), University of California, Davis, Sacramento; and Department of Neurology (W.B.M., S.J.G., R.C.G.), University of Rochester Medical Centre, NY
| | - Robert C Griggs
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.G.M., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, United Kingdom; Department of Biostatistics and Computational Biology (M.P.M.); Department of Neurology, University of Rochester Medical Centre, NY; Department of Health Sciences (J.B., K.R.A.), University of Leicester, United Kingdom; Department of Physical Medicine and Rehabilitation (C.M.M.), University of California, Davis, Sacramento; and Department of Neurology (W.B.M., S.J.G., R.C.G.), University of Rochester Medical Centre, NY
| | - Michela Guglieri
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.G.M., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, United Kingdom; Department of Biostatistics and Computational Biology (M.P.M.); Department of Neurology, University of Rochester Medical Centre, NY; Department of Health Sciences (J.B., K.R.A.), University of Leicester, United Kingdom; Department of Physical Medicine and Rehabilitation (C.M.M.), University of California, Davis, Sacramento; and Department of Neurology (W.B.M., S.J.G., R.C.G.), University of Rochester Medical Centre, NY
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Hoskens J, Schiava M, Goemans N, Feys H, McDermott MP, Martens WB, Mayhew A, Griggs RC, Klingels K, Guglieri M. Reference curves of motor function outcomes in young steroid-naïve males with Duchenne muscular dystrophy. Dev Med Child Neurol 2024; 66:644-653. [PMID: 37885269 DOI: 10.1111/dmcn.15788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023]
Abstract
AIM To investigate functional motor performance in a large cohort of young steroid-naïve males with Duchenne muscular dystrophy (DMD) and typically developing males, and to develop specific reference curves for both groups. Also, to describe associations between anthropometric values and functional motor outcomes. METHOD Cross-sectional data of 196 steroid-naïve males with DMD aged 4 to 8 years and 497 typically developing males aged 2 years 6 months to 8 years were included. Both groups were evaluated with the time to rise from the floor test, 10-metre walk/run test, 6-minute walk test, and North Star Ambulatory Assessment. Reference curves with centiles 5%, 10%, 25%, 50%, 75%, 90%, and 95% were estimated using quantile regression. RESULTS Males with DMD scored significantly worse on all functional motor outcomes than age-matched typically developing males (p < 0.001): 89% to 95% of the males with DMD scored below the 5th centile of the typically developing males. No or weak correlations exist between anthropometric values and functional motor outcomes. INTERPRETATION The estimated reference curves can support consultation with families of young males with DMD and can support the evaluation of treatment for reaching motor skills and functional motor outcomes compared with typically developing males.
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Affiliation(s)
- Jasmine Hoskens
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), UHasselt, Leuven, Belgium
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), KU Leuven, Leuven, Belgium
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle upon Tyne, UK
| | - Nathalie Goemans
- Department of Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), KU Leuven, Leuven, Belgium
| | - Michael P McDermott
- Department of Neurology, University of Rochester Medical Centre, Rochester, NY, USA
- Department of Biostatistics and Computational Biology, University of Rochester Medical Centre, Rochester, NY, USA
| | - William B Martens
- Department of Neurology, University of Rochester Medical Centre, Rochester, NY, USA
| | - Anna Mayhew
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle upon Tyne, UK
| | - Robert C Griggs
- Department of Neurology, University of Rochester Medical Centre, Rochester, NY, USA
| | - Katrijn Klingels
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), UHasselt, Leuven, Belgium
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), KU Leuven, Leuven, Belgium
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle upon Tyne, UK
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Li X, Sabbatini D, Pegoraro E, Bello L, Clemens P, Guglieri M, van den Anker J, Damsker J, McCall J, Dang UJ, Hoffman EP, Jusko WJ. Assessing Pharmacogenomic loci Associated with the Pharmacokinetics of Vamorolone in Boys with Duchenne Muscular Dystrophy. J Clin Pharmacol 2024. [PMID: 38682893 DOI: 10.1002/jcph.2446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/27/2024] [Indexed: 05/01/2024]
Abstract
Human genetic variation (polymorphisms) in genes coding proteins involved in the absorption, distribution, metabolism, and elimination (ADME) of drugs can have a strong effect on drug exposure and downstream efficacy and safety outcomes. Vamorolone, a dissociative steroidal anti-inflammatory drug for treating Duchenne muscular dystrophy (DMD), primarily undergoes oxidation by CYP3A4 and CYP3A5 and glucuronidation by UDP-glucuronosyltransferases. This work assesses the pharmacokinetics (PKs) of vamorolone and sources of interindividual variability (IIV) in 81 steroid-naïve boys with DMD aged 4 to <7 years old considering the genetic polymorphisms of CYPS3A4 (CYP3A4*22, CYP3A4*1B), CYP3A5 (CYP3A5*3), and UGT1A1 (UGT1A1*60) utilizing population PK modeling. A one-compartment model with zero-order absorption (Tk0, duration of absorption), linear clearance (CL/F), and volume (V/F) describes the plasma PK data for boys with DMD receiving a wide range of vamorolone doses (0.25-6 mg/kg/day). The typical CL/F and V/F values of vamorolone were 35.8 L/h and 119 L, with modest IIV. The population Tk0 was 3.14 h yielding an average zero-order absorption rate (k0) of 1.16 mg/kg/h with similar absorption kinetics across subjects at the same vamorolone dose (i.e., no IIV on Tk0). The covariate analysis showed that none of the genetic covariates had any significant impact on the PKs of vamorolone in boys with DMD. Thus, the PKs of vamorolone is very consistent in these young boys with DMD.
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Affiliation(s)
- Xiaonan Li
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | | | - Elena Pegoraro
- Department of Neurosciences, University of Padova, Padua, Italy
| | - Luca Bello
- Department of Neurosciences, University of Padova, Padua, Italy
| | - Paula Clemens
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michela Guglieri
- John Walton Centre for Neuromuscular Disease, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, USA
- ReveraGen BioPharma, Rockville, MD, USA
| | | | | | - Utkarsh J Dang
- Department of Health Sciences, Carleton University, Ottawa, Canada
| | - Eric P Hoffman
- ReveraGen BioPharma, Rockville, MD, USA
- Department of Pharmaceutical Sciences, Binghamton University, State University of New York, Binghamton, NY, USA
| | - William J Jusko
- Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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Childs AM, Turner C, Astin R, Bianchi S, Bourke J, Cunningham V, Edel L, Edwards C, Farrant P, Heraghty J, James M, Massey C, Messer B, Michel Sodhi J, Murphy PB, Schiava M, Thomas A, Trucco F, Guglieri M. Development of respiratory care guidelines for Duchenne muscular dystrophy in the UK: key recommendations for clinical practice. Thorax 2024; 79:476-485. [PMID: 38123347 DOI: 10.1136/thorax-2023-220811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/17/2023] [Indexed: 12/23/2023]
Abstract
Significant inconsistencies in respiratory care provision for Duchenne muscular dystrophy (DMD) are reported across different specialist neuromuscular centres in the UK. The absence of robust clinical evidence and expert consensus is a barrier to the implementation of care recommendations in public healthcare systems as is the need to increase awareness of key aspects of care for those living with DMD. Here, we provide evidenced-based and/or consensus-based best practice for the respiratory care of children and adults living with DMD in the UK, both as part of routine care and in an emergency. METHODOLOGY Initiated by an expert working group of UK-based respiratory physicians (including British Thoracic Society (BTS) representatives), neuromuscular clinicians, physiotherapist and patient representatives, draft guidelines were created based on published evidence, current practice and expert opinion. After wider consultation with UK respiratory teams and neuromuscular services, consensus was achieved on these best practice recommendations for respiratory care in DMD. RESULT The resulting recommendations are presented in the form of a flow chart for assessment and monitoring, with additional guidance and a separate chart setting out key considerations for emergency management. The recommendations have been endorsed by the BTS. CONCLUSIONS These guidelines provide practical, reasoned recommendations for all those managing day-to-day and acute respiratory care in children and adults with DMD. The hope is that this will support patients and healthcare professionals in accessing high standards of care across the UK.
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Affiliation(s)
- Anne-Marie Childs
- Department of Paediatric Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Catherine Turner
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Ronan Astin
- Division of Medical Specialties, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Bianchi
- Academic Department of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Bourke
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Lisa Edel
- Respiratory Neuromuscular Physiotherapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christopher Edwards
- Leeds Centre for Children's Respiratory Medicine, Leeds Children's Hospital, Leeds General Infirmary, Leeds, UK
| | | | - Jane Heraghty
- Department of Paediatrics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Meredith James
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Charlotte Massey
- Queen Square Centre for Neuromuscular Diseases, University College London NHS Foundation Trust, London, UK
- Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Ben Messer
- North East Assisted Ventilation Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jassi Michel Sodhi
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Patrick Brian Murphy
- Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ajit Thomas
- Department of Respiratory Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Federica Trucco
- Dubowitz Neuromuscular Centre, University College London, London, UK
- Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Salman D, Bolano-Diaz C, Muni-Lofra R, Wong K, Elseed M, Harris E, Diaz-Manera J, Guglieri M, Marini-Bettolo C, Straub V, Tasca G. Axial involvement as a prominent feature in SMPX-related distal myopathy. Neuromuscul Disord 2024; 39:3-4. [PMID: 38615630 DOI: 10.1016/j.nmd.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024]
Affiliation(s)
- D Salman
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK.
| | - C Bolano-Diaz
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK
| | - R Muni-Lofra
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK
| | - K Wong
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK; Northern Genetics Service, Institute of Genetics Medicine, Newcastle upon Tyne, UK
| | - M Elseed
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK
| | - E Harris
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK; Northern Genetics Service, Institute of Genetics Medicine, Newcastle upon Tyne, UK
| | - J Diaz-Manera
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK
| | - M Guglieri
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK
| | - C Marini-Bettolo
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK
| | - V Straub
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK
| | - G Tasca
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE13BZ, UK
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Esteller D, Schiava M, Verdú-Díaz J, Villar-Quiles RN, Dibowski B, Venturelli N, Laforet P, Alonso-Pérez J, Olive M, Domínguez-González C, Paradas C, Vélez B, Kostera-Pruszczyk A, Kierdaszuk B, Rodolico C, Claeys K, Pál E, Malfatti E, Souvannanorath S, Alonso-Jiménez A, de Ridder W, De Smet E, Papadimas G, Papadopoulos C, Xirou S, Luo S, Muelas N, Vilchez JJ, Ramos-Fransi A, Monforte M, Tasca G, Udd B, Palmio J, Sri S, Krause S, Schoser B, Fernández-Torrón R, López de Munain A, Pegoraro E, Farrugia ME, Vorgerd M, Manousakis G, Chanson JB, Nadaj-Pakleza A, Cetin H, Badrising U, Warman-Chardon J, Bevilacqua J, Earle N, Campero M, Díaz J, Ikenaga C, Lloyd TE, Nishino I, Nishimori Y, Saito Y, Oya Y, Takahashi Y, Nishikawa A, Sasaki R, Marini-Bettolo C, Guglieri M, Straub V, Stojkovic T, Carlier RY, Díaz-Manera J. Correction to: Analysis of muscle magnetic resonance imaging of a large cohort of patient with VCP‑mediated disease reveals characteristic features useful for diagnosis. J Neurol 2024; 271:2147-2148. [PMID: 38349561 PMCID: PMC10973025 DOI: 10.1007/s00415-023-12178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Affiliation(s)
- Diana Esteller
- Neurology Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - José Verdú-Díaz
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Rocío-Nur Villar-Quiles
- APHP, Centre de Référence des Maladies Neuromusculaires, Institut de Myologie, Centre de Recherche en Myologie, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Boris Dibowski
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Nadia Venturelli
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Pascal Laforet
- Département de Neurologie Hôpital Raymond-Poincaré Garches France Inserm U1179, Garches, France
| | - Jorge Alonso-Pérez
- Servicio de Neurología. Hospital Virgen de la Candelaria, Tenerife, Spain
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Montse Olive
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Domínguez-González
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Instituto de Investigación imas12, Hospital 12 de Octubre, Madrid, Spain
| | - Carmen Paradas
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital Virgen del Rocio, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Beatriz Vélez
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital Virgen del Rocio, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Anna Kostera-Pruszczyk
- Department of Neurology, Medical University of Warsaw, ERN EURO NMD, Warsaw, Poland
- Neuromuscular Reference Centre, ERN-EURO-NMD, Warsaw, Poland
| | - Biruta Kierdaszuk
- Department of Neurology, Medical University of Warsaw, ERN EURO NMD, Warsaw, Poland
- Neuromuscular Reference Centre, ERN-EURO-NMD, Warsaw, Poland
| | - Carmelo Rodolico
- UOC di Neurologia e Malattie Neuromuscolari, AOU Policlinico "G. Martino", Rome, Italy
| | - Kristl Claeys
- Neurologie, Neuromusculair Referentiecentrum, Universitaire Ziekenhuizen, Leuven, Belgium
| | - Endre Pál
- Neurology Department, University of Pécs, Pécs, Hungary
| | - Edoardo Malfatti
- Université Paris Est, U955 INSERM, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, EURO-NMD, 94010, Creteil, France
| | - Sarah Souvannanorath
- Université Paris Est, U955 INSERM, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, EURO-NMD, 94010, Creteil, France
| | | | - Willem de Ridder
- Neurology Department, Universitary Hospital Antwerpen, Edegem, Belgium
| | - Eline De Smet
- Neurology Department, Universitary Hospital Antwerpen, Edegem, Belgium
| | - George Papadimas
- Department of Neurology, Eginition Hospital, Medical School, NKUA, ERN, EURO NMD, Athens, Greece
| | | | - Sofia Xirou
- Department of Neurology, Eginition Hospital, Medical School, NKUA, ERN, EURO NMD, Athens, Greece
| | - Sushan Luo
- Neurology Department, Huashan Hospital, Fudan University, Shangai, China
| | - Nuria Muelas
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Juan J Vilchez
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Alba Ramos-Fransi
- Unitat de Malalties Neuromusculars, Servei de Neurologia, Hospital Germans Tries I Pujol, Badalona, Spain
| | - Mauro Monforte
- UOC di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Tasca
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Bjarne Udd
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
- Folkhalsan Genetic Institute, Helsinki University, Helsinki, Finland
| | - Johanna Palmio
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
- Folkhalsan Genetic Institute, Helsinki University, Helsinki, Finland
| | - Srtuhi Sri
- Sree Chitra Tirunal Insitute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Sabine Krause
- Department of Neurology, Friedrich-Baur-Institute, LMU Clinics, Munich, Germany
| | - Benedikt Schoser
- Department of Neurology, Friedrich-Baur-Institute, LMU Clinics, Munich, Germany
| | - Roberto Fernández-Torrón
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Neurology Department, Biodonostia Health Research Institute, Donostia, Spain
| | - Adolfo López de Munain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Neurology Department, Biodonostia Health Research Institute, Donostia, Spain
| | - Elena Pegoraro
- Department of Neurosciences, University of Padova, Padua, Italy
| | - Maria Elena Farrugia
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Mathias Vorgerd
- Heimer Institut for Muscle Research, Klinikum Bergmannsheil Ruhr, University Bochum, Bochum, Germany
| | | | - Jean Baptiste Chanson
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile-de-France and ERN-EURO-NMD, Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aleksandra Nadaj-Pakleza
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile-de-France and ERN-EURO-NMD, Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hakan Cetin
- Neurology Department, Medical University of Vienna, Vienna, Austria
| | | | | | - Jorge Bevilacqua
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Nicholas Earle
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Mario Campero
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Jorge Díaz
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Chiseko Ikenaga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Thomas E Lloyd
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yukako Nishimori
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yoshihiko Saito
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yasushi Oya
- Department of Neurology, National Center Hospital, NCNP, Tokyo, Japan
| | - Yoshiaki Takahashi
- Department of Neurology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | | | - Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Tanya Stojkovic
- APHP, Centre de Référence des Maladies Neuromusculaires, Institut de Myologie, Centre de Recherche en Myologie, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Robert Y Carlier
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Jordi Díaz-Manera
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom.
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.
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Dang UJ, Damsker JM, Guglieri M, Clemens PR, Perlman SJ, Smith EC, Horrocks I, Finkel RS, Mah JK, Deconinck N, Goemans NM, Haberlová J, Straub V, Mengle-Gaw L, Schwartz BD, Harper A, Shieh PB, De Waele L, Castro D, Yang ML, Ryan MM, McDonald CM, Tulinius M, Webster RI, Mcmillan HJ, Kuntz N, Rao VK, Baranello G, Spinty S, Childs AM, Sbrocchi AM, Selby KA, Monduy M, Nevo Y, Vilchez JJ, Nascimento-Osorio A, Niks EH, De Groot IJM, Katsalouli M, Van Den Anker JN, Ward LM, Leinonen M, D'Alessandro AL, Hoffman EP. Efficacy and Safety of Vamorolone Over 48 Weeks in Boys With Duchenne Muscular Dystrophy: A Randomized Controlled Trial. Neurology 2024; 102:e208112. [PMID: 38335499 PMCID: PMC11067696 DOI: 10.1212/wnl.0000000000208112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Vamorolone is a dissociative agonist of the glucocorticoid receptor that has shown similar efficacy and reduced safety concerns in comparison with prednisone in Duchenne muscular dystrophy (DMD). This study was conducted to determine the efficacy and safety of vamorolone over 48 weeks and to study crossover participants (prednisone to vamorolone; placebo to vamorolone). METHODS A randomized, double-blind, placebo-controlled and prednisone-controlled clinical trial of 2 doses of vamorolone was conducted in participants with DMD, in the ages from 4 years to younger than 7 years at baseline. The interventions were 2 mg/kg/d of vamorolone and 6 mg/kg/d of vamorolone for 48 weeks (period 1: 24 weeks + period 2: 24 weeks) and 0.75 mg/kg/d of prednisone and placebo for the first 24 weeks (before crossover). Efficacy was evaluated through gross motor outcomes and safety through adverse events, growth velocity, body mass index (BMI), and bone turnover biomarkers. This analysis focused on period 2. RESULTS A total of 121 participants with DMD were randomized. Vamorolone at a dose of 6 mg/kg/d showed maintenance of improvement for all motor outcomes to week 48 (e.g., for primary outcome, time to stand from supine [TTSTAND] velocity, week 24 least squares mean [LSM] [SE] 0.052 [0.0130] rises/s vs week 48 LSM [SE] 0.0446 [0.0138]). After 48 weeks, vamorolone at a dose of 2 mg/kg/d showed similar improvements as 6 mg/kg/d for North Star Ambulatory Assessment (NSAA) (vamorolone 6 mg/kg/d-vamorolone 2 mg/kg/d LSM [SE] 0.49 [1.14]; 95% CI -1.80 to 2.78, p = 0.67), but less improvement for other motor outcomes. The placebo to vamorolone 6 mg/kg/d group showed rapid improvements after 20 weeks of treatment approaching benefit seen with 48-week 6 mg/kg/d of vamorolone treatment for TTSTAND, time to run/walk 10 m, and NSAA. There was significant improvement in linear growth after crossover in the prednisone to vamorolone 6 mg/kg/d group, and rapid reversal of prednisone-induced decline in bone turnover biomarkers in both crossover groups. There was an increase in BMI after 24 weeks of treatment that then stabilized for both vamorolone groups. DISCUSSION Improvements of motor outcomes seen with 6 mg/kg/d of vamorolone at 24 weeks of treatment were maintained to 48 weeks of treatment. Vamorolone at a dose of 6 mg/kg/d showed better maintenance of effect compared with vamorolone at a dose of 2 mg/kg/d for most (3/5) motor outcomes. Bone morbidities of prednisone (stunting of growth and declines in serum bone biomarkers) were reversed when treatment transitioned to vamorolone. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT03439670. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for boys with DMD, the efficacy of vamorolone at a dose of 6 mg/kg/d was maintained over 48 weeks.
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Affiliation(s)
- Utkarsh J Dang
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Jesse M Damsker
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Michela Guglieri
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Paula R Clemens
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Seth J Perlman
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Edward C Smith
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Iain Horrocks
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Richard S Finkel
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Jean K Mah
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Nicolas Deconinck
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Nathalie M Goemans
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Jana Haberlová
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Volker Straub
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Laurel Mengle-Gaw
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Benjamin D Schwartz
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Amy Harper
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Perry B Shieh
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Liesbeth De Waele
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Diana Castro
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Michele L Yang
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Monique M Ryan
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Craig M McDonald
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Mar Tulinius
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Richard I Webster
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Hugh J Mcmillan
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Nancy Kuntz
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Vamshi K Rao
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Giovanni Baranello
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Stefan Spinty
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Anne-Marie Childs
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Annie M Sbrocchi
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Kathryn A Selby
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Migvis Monduy
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Yoram Nevo
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Juan J Vilchez
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Andres Nascimento-Osorio
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Erik H Niks
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Imelda J M De Groot
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Marina Katsalouli
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - John N Van Den Anker
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Leanne M Ward
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Mika Leinonen
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Andrea L D'Alessandro
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
| | - Eric P Hoffman
- From Carleton University (U.J.D.), Ottawa, Ontario, Canada; ReveraGen BioPharma (J.M.D., J.N.V.D.A., E.P.H.), Rockville, MD; John Walton Muscular Dystrophy Research Centre (M.G., V.S.), Newcastle Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; University of Pittsburgh School of Medicine and Department of Veterans Affairs Medical Center (P.R.C.), PA; University of Washington School of Medicine (S.J.P.), Seattle; Duke University School of Medicine (E.C.S.), Durham, NC; Royal Hospital for Children (I.H.), Glasgow, United Kingdom; Nemours Children's Hospital (R.S.F.), Orlando, FL. Dr. Finkel is now with St. Jude Children's Research Hospital, Memphis, TN; Alberta Children's Hospital Research Institute (J.K.M.), University of Calgary, Canada; Neuromuscular Reference Center (NMRC) (N.D.), UZ Ghent; KU Leuven Department of Development and Regeneration (N.M.G., L.D.W.); Department of Paediatric Neurology (N.M.G., L.D.W.), University Hospitals Leuven, Belgium; Neuromuscular Centre (J.H.), Department of Pediatric Neurology Motol University Hospital; 2nd School of Medicine Charles University in Prague (J.H.), Czech Republic; The Camden Group (L.M.-G., B.D.S.), St. Louis, MO; Children's Hospital of Richmond (A.H.), Richmond, VA; UCLA Medical School (P.B.S.), Los Angeles, CA; UT Southwestern Medical Center (D.C.), Dallas, TX; University of Colorado School of Medicine (M.L.Y.), Children's Hospital Colorado, Aurora; The Royal Children's Hospital (M.M.R.); Murdoch Children's Research Institute (M.M.R.), Melbourne, Victoria, Australia; University of California, Davis (C.M.M.), Sacramento; Queen Silvia Children's Hospital (M.T.), Gothenburg, Sweden; Kids Neuroscience Centre (R.I.W.), The Children's Hospital at Westmead, Australia; University of Ottawa (H.J.M.), Ontario, Canada; Ann & Robert H. Lurie Children's Hospital (N.K., V.K.R.), Chicago, IL; The Dubowitz Neuromuscular Centre (G.B.), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College, London; Alder Hey Children's NHS Foundation Trust (S.S.), Liverpool; Leeds Teaching Hospitals Trust (A.-M.C.), United Kingdom; Montreal Children's Hospital (A.M.S.), Quebec; BC Children's Hospital Research Institute (K.A.S.), Vancouver, Canada; Nemours Children's Hospital (M.M.), Orlando, FL. Dr. Monduy is now with Nicklaus Children's Hospital, Miami, FL; Schneider Children's Medical Center (Y.N.), Tel Aviv University, Israel; Hospital Quirónsalud Valencia (J.J.V.), Spain; Neuropaediatrics Department (A.N.-O.), Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain; Department of Neurology (E.H.N.), Leiden University Medical Center; Radboud University Medical Center (I.J.M.D.G.), Nijmegen, the Netherlands; "P&A Kyriakou" Children's Hospital (M.K.), Athens, Greece; Children's National Medical Center (J.N.V.D.A.), Washington, DC; Children's Hospital of Eastern Ontario (CHEO) Research Institute (L.M.W.), Ottawa, Ontario, Canada; Santhera Pharmaceuticals (M.L.), Prattein, Switzerland; TRiNDS (A.L.D.A.), Pittsburgh, PA; and Binghamton University-State University of New York (E.P.H.), Binghamton
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9
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Piñol-Jurado P, Verdú-Díaz J, Fernández-Simón E, Domínguez-González C, Hernández-Lain A, Lawless C, Vincent A, González-Chamorro A, Villalobos E, Monceau A, Laidler Z, Mehra P, Clark J, Filby A, McDonald D, Rushton P, Bowey A, Alonso Pérez J, Tasca G, Marini-Bettolo C, Guglieri M, Straub V, Suárez-Calvet X, Díaz-Manera J. Imaging mass cytometry analysis of Becker muscular dystrophy muscle samples reveals different stages of muscle degeneration. Sci Rep 2024; 14:3365. [PMID: 38336890 PMCID: PMC10858026 DOI: 10.1038/s41598-024-51906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
Becker muscular dystrophy (BMD) is characterised by fiber loss and expansion of fibrotic and adipose tissue. Several cells interact locally in what is known as the degenerative niche. We analysed muscle biopsies of controls and BMD patients at early, moderate and advanced stages of progression using Hyperion imaging mass cytometry (IMC) by labelling single sections with 17 markers identifying different components of the muscle. We developed a software for analysing IMC images and studied changes in the muscle composition and spatial correlations between markers across disease progression. We found a strong correlation between collagen-I and the area of stroma, collagen-VI, adipose tissue, and M2-macrophages number. There was a negative correlation between the area of collagen-I and the number of satellite cells (SCs), fibres and blood vessels. The comparison between fibrotic and non-fibrotic areas allowed to study the disease process in detail. We found structural differences among non-fibrotic areas from control and patients, being these latter characterized by increase in CTGF and in M2-macrophages and decrease in fibers and blood vessels. IMC enables to study of changes in tissue structure along disease progression, spatio-temporal correlations and opening the door to better understand new potential pathogenic pathways in human samples.
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Affiliation(s)
- Patricia Piñol-Jurado
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - José Verdú-Díaz
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Esther Fernández-Simón
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Cristina Domínguez-González
- Neuromuscular Disorders Unit, Neurology Department, imas12 Research Institute, Hospital Universitario, 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Aurelio Hernández-Lain
- Neuropathology Unit, imas12 Research Institute, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Conor Lawless
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Amy Vincent
- Faculty of Medical Sciences, Welcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Alejandro González-Chamorro
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Elisa Villalobos
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Alexandra Monceau
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Zoe Laidler
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Priyanka Mehra
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - James Clark
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Andrew Filby
- Newcastle University Biosciences Institute and Innovation Methodology and Application Research Theme, Newcastle University, Newcastle Upon Tyne, UK
| | - David McDonald
- Newcastle University Biosciences Institute and Innovation Methodology and Application Research Theme, Newcastle University, Newcastle Upon Tyne, UK
| | - Paul Rushton
- Department of Orthopaedic Spine Surgery, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Andrew Bowey
- Department of Orthopaedic Spine Surgery, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Jorge Alonso Pérez
- Neuromuscular Disease Unit, Neurology Department, Hospital Universitario Nuestra Señora de Candelaria, Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Tenerife, Spain
| | - Giorgio Tasca
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK
| | - Xavier Suárez-Calvet
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IBB SANT PAU), Barcelona, Spain
| | - Jordi Díaz-Manera
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, UK.
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain.
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IBB SANT PAU), Barcelona, Spain.
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10
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Mercer V, Smith N, Jandial S, Guglieri M, Jones SA, Foster HE. Beyond pGALS: the need for a multifaceted musculoskeletal decision-making tool ('pGALSplus') in community-based clinical practice. Rheumatol Adv Pract 2024; 8:rkae004. [PMID: 38283055 PMCID: PMC10822673 DOI: 10.1093/rap/rkae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Musculoskeletal (MSK) problems in children are common, and health-care professionals must identify those requiring onward referral. Paediatric gait, arms, legs and spine (pGALS) is an MSK assessment to discern abnormal joints. We aimed to identify MSK assessments to add to pGALS (pGALSplus) to facilitate decision-making in the context of exemplar conditions representing a spectrum of MSK presentations, namely JIA, mucopolysaccharidoses, muscular dystrophy and developmental co-ordination disorder. A literature review identified 35 relevant articles that focused on clinical assessments [including questionnaire(s), physical examination and functional tests] used by health-care professionals in the context of the exemplar conditions. We provide a description of these assessments and the rationale regarding how they, or components of such tools, might be useful within pGALSplus. This process provides a foundation for further work to develop and validate pGALSplus.
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Affiliation(s)
- Vicky Mercer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Children’s Physiotherapy, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Nicola Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sharmila Jandial
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Rheumatology, Great North Children’s Hospital, Newcastle upon Tyne, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon A Jones
- Manchester Centre for Genomic Medicine, Saint Mary’s Hospital, Manchester, UK
| | - Helen E Foster
- Population Health Institute, Newcastle University, Newcastle upon Tyne, UK
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11
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Broomfield J, Hill M, Chandler F, Crowther MJ, Godfrey J, Guglieri M, Hastie J, Larkindale J, Mumby-Croft J, Reuben E, Woodcock F, Abrams KR. Developing a Natural History Model for Duchenne Muscular Dystrophy. Pharmacoecon Open 2024; 8:79-89. [PMID: 38019449 PMCID: PMC10781931 DOI: 10.1007/s41669-023-00450-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The aim of this study was to pool multiple data sets to build a patient-centric, data-informed, natural history model (NHM) for Duchenne muscular dystrophy (DMD) to estimate disease trajectory across patient lifetime under current standard of care in future economic evaluations. The study was conducted as part of Project HERCULES, a multi-stakeholder collaboration to develop tools to support health technology assessments of new treatments for DMD. METHODS Health states were informed by a review of NHMs for DMD and input from clinicians, patients and caregivers, and defined using common outcomes in clinical trials and real-world practice. The primary source informing the NHM was the Critical Path Institute Duchenne Regulatory Science Consortium (D-RSC) database. This was supplemented with expert input obtained via an elicitation exercise, and a systematic literature review and meta-analysis of mortality data. RESULTS The NHM includes ambulatory, transfer and non-ambulatory phases, which capture loss of ambulation, ability to weight bear and upper body and respiratory function, respectively. The NHM estimates patients spend approximately 9.5 years in ambulatory states, 1.5 years in the transfer state and the remainder of their lives in non-ambulatory states. Median predicted survival is 34.8 years (95% CI 34.1-35.8). CONCLUSION The model includes a detailed disease pathway for DMD, including the clinically and economically important transfer state. The NHM may be used to estimate the current trajectory of DMD in economic evaluations of new treatments, facilitating inclusion of a lifetime time horizon, and will help identify areas for further research.
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Affiliation(s)
| | - M Hill
- GlaxoSmithKline, Middlesex, UK
| | - F Chandler
- Sanofi, Reading, UK
- Duchenne UK, London, UK
| | - M J Crowther
- Karolinska Institute, Stockholm, Sweden
- Red Door Analytics, Stockholm, Sweden
| | | | - M Guglieri
- Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | | | | | | | | | | | - K R Abrams
- University of Warwick, Coventry, UK
- University of York, York, UK
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12
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Clemens PR, Gordish-Dressman H, Niizawa G, Gorni K, Guglieri M, Connolly AM, Wicklund M, Bertorini T, Mah J, Thangarajh M, Smith EC, Kuntz NL, McDonald CM, Henricson E, Upadhyayula S, Byrne B, Manousakis G, Harper A, Iannaccone S, Dang UJ. Findings from the Longitudinal CINRG Becker Natural History Study. J Neuromuscul Dis 2024; 11:201-212. [PMID: 37980682 PMCID: PMC10789327 DOI: 10.3233/jnd-230178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Becker muscular dystrophy is an X-linked, genetic disorder causing progressive degeneration of skeletal and cardiac muscle, with a widely variable phenotype. OBJECTIVE A 3-year, longitudinal, prospective dataset contributed by patients with confirmed Becker muscular dystrophy was analyzed to characterize the natural history of this disorder. A better understanding of the natural history is crucial to rigorous therapeutic trials. METHODS A cohort of 83 patients with Becker muscular dystrophy (5-75 years at baseline) were followed for up to 3 years with annual assessments. Muscle and pulmonary function outcomes were analyzed herein. Age-stratified statistical analysis and modeling were conducted to analyze cross-sectional data, time-to-event data, and longitudinal data to characterize these clinical outcomes. RESULTS Deletion mutations of dystrophin exons 45-47 or 45-48 were most common. Subgroup analysis showed greater pairwise association between motor outcomes at baseline than association between these outcomes and age. Stronger correlations between outcomes for adults than for those under 18 years were also observed. Using cross-sectional binning analysis, a ceiling effect was seen for North Star Ambulatory Assessment but not for other functional outcomes. Longitudinal analysis showed a decline in percentage predicted forced vital capacity over the life span. There was relative stability or improved median function for motor functional outcomes through childhood and adolescence and decreasing function with age thereafter. CONCLUSIONS There is variable progression of outcomes resulting in significant heterogeneity of the clinical phenotype of Becker muscular dystrophy. Disease progression is largely manifest in adulthood. There are implications for clinical trial design revealed by this longitudinal analysis of a Becker natural history dataset.
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Affiliation(s)
| | | | | | | | - Michela Guglieri
- Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Matthew Wicklund
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Jean Mah
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | | | | | | | | | | | | | - Amy Harper
- Virginia Commonwealth University, Richmond, VA, USA
| | - Susan Iannaccone
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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13
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Phung K, Crabtree N, Connolly AM, Furlong P, Hoffman EP, Jackowski SA, Jayash SN, Johnson A, Koujok K, Munns CF, Niks E, Rauch F, Schrader R, Turner C, Vroom E, Weber DR, Wong BL, Guglieri M, Ward LM, Wong SC. Moving Beyond the 2018 Minimum International Care Considerations for Osteoporosis Management in Duchenne Muscular Dystrophy (DMD): Meeting Report from the 3rd International Muscle-Bone Interactions Meeting 7th and 14th November 2022. J Neuromuscul Dis 2024; 11:233-252. [PMID: 37980681 PMCID: PMC10789336 DOI: 10.3233/jnd-230176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Kim Phung
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicola Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Anne M. Connolly
- Nationwide Children’s Hospital, Ohio State University, Columbus, OH, USA
| | - Pat Furlong
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Eric P. Hoffman
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences Binghamton University, State University of New York, Binghamton, NY, USA
| | - Stefan A. Jackowski
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Soher Nagi Jayash
- Roslin institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Khaldoun Koujok
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Craig F. Munns
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
- Department of Endocrinology and Diabetes, Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Erik Niks
- Leiden University Medical Center, Leiden, The Netherlands
| | - Frank Rauch
- Shriners Hospital for Children, Montreal, QC, Canada
| | | | | | | | | | | | | | - Leanne M. Ward
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Sze Choong Wong
- Correspondence to: Dr. Sze Choong Wong, Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF United Kingdom. Tel.: +44 141 451 5841; E-mail:
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14
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Esteller D, Schiava M, Verdú-Díaz J, Villar-Quiles RN, Dibowski B, Venturelli N, Laforet P, Alonso-Pérez J, Olive M, Domínguez-González C, Paradas C, Vélez B, Kostera-Pruszczyk A, Kierdaszuk B, Rodolico C, Claeys K, Pál E, Malfatti E, Souvannanorath S, Alonso-Jiménez A, de Ridder W, De Smet E, Papadimas G, Papadopoulos C, Xirou S, Luo S, Muelas N, Vilchez JJ, Ramos-Fransi A, Monforte M, Tasca G, Udd B, Palmio J, Sri S, Krause S, Schoser B, Fernández-Torrón R, López de Munain A, Pegoraro E, Farrugia ME, Vorgerd M, Manousakis G, Chanson JB, Nadaj-Pakleza A, Cetin H, Badrising U, Warman-Chardon J, Bevilacqua J, Earle N, Campero M, Díaz J, Ikenaga C, Lloyd TE, Nishino I, Nishimori Y, Saito Y, Oya Y, Takahashi Y, Nishikawa A, Sasaki R, Marini-Bettolo C, Guglieri M, Straub V, Stojkovic T, Carlier RY, Díaz-Manera J. Analysis of muscle magnetic resonance imaging of a large cohort of patient with VCP-mediated disease reveals characteristic features useful for diagnosis. J Neurol 2023; 270:5849-5865. [PMID: 37603075 PMCID: PMC10632218 DOI: 10.1007/s00415-023-11862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND The diagnosis of patients with mutations in the VCP gene can be complicated due to their broad phenotypic spectrum including myopathy, motor neuron disease and peripheral neuropathy. Muscle MRI guides the diagnosis in neuromuscular diseases (NMDs); however, comprehensive muscle MRI features for VCP patients have not been reported so far. METHODS We collected muscle MRIs of 80 of the 255 patients who participated in the "VCP International Study" and reviewed the T1-weighted (T1w) and short tau inversion recovery (STIR) sequences. We identified a series of potential diagnostic MRI based characteristics useful for the diagnosis of VCP disease and validated them in 1089 MRIs from patients with other genetically confirmed NMDs. RESULTS Fat replacement of at least one muscle was identified in all symptomatic patients. The most common finding was the existence of patchy areas of fat replacement. Although there was a wide variability of muscles affected, we observed a common pattern characterized by the involvement of periscapular, paraspinal, gluteal and quadriceps muscles. STIR signal was enhanced in 67% of the patients, either in the muscle itself or in the surrounding fascia. We identified 10 diagnostic characteristics based on the pattern identified that allowed us to distinguish VCP disease from other neuromuscular diseases with high accuracy. CONCLUSIONS Patients with mutations in the VCP gene had common features on muscle MRI that are helpful for diagnosis purposes, including the presence of patchy fat replacement and a prominent involvement of the periscapular, paraspinal, abdominal and thigh muscles.
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Affiliation(s)
- Diana Esteller
- Neurology Department, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - José Verdú-Díaz
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Rocío-Nur Villar-Quiles
- APHP, Centre de Référence des Maladies Neuromusculaires, Institut de Myologie, Centre de Recherche en Myologie, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Boris Dibowski
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Nadia Venturelli
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Pascal Laforet
- Département de Neurologie Hôpital Raymond-Poincaré Garches France Inserm U1179, Garches, France
| | - Jorge Alonso-Pérez
- Servicio de Neurología. Hospital Virgen de la Candelaria, Tenerife, Spain
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Montse Olive
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Domínguez-González
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Instituto de Investigación imas12, Hospital 12 de Octubre, Madrid, Spain
| | - Carmen Paradas
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital Virgen del Rocio, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Beatriz Vélez
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital Virgen del Rocio, Seville, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Anna Kostera-Pruszczyk
- Department of Neurology, Medical University of Warsaw, ERN EURO NMD, Warsaw, Poland
- Neuromuscular Reference Centre, ERN-EURO-NMD, Warsaw, Poland
| | - Biruta Kierdaszuk
- Department of Neurology, Medical University of Warsaw, ERN EURO NMD, Warsaw, Poland
- Neuromuscular Reference Centre, ERN-EURO-NMD, Warsaw, Poland
| | - Carmelo Rodolico
- UOC di Neurologia e Malattie Neuromuscolari, AOU Policlinico "G. Martino", Rome, Italy
| | - Kristl Claeys
- Neurologie, Neuromusculair Referentiecentrum, Universitaire Ziekenhuizen, Leuven, Belgium
| | - Endre Pál
- Neurology Department, University of Pécs, Pécs, Hungary
| | - Edoardo Malfatti
- Université Paris Est, U955 INSERM, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, EURO-NMD, 94010, Creteil, France
| | - Sarah Souvannanorath
- Université Paris Est, U955 INSERM, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, EURO-NMD, 94010, Creteil, France
| | | | - Willem de Ridder
- Neurology Department, Universitary Hospital Antwerpen, Edegem, Belgium
| | - Eline De Smet
- Neurology Department, Universitary Hospital Antwerpen, Edegem, Belgium
| | - George Papadimas
- Department of Neurology, Eginition Hospital, Medical School, NKUA, ERN, EURO NMD, Athens, Greece
| | | | - Sofia Xirou
- Department of Neurology, Eginition Hospital, Medical School, NKUA, ERN, EURO NMD, Athens, Greece
| | - Sushan Luo
- Neurology Department, Huashan Hospital, Fudan University, Shangai, China
| | - Nuria Muelas
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Juan J Vilchez
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitari I Politècnic La Fe, Valencia, Spain
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Alba Ramos-Fransi
- Unitat de Malalties Neuromusculars, Servei de Neurologia, Hospital Germans Tries I Pujol, Badalona, Spain
| | - Mauro Monforte
- UOC di Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Tasca
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Bjarne Udd
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
- Folkhalsan Genetic Institute, Helsinki University, Helsinki, Finland
| | - Johanna Palmio
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
- Folkhalsan Genetic Institute, Helsinki University, Helsinki, Finland
| | - Srtuhi Sri
- Sree Chitra Tirunal Insitute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Sabine Krause
- Department of Neurology, Friedrich-Baur-Institute, LMU Clinics, Munich, Germany
| | - Benedikt Schoser
- Department of Neurology, Friedrich-Baur-Institute, LMU Clinics, Munich, Germany
| | - Roberto Fernández-Torrón
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Neurology Department, Biodonostia Health Research Institute, Donostia, Spain
| | - Adolfo López de Munain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
- Neurology Department, Biodonostia Health Research Institute, Donostia, Spain
| | - Elena Pegoraro
- Department of Neurosciences, University of Padova, Padua, Italy
| | - Maria Elena Farrugia
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Mathias Vorgerd
- Heimer Institut for Muscle Research, Klinikum Bergmannsheil Ruhr, University Bochum, Bochum, Germany
| | | | - Jean Baptiste Chanson
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile-de-France and ERN-EURO-NMD, Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aleksandra Nadaj-Pakleza
- Centre de Référence des Maladies Neuromusculaires Nord/Est/Ile-de-France and ERN-EURO-NMD, Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hakan Cetin
- Neurology Department, Medical University of Vienna, Vienna, Austria
| | | | | | - Jorge Bevilacqua
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Nicholas Earle
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Mario Campero
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Jorge Díaz
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | - Chiseko Ikenaga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Thomas E Lloyd
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yukako Nishimori
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yoshihiko Saito
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology, Tokyo, Japan
| | - Yasushi Oya
- Department of Neurology, National Center Hospital, NCNP, Tokyo, Japan
| | - Yoshiaki Takahashi
- Department of Neurology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | | | - Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom
| | - Tanya Stojkovic
- APHP, Centre de Référence des Maladies Neuromusculaires, Institut de Myologie, Centre de Recherche en Myologie, Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Robert Y Carlier
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Start Imaging, Raymond Poincaré Teaching Hospital, Garches, France
| | - Jordi Díaz-Manera
- John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute and Newcastle Hospitals NHS Foundation Trust, Center for Life, Central Parkway, Newcastle Upon Tyne, NE13BZ, United Kingdom.
- Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.
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15
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Broomfield J, Abrams K, Latimer N, Guglieri M, Rutherford M, Crowther M. Natural history of Duchenne muscular dystrophy in the United Kingdom: A descriptive study using the Clinical Practice Research Datalink. Brain Behav 2023; 13:e3331. [PMID: 37957895 PMCID: PMC10726817 DOI: 10.1002/brb3.3331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a rare, muscle-degenerative disease predominantly affecting males. Natural history models capture the full disease pathway under current care and combine with estimates of new interventions' effects to assess cost-effectiveness by health technology decision-makers. These models require mortality estimates throughout a patient's lifetime, but rare disease datasets typically contain relatively few patients with short follow-ups. Alternative (published) sources of mortality data may therefore be required. METHODS The Clinical Practice Research Datalink (CPRD) was evaluated as a source of mortality and natural history data for future economic evaluations of health technologies for DMD and rare diseases in general in the UK population. This retrospective longitudinal cohort study provides flexible parametric estimates of mortality rates and survival probabilities in the current UK DMD population through primary/secondary records in the CPRD since 1990. It also investigates clinically significant milestones such as corticosteroid use, spinal surgery, and cardiomyopathy in these patients. RESULTS A total of 1121 male patients were included in the study, observed from 0.7 to 48.9 years. Median life expectancy was 25.64 years (95% confidence interval 24.73, 26.47), consistent with previous global estimates. This has improved to 26.47 (25.16, 27.89) years in patients born after 1990. The median ages at corticosteroid initiation, spinal surgery, ventilation, and cardiomyopathy diagnosis were 6.06 years (5.77, 6.29), 14.79 years (14.29, 15.09), 16.97 years (16.50, 18.31), and 15.26 years (14.22, 16.70), respectively. CONCLUSIONS Estimates of mortality in UK-based DMD patients are age-specific in a uniquely large and nationally representative sample from the CPRD.
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Affiliation(s)
| | - Keith Abrams
- Department of StatisticsUniversity of WarwickCoventryUK
- Centre for Health EconomicsUniversity of YorkYorkUK
| | - Nick Latimer
- School of Health and Related Research (ScHARR)University of SheffieldSheffieldUK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research CentreNewcastle University and Newcastle Hospitals NHSNewcastleUK
| | - Mark Rutherford
- Department of Population Health SciencesUniversity of LeicesterLeicesterUK
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16
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Thangarajh M, McDermott MP, Guglieri M, Griggs RC. Association between neurodevelopmental impairments and motor function in Duchenne muscular dystrophy. Ann Clin Transl Neurol 2023; 10:2285-2296. [PMID: 37804000 PMCID: PMC10723228 DOI: 10.1002/acn3.51914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/13/2023] [Accepted: 09/09/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE We explored various prognostic factors of motor outcomes in corticosteroid-naive boys with Duchenne Muscular Dystrophy (DMD). METHODS The associations between parent-reported neurodevelopmental concerns (speech delay, speech and language difficulties (SLD), and learning difficulties), DMD mutation location, and motor outcomes (6-minute walk distance (6MWD), North Star Ambulatory Assessment (NSAA) total score, 10-meter walk/run velocity, and rise from floor velocity) were studied in 196 corticosteroid-naive boys from ages 4 to less than 8 years. RESULTS Participants with SLD walked 25.8 fewer meters in 6 minutes than those without SLD (p = 0.005) but did not demonstrate statistical differences in NSAA total score, 10-meter walk/run velocity, and rise from floor velocity. Participants with distal DMD mutations with learning difficulties walked 51.8 fewer meters in 6 minutes than those without learning difficulties (p = 0.0007). Participants with distal DMD mutations were slower on 10-meter walk/run velocity, and rise from floor velocity (p = 0.02) than those with proximal DMD mutations. Participants with distal DMD mutations, who reported speech delay or learning difficulties, were slower on rise from floor velocity (p = 0.04, p = 0.01) than those with proximal DMD mutations. The mean NSAA total score was lower in participants with learning difficulties than in those without (p = 0.004). INTERPRETATION Corticosteroid-naive boys with DMD with distal DMD mutations may perform worse on some timed function tests, and that those with learning difficulties may perform worse on the NSAA. Pending confirmatory studies, our data underscore the importance of considering co-existing neurodevelopmental symptoms on motor outcome measures.
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Affiliation(s)
- Mathula Thangarajh
- Department of NeurologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Michael P. McDermott
- University of Rochester Medical CenterSchool of Medicine and DentistryRochesterNew YorkUSA
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research CentreNewcastle University and Newcastle Hospitals National Health Service Foundation TrustNewcastleUK
| | - Robert C. Griggs
- University of Rochester Medical CenterSchool of Medicine and DentistryRochesterNew YorkUSA
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17
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarise the recent developments in trial readiness, natural history studies, and interventional clinical trials for Becker muscular dystrophy (BMD). RECENT FINDINGS As several treatment concepts have claimed to convert patients with Duchenne muscular dystrophy (DMD) into a BMD phenotype, BMD itself has moved into the focus of clinical research. Natural history studies have helped to better characterize patients with BMD and the disease is now a target for interventional trials. In parallel, there have been advances in diagnostics and in the development of preclinical models. SUMMARY Despite increased collaborative efforts to improve trial readiness amongst patients with BMD, there is still a lack of long-term natural history data, and the broad spectrum of disease severity remains a challenge for well designed clinical trials.
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Affiliation(s)
- Volker Straub
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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18
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Schiava M, Ikenaga C, Topf A, Caballero-Ávila M, Chou TF, Li S, Wang F, Daw J, Stojkovic T, Villar-Quiles R, Nishino I, Inoue M, Nishimori Y, Saito Y, Katsuno M, Noda S, Ito C, Otsuka M, Nahir S, Manousakis G, Walk D, Quinn C, Alfano L, Sahenk Z, Tasca G, Monforte M, Sabatelli M, Bisogni G, Oldfors A, Rydeliu A, Pal E, Paradas C, Velez B, De Bleecker JL, Farugia ME, Longman C, Harms MB, Ralston S, Zanoteli E, Macedo Serafim da Silva A, Sotoca J, Juntas-Morales R, Bevilacqua J, Balart M, Talbot S, Straub V, Guglieri M, Marini-Bettolo C, Diaz-Manera J, Weihl CC. Clinical Classification of Variants in the Valosin-Containing Protein Gene Associated With Multisystem Proteinopathy. Neurol Genet 2023; 9:e200093. [PMID: 37588275 PMCID: PMC10427110 DOI: 10.1212/nxg.0000000000200093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/14/2023] [Indexed: 08/18/2023]
Abstract
Background and Objectives Pathogenic variants in the valosin-containing protein (VCP) gene cause a phenotypically heterogeneous disorder that includes myopathy, motor neuron disease, Paget disease of the bone, frontotemporal dementia, and parkinsonism termed multisystem proteinopathy. This hallmark pleiotropy makes the classification of novel VCP variants challenging. This retrospective study describes and assesses the effect of 19 novel or nonpreviously clinically characterized VCP variants identified in 28 patients (26 unrelated families) in the retrospective VCP International Multicenter Study. Methods A 6-item clinical score was developed to evaluate the phenotypic level of evidence to support the pathogenicity of the novel variants. Each item is allocated a value, a score ranging from 0.5 to 5.5 points. A receiver-operating characteristic curve was used to identify a cutoff value of 3 to consider a variant as high likelihood disease associated. The scoring system results were confronted with results of in vitro ATPase activity assays and with in silico analysis. Results All variants were missense, except for one small deletion-insertion, 18 led to amino acid changes within the N and D1 domains, and 13 increased the enzymatic activity. The clinical score coincided with the functional studies in 17 of 19 variants and with the in silico analysis in 12 of 19. For 12 variants, the 3 predictive tools agreed, and for 7 variants, the predictive tools disagreed. The pooled data supported the pathogenicity of 13 of 19 novel VCP variants identified in the study. Discussion This study provides data to support pathogenicity of 14 of 19 novel VCP variants and provides guidance for clinicians in the evaluation of novel variants in the VCP gene.
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Affiliation(s)
- Marianela Schiava
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Chiseko Ikenaga
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Ana Topf
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Marta Caballero-Ávila
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Tsui-Fen Chou
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Shan Li
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Feng Wang
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Jil Daw
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Tanya Stojkovic
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Rocio Villar-Quiles
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Ichizo Nishino
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Michio Inoue
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Yukako Nishimori
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Yoshihiko Saito
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Masahisa Katsuno
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Seiya Noda
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Chihiro Ito
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Mieko Otsuka
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Sruthi Nahir
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Georgios Manousakis
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - David Walk
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Colin Quinn
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Lindsay Alfano
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Zarife Sahenk
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Giorgio Tasca
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Mauro Monforte
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Mario Sabatelli
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Giulia Bisogni
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Anders Oldfors
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Anna Rydeliu
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Endre Pal
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Carmen Paradas
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Beatriz Velez
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Jan L De Bleecker
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Maria Elena Farugia
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Cheryl Longman
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Matthew B Harms
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Stuart Ralston
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Edmar Zanoteli
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Andre Macedo Serafim da Silva
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Javier Sotoca
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Raul Juntas-Morales
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Jorge Bevilacqua
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Mireya Balart
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Stuart Talbot
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Volker Straub
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Michela Guglieri
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Chiara Marini-Bettolo
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Jordi Diaz-Manera
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
| | - Conrad Chris Weihl
- From the John Walton Muscular Dystrophy Research Centre (M. Schiava, A.T., V.S., M.G., C.M.-B., J.D.-M.), Institute of Genetic Medicine, Centre for Life, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, United Kingdom; Johns Hopkins University School of Medicine (C. Ikenaga), Baltimore, MD; Unidad de Enfermedades Neuromusculares (M.C.-Á.), Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Division of Biology and Biological Engineering (T.-F.C., S.L., F.W.), California Institute of Technology, Pasadena; Department of Neurology (J.D.), Washington University School of Medicine, St. Louis, MO; APHP Centre de référence des maladies neuromusculaires Institut de Myologie Sorbonne Université APHP Hôpital Pitié-Salpêtrière Paris (T.S., R.V.-Q.), France; Department of Neuromuscular Research (I.N., M.I., Y.N., Y.S.), National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP); Departments of Neurology (M.K., S. Noda) and Clinical Research Education (M.K., S. Noda), Nagoya University Graduate School of Medicine; Department of Neurology (M.K., S. Noda), National Hospital Organization Suzuka Hospital; Department of Neurology (C. Ito), Aichi Medical University School of Medicine; Department of Neurology (M.O.), International University of Health and Welfare Hospital, Japan; Department of Neurology Sree Chitra Tirunal Institute for Medical Sciences and Technology (S. Nahir), Thiruvananthapuram, Kerala, India; Department of Neurology (G.M., D.W.), University of Minnesota, Minneapolis; Department of Neurology (C.Q.), University of Pennsylvania, Perelman School of Medicine, Philadelphia; Center for Gene Therapy (L.A., Z.S.), The Abigail Wexner Research Institute at Nationwide Children's Hospital; Department of Pediatrics (L.A., Z.S.), The Ohio State University College of Medicine, Columbus; Unità Operativa Complessa di Neurologia Fondazione Policlinico Universitario A Gemelli IRCCS (G.T., M.M.); Centro clinico NEMO- Fondazione policlinico universitario A. Gemelli IRCCS (M. Sabatelli, G.B.), Rome, Italy; Department of Laboratory Medicine, Institute of Biomedicine, University of Gothenburg (A.O.); Department of Neurology (A.R.), Clinical Sciences Lund, Lund University, Sweden; Departments of Neurology and Neuropathology (E.P.), University of Pécs, Hungary; Neurology Department, Neuromuscular Disorders Unit, Hospital Universitario Virgen del Rocío (C.P., B.V.); Instituto de Biomedicina de Sevilla (C.P.); Centre for Biomedical Network Research on Neurodegenerative Disorders (CIBERNED) Instituto de Salud Carlos III (C.P., B.V.), Madrid, Spain; Neurology Department and Neuromuscular Reference Centre (J.L.D.B.), Gent, Blegium, part of the ERN NMD; Institute of Neurological Sciences (M.E.F.); West Scotland Regional Genetics Service (C.L.), Queen Elizabeth University Hospital, Glasgow, United Kingdom; Columbia University Irving Medical Centre (M.B.H.), New York; Centre for Genomic and Experimental Medicine (S.R.), Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Edinburgh, United Kingdom; Department of Neurology (E.Z., A.M.S.S.), School of Medicine, Universidade de São Paulo (FMUSP), Brazil; Neurology Service (J.S., R.J.-M.), Neuromuscular Disorders Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departamento de Neurología y Neurocirugía (J.B.), HCUCH, Departamento de Anatomía y Medicina Legal, Facultad de Medicina, Universidad de Chile; Departamento de Neurología y Neurocirugía Clínica (M.B.), Clínica Dávila, Santiago Chile; Newcastle University (S.T.), Newcastle Upon Tyne, United Kingdom; and Department of Neurology (C.C.W.), Washington University School of Medicine, Saint Louis, MO
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19
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Suárez-Calvet X, Fernández-Simón E, Natera D, Jou C, Pinol-Jurado P, Villalobos E, Ortez C, Monceau A, Schiava M, Codina A, Verdu-Díaz J, Clark J, Laidler Z, Mehra P, Gokul-Nath R, Alonso-Perez J, Marini-Bettolo C, Tasca G, Straub V, Guglieri M, Nascimento A, Diaz-Manera J. Decoding the transcriptome of Duchenne muscular dystrophy to the single nuclei level reveals clinical-genetic correlations. Cell Death Dis 2023; 14:596. [PMID: 37673877 PMCID: PMC10482944 DOI: 10.1038/s41419-023-06103-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
Duchenne muscular dystrophy is a genetic disease produced by mutations in the dystrophin gene characterized by early onset muscle weakness leading to severe and irreversible disability. The cellular and molecular consequences of the lack of dystrophin in humans are only partially known, which is crucial for the development of new therapies aiming to slow or stop the progression of the disease. Here we have analyzed quadriceps muscle biopsies of seven DMD patients aged 2 to 4 years old and five age and gender matched controls using single nuclei RNA sequencing (snRNAseq) and correlated the results obtained with clinical data. SnRNAseq identified significant differences in the proportion of cell population present in the muscle samples, including an increase in the number of regenerative fibers, satellite cells, and fibro-adipogenic progenitor cells (FAPs) and a decrease in the number of slow fibers and smooth muscle cells. Muscle samples from the younger patients with stable mild weakness were characterized by an increase in regenerative fibers, while older patients with moderate and progressive weakness were characterized by loss of muscle fibers and an increase in FAPs. An analysis of the gene expression profile in muscle fibers identified a strong regenerative signature in DMD samples characterized by the upregulation of genes involved in myogenesis and muscle hypertrophy. In the case of FAPs, we observed upregulation of genes involved in the extracellular matrix regeneration but also several signaling pathways. Indeed, further analysis of the potential intercellular communication profile showed a dysregulation of the communication profile in DMD samples identifying FAPs as a key regulator of cell signaling in DMD muscle samples. In conclusion, our study has identified significant differences at the cellular and molecular levels in the different cell populations present in skeletal muscle samples of patients with DMD compared to controls.
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Affiliation(s)
- Xavier Suárez-Calvet
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), 08041, Barcelona, Spain
| | - Esther Fernández-Simón
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Daniel Natera
- Neuromuscular Disorders Unit. Neurology department, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain
| | - Cristina Jou
- Pathology department, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain
| | - Patricia Pinol-Jurado
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Elisa Villalobos
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Carlos Ortez
- Neuromuscular Disorders Unit. Neurology department, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain
| | - Alexandra Monceau
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Anna Codina
- Pathology department, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain
| | - José Verdu-Díaz
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - James Clark
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Zoe Laidler
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Priyanka Mehra
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Rasya Gokul-Nath
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Jorge Alonso-Perez
- Neuromuscular Disease Unit. Neurology Department. Hospital Nuestra Señora de Candelaria, Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Tenerife, Spain
| | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Giorgio Tasca
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Volker Straub
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK
| | - Andrés Nascimento
- Neuromuscular Disorders Unit. Neurology department, Hospital Sant Joan de Deu, Esplugues de Llobregat, Spain
| | - Jordi Diaz-Manera
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), 08041, Barcelona, Spain.
- John Walton Muscular Dystrophy Research Center, Newcastle University Translational and Clinical Research Institute, Newcastle Upon Tyne, UK.
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20
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Wood CL, Hollingsworth KG, Bokaie E, Hughes E, Muni-Lofra R, Mayhew A, Mitchell RT, Guglieri M, McElvaney J, Cheetham TD, Straub V. Is ongoing testosterone required after pubertal induction in Duchenne muscular dystrophy? Endocr Connect 2023; 12:EC-23-0245. [PMID: 37768006 PMCID: PMC10620460 DOI: 10.1530/ec-23-0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/28/2023] [Indexed: 09/29/2023]
Abstract
Glucocorticoids (GC) reduce inflammation and preserve muscle function in boys with Duchenne muscular dystrophy (DMD) but cause pubertal delay. Pubertal induction with testosterone is recommended but longer-term outcome is unknown. OBJECTIVE To assess hypothalamic-pituitary-gonadal axis, muscle volume and function 5 years after pubertal induction. METHODS A prospective observational follow-up of a clinical study was conducted. 15 GC-treated males with DMD were treated with incremental testosterone for 2 years (end of regimen +2y) then evaluated at +2.5y and +5y (final follow-up~ 3 years after last injection). Data collected included testicular volume (TV), gonadotrophin, testosterone, inhibin B, muscle function and limb muscle MRI. RESULTS Participants were 18.7 years (SD 1.6) at final follow-up and had been on GC for 11.2 years (SD 2.2). Testosterone levels were similar at +2.5y (8.6nmol/l (SD 3.4) and 5y (11.0 nmol/l (SD 6.1). TV increased from 2.8 mls (SD 0.9) at +2y to 7.1 mls (SD 1.8) then 10.6 mls (SD 3.5) at +2.5y and +5.0y(p<0.001). Inhibin B levels increased from 55.6 pg/ml (SD 47.0) at baseline to 158.2 pg/ml (SD 87.6), p=0.004 at 5y but remained lower than reference values (mean 305 pg/ml). Muscle contractile bulk decreased. INTERPRETATION Pubertal induction with testosterone in DMD is associated with HPG axis activation and ongoing increases in Inhibin B, TV and testosterone concentrations. Some patients have normal levels which is promising regarding future fertility. Given the beneficial impact of testosterone on bone health, muscle and wellbeing, monitoring testosterone levels in this population and supplementation of sub-optimal levels is important.
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Affiliation(s)
- Claire L Wood
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kieren G Hollingsworth
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Edrina Bokaie
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Eric Hughes
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Muni-Lofra
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anna Mayhew
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, The University of Edinburgh, Queens Medical Research Institute, Edinburgh, UK
| | - Michela Guglieri
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Joseph McElvaney
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Timothy D Cheetham
- Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Volker Straub
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Muni-Lofra R, Juanola-Mayos E, Schiava M, Moat D, Elseed M, Michel-Sodhi J, Harris E, McCallum M, Moore U, Richardson M, Trainor C, Wong K, Malinova M, Bolano-Diaz C, Keogh MJ, Ghimenton E, Verdu-Diaz J, Mayhew A, Guglieri M, Straub V, James MK, Marini-Bettolo C, Diaz-Manera J. Longitudinal Analysis of Respiratory Function of Different Types of Limb Girdle Muscular Dystrophies Reveals Independent Trajectories. Neurol Genet 2023; 9:e200084. [PMID: 37440793 PMCID: PMC10335843 DOI: 10.1212/nxg.0000000000200084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/24/2023] [Indexed: 07/15/2023]
Abstract
Background and Objectives The prevalence and progression of respiratory muscle dysfunction in patients with limb girdle muscular dystrophies (LGMDs) has been only partially described to date. Most reports include cross-sectional data on a limited number of patients making it difficult to gain a wider perspective on respiratory involvement throughout the course of the disease and to compare the most prevalent LGMD subtypes. Methods We reviewed the results of spirometry studies collected longitudinally in our cohort of patients in routine clinical visits from 2002 to 2020 along with additional clinical and genetic data. A linear mixed model was used to investigate the factors associated with the progression of respiratory dysfunction. Results We followed up 156 patients with 5 different forms of LGMDs for a median of 8 years (range 1-25 years). Of them, 53 patients had pathogenic variants in the Capn3 gene, 47 patients in the Dysf gene, 24 patients in the Fkrp gene, 19 in the Ano5 gene, and 13 in one of the sarcoglycan genes (SCG). At baseline, 58 patients (37.1%) had a forced vital capacity percentage predicted (FVCpp) below 80%, while 14 patients (8.9%) had peak cough flow (PCF) values below 270 L/min. As a subgroup, FKRP was the group with a higher number of patients having FVC <80% and/or PCF <270 L/min at initial assessment (66%). We observed a progressive decline in FVCpp and PCF measurements over time, being age, use of wheelchair, and LGMD subtype independent factors associated with this decline. Fkrp and sarcoglycan patients had a quicker decline in their FVC (Kaplan-Meier curve, F test, p < 0.001 and p = 0.02, respectively). Only 7 of the 58 patients with low FVCpp values reported symptoms of respiratory dysfunction, which are commonly reported by patients with FVCpp below 50%-60%. The number of patients ventilated increased from 2 to 8 during follow-up. Discussion Respiratory dysfunction is a frequent complication of patients with LGMDs that needs to be carefully studied and has direct implications in the care offered in daily clinics. Respiratory dysfunction is associated with disease progression because it is especially seen in patients who are full-time wheelchair users, being more frequent in patients with mutations in the Fkrp and sarcoglycan genes.
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Affiliation(s)
- Robert Muni-Lofra
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Eduard Juanola-Mayos
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Marianela Schiava
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Dionne Moat
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Maha Elseed
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Jassi Michel-Sodhi
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Elizabeth Harris
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Michelle McCallum
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Ursula Moore
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Mark Richardson
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Christina Trainor
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Karen Wong
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Monika Malinova
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Carla Bolano-Diaz
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Michael John Keogh
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Elisabetta Ghimenton
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Jose Verdu-Diaz
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Anna Mayhew
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Michela Guglieri
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Volker Straub
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Meredith K James
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Chiara Marini-Bettolo
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Jordi Diaz-Manera
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
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22
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Anthony K, Ala P, Catapano F, Meng J, Domingos J, Perry M, Ricotti V, Maresh K, Phillips LC, Servais L, Seferian AM, De Lucia S, de Groot I, Krom YD, Verschuuren JGM, Niks EH, Straub V, Guglieri M, Voit T, Morgan J, Muntoni F. T Cell Responses to Dystrophin in a Natural History Study of Duchenne Muscular Dystrophy. Hum Gene Ther 2023; 34:439-448. [PMID: 36453228 DOI: 10.1089/hum.2022.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is caused by the lack of dystrophin, but many patients have rare revertant fibers that express dystrophin. The skeletal muscle pathology of DMD patients includes immune cell infiltration and inflammatory cascades. There are several strategies to restore dystrophin in skeletal muscles of patients, including exon skipping and gene therapy. There is some evidence that dystrophin restoration leads to a reduction in immune cells, but dystrophin epitopes expressed in revertant fibers or following genome editing, cell therapy, or microdystrophin delivery after adeno-associated viral gene therapy may elicit T cell production in patients. This may affect the efficacy of the therapeutic intervention, and potentially lead to serious adverse events. To confirm and extend previous studies, we performed annual enzyme- linked immunospot interferon-gamma assays on peripheral blood mononuclear cells from 77 pediatric boys with DMD recruited into a natural history study, 69 of whom (89.6%) were treated with corticosteroids. T cell responses to dystrophin were quantified using a total of 368 peptides spanning the entire dystrophin protein, organized into nine peptide pools. Peptide mapping pools were used to further localize the immune response in one positive patient. Six (7.8%) patients had a T cell-mediated immune response to dystrophin at at least one time point. All patients who had a positive result had been treated with corticosteroids, either prednisolone or prednisone. Our results show that ∼8% of DMD individuals in our cohort have a pre-existing T cell-mediated immune response to dystrophin, despite steroid treatment. Although these responses are relatively low level, this information should be considered a useful immunological baseline before undertaking clinical trials and future DMD studies. We further highlight the importance for a robust, reproducible standard operating procedure for collecting, storing, and shipping samples from multiple centers to minimize the number of inconclusive data.
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Affiliation(s)
- Karen Anthony
- The Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
- Centre for Physical Activity and Life Sciences, University of Northampton, Northampton, United Kingdom
| | - Pierpaolo Ala
- The Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
| | - Francesco Catapano
- The Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
| | - Jinhong Meng
- The Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
| | - Joana Domingos
- The Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
| | - Mark Perry
- The Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
| | - Valeria Ricotti
- The Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
| | - Kate Maresh
- The Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
| | - Lauren C Phillips
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Laurent Servais
- Institut de Myologie, Groupe hospitalier La Pitié Salpétrière, Paris, France
- MDUK Oxford Neuromuscular Center, University of Oxford, Oxford, United Kingdom
- Division of Paediatrics, Neuromuscular Center, University Hospital and University of Liège, Liège, Belgium
| | | | | | | | - Yvonne D Krom
- Leiden University Medical Centre, Leiden, Netherlands
| | | | - Erik H Niks
- Leiden University Medical Centre, Leiden, Netherlands
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Thomas Voit
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
| | - Jennifer Morgan
- The Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
| | - Francesco Muntoni
- The Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- National Institute for Health Research, Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, United Kingdom
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23
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Moore U, Emmons SS, Rufibach L, Straub V, Diaz-Manera J, Guglieri M. Patient reported pregnancy and birth outcomes in genetic neuromuscular diseases. Neuromuscul Disord 2023; 33:241-249. [PMID: 36753800 DOI: 10.1016/j.nmd.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/21/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
Pregnancy and birth in women with neuromuscular conditions has been associated with more rapid disease progression and obstetric complications. This study assessed the impact of functional status and specific diagnosis on patient reported pregnancy and birth outcomes in 26 genetic neuromuscular diseases. Pregnancy and birth outcomes were collected through electronic patient questionnaires and analysed by mobility group and diagnosis. Free text responses were grouped into themes. 721 pregnancies were reported by 305 women. Miscarriage (21% of pregnancies), caesarean delivery (38% of births) and instrumental vaginal delivery (19% of births) were all more frequent in respondents than in the general population (p<0.05), and were more common in those who were non-ambulant at conception than other mobility levels (p <0.05). Falls occurred during 42% of pregnancies and a deterioration in muscle strength during 43%. There was not an increased incidence of maternal complications, apart from maternal hypertension which was more common in limb girdle muscular dystrophy 2A/R1 (35%) and myotonic dystrophy (24%). Patients offered specific practical advice to prospective mothers. Women with neuromuscular conditions have a more complex antenatal and perinatal course than unaffected women. Prenatal counselling, specialist obstetric review and additional occupational therapy support should be considered.
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Affiliation(s)
- Ursula Moore
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK
| | | | | | - V Straub
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK
| | - Jordi Diaz-Manera
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK
| | - Michela Guglieri
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK.
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24
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Moore U, Fernández-Simón E, Schiava M, Cox D, Gordish-Dressman H, James MK, Mayhew A, Wilson I, Guglieri M, Rufibach L, Blamire A, Carlier PG, Mori-Yoshimura M, Day JW, Jones KJ, Bharucha-Goebel DX, Salort-Campana E, Pestronk A, Walter MC, Paradas C, Stojkovic T, Bravver E, Pegoraro E, Mendell JR, Bushby K, Diaz-Manera J, Straub V. Myostatin and follistatin as monitoring and prognostic biomarkers in dysferlinopathy. Neuromuscul Disord 2023; 33:199-207. [PMID: 36689846 DOI: 10.1016/j.nmd.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
Myostatin is a myokine which acts upon skeletal muscle to inhibit growth and regeneration. Myostatin is endogenously antagonised by follistatin. This study assessed serum myostatin and follistatin concentrations as monitoring or prognostic biomarkers in dysferlinopathy, an autosomal recessively inherited muscular dystrophy. Myostatin was quantified twice with a three-year interval in 76 patients with dysferlinopathy and 38 controls. Follistatin was quantified in 62 of these patients at the same timepoints, and in 31 controls. Correlations with motor function, muscle fat fraction and contractile cross-sectional area were performed. A regression model was used to account for confounding variables. Baseline myostatin, but not follistatin, correlated with baseline function and MRI measures. However, in individual patients, three-year change in myostatin did not correlate with functional or MRI changes. Linear modelling demonstrated that function, serum creatine kinase and C-reactive protein, but not age, were independently related to myostatin concentration. Baseline myostatin concentration predicted loss of ambulation but not rate of change of functional or MRI measures, even when relative inhibition with follistatin was considered. With adjustment for extra-muscular causes of variation, myostatin could form a surrogate measure of functional ability or muscle mass, however myostatin inhibition does not form a promising treatment target in dysferlinopathy.
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Affiliation(s)
- Ursula Moore
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Esther Fernández-Simón
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Marianela Schiava
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dan Cox
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Heather Gordish-Dressman
- Center for Translational Science, Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC, USA; Pediatrics, Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | - Meredith K James
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anna Mayhew
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian Wilson
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michela Guglieri
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Andrew Blamire
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Madoka Mori-Yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - John W Day
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristi J Jones
- The Children's Hospital at Westmead and The University of Sydney, Sydney, NSW, Australia
| | - Diana X Bharucha-Goebel
- Department of Neurology, Children's National Health System, Washington, DC, USA; National Institutes of Health (NINDS), Bethesda, MD, USA
| | | | - Alan Pestronk
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Maggie C Walter
- Friedrich-Baur-Institute, Department of Neurology, LudwigMaximilians-University of Munich, Munich, Germany
| | - Carmen Paradas
- Neuromuscular Unit, Department of Neurology, Hospital U. Virgen del Rocío/Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Tanya Stojkovic
- Centre de reference des maladies neuromusculaires, Institut de Myologie, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Elena Bravver
- Neuroscience Institute, Carolinas Neuromuscular/ALS-MDA Center, Carolinas HealthCare System, Charlotte, NC, USA
| | - Elena Pegoraro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Jerry R Mendell
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Kate Bushby
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jordi Diaz-Manera
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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25
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Muntoni F, Signorovitch J, Sajeev G, Lane H, Jenkins M, Dieye I, Ward SJ, McDonald C, Goemans N, Niks EH, Wong B, Servais L, Straub V, Guglieri M, de Groot IJM, Chesshyre M, Tian C, Manzur AY, Mercuri E, Aartsma-Rus A. DMD Genotypes and Motor Function in Duchenne Muscular Dystrophy: A Multi-institution Meta-analysis With Implications for Clinical Trials. Neurology 2023; 100:e1540-e1554. [PMID: 36725339 PMCID: PMC10103111 DOI: 10.1212/wnl.0000000000201626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical trials of genotype-targeted treatments in Duchenne muscular dystrophy (DMD) traditionally compare treated patients to untreated patients with the same DMD genotype class. This avoids confounding of drug efficacy by genotype effects but also shrinks the pool of eligible controls, increasing challenges for trial enrollment in this already rare disease. To evaluate the suitability of genotypically unmatched controls in DMD, we quantified effects of genotype class on 1-year changes in motor function endpoints used in clinical trials. METHODS Over 1,600 patient-years of follow-up (>700 patients) were studied from six real-world/natural history data sources (UZ Leuven, PRO-DMD-01 shared by CureDuchenne, iMDEX, North Star UK, Cincinnati Children's Hospital Medical Center, and the DMD Italian Group), with genotypes classified as amenable to skipping exons 44, 45, 51 or 53, other skippable, nonsense, and other mutations. Associations between genotype class and 1-year changes in North Star Ambulatory Assessment total score (ΔNSAA) and in 10-meter walk/run velocity (Δ10MWR) were studied in each data source with and without adjustment for baseline prognostic factors. RESULTS The studied genotype classes accounted for approximately 2% of variation in ΔNSAA outcomes after 12 months, whereas other prognostic factors explained >30% of variation in large data sources. Based on a meta-analysis across all data sources, pooled effect estimates for the studied skip-amenable mutation classes were all small in magnitude (<2 units in ΔNSAA total score in 1-year follow up), smaller than clinically important differences in NSAA, and were precisely estimated with standard errors <1 unit after adjusting for non-genotypic prognostic factors. DISCUSSION These findings suggest viability of trial designs incorporating genotypically mixed or unmatched controls for up to 12 months in duration for motor function outcomes, which would ease recruitment challenges and reduce numbers of patients assigned to placebos. Such trial designs, including multi-genotype platform trials and hybrid designs, should ensure baseline balance between treatment and control groups for the most important prognostic factors, while accounting for small remaining genotype effects quantified in the present study.
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Affiliation(s)
- Francesco Muntoni
- Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, UK
| | - James Signorovitch
- Analysis Group, Inc., Boston, Massachusetts, USA .,The collaborative Trajectory Analysis Project, Cambridge, Massachusetts, USA
| | | | - Henry Lane
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | | | - Susan J Ward
- The collaborative Trajectory Analysis Project, Cambridge, Massachusetts, USA
| | - Craig McDonald
- Department of Physical Medicine and Rehabilitation, and Pediatrics, University of California, Davis, Sacramento, California, USA
| | | | - Erik H Niks
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Brenda Wong
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Laurent Servais
- MDUK Oxford Neuromuscular Center, Department of Paediatrics, University of Oxford, UK and Neuromuscular Center of Liège, Division of Paediatrics, CHU and University of Liège, Belgium
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Imelda J M de Groot
- Radboud University Nijmegen Medical Center, Donders Centre of Neuroscience, Department of Rehabilitation, Nijmegen, Netherlands
| | - Mary Chesshyre
- Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, UK
| | - Cuixia Tian
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio & College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Adnan Y Manzur
- Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, UK
| | - Eugenio Mercuri
- Department of Pediatric Neurology, Fondazione Policlinico Gemelli IRCCS, Catholic University, Rome, Italy
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26
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Sherlock SP, Palmer J, Wagner KR, Abdel-Hamid HZ, Tian C, Mah JK, Muntoni F, Guglieri M, Butterfield RJ, Charnas L, Marraffino S. Dual-energy X-ray absorptiometry measures of lean body mass as a biomarker for progression in boys with Duchenne muscular dystrophy. Sci Rep 2022; 12:18762. [PMID: 36335191 PMCID: PMC9637094 DOI: 10.1038/s41598-022-23072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
We evaluated whether whole-body dual-energy X-ray absorptiometry (DXA) measures of lean body mass can be used as biomarkers for disease progression and treatment effects in patients with Duchenne muscular dystrophy. This post hoc analysis utilized data from a randomized, 2-period study of domagrozumab versus placebo in 120 ambulatory boys with DMD. DXA measures of lean body mass were obtained from the whole body (excluding head), arms, legs and appendicular skeleton at baseline and every 16 weeks. Treatment effects on DXA measures for domagrozumab versus placebo were assessed at Week 49. At Week 49, domagrozumab statistically significantly increased lean body mass versus placebo in the appendicular skeleton (p = 0.050) and arms (p < 0.001). The relationship between lean body mass at Week 49 and functional endpoints at Week 97 was evaluated. Changes in lean body mass at Week 49 in all regions except arms were significantly correlated with percent change from baseline in 4-stair climb (4SC) at Week 97. DXA-derived percent lean mass at Week 49 also correlated with 4SC and North Star Ambulatory Assessment at Week 97. These data indicate that whole-body DXA measures can be used as biomarkers for treatment effects and disease progression in patients with DMD, and warrant further investigation.Trial registration: ClinicalTrials.gov, NCT02310763; registered 8 December 2014.
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Affiliation(s)
| | | | - Kathryn R Wagner
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hoda Z Abdel-Hamid
- Division of Child Neurology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cuixia Tian
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Jean K Mah
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
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Moore U, Simon EF, Day J, Jones K, Bharucha-Goebel D, Pestronk A, Walter M, Paradas C, Stojkovic T, Bravver E, Pegoraro E, Mendell J, Guglieri M, Straub V, Díaz-Manera J. FP.35 Myostatin concentration is unreliable as a biomarker of disease progression in dysferlinopathy. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Heslop E, Cammish P, McNiff M, Pegg K, Irvin A, Reuben E, Johnson A, Gaeta A, Turner C, Fischer R, Peay H, Muntoni F, Childs A, Straub V, Guglieri M. P.125 DMD Hub: A UK network enabling trials in Duchenne muscular dystrophy. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bourke J, Turner C, Bradlow W, Chikermane A, Coats C, Fenton M, Ilina M, Johnson A, Kapetanakis S, Kuhwald L, Morley-Davies A, Quinlivan R, Savvatis K, Schiava M, Yousef Z, Guglieri M. Cardiac care of children with dystrophinopathy and females carrying DMD-gene variations. Open Heart 2022; 9:e001977. [PMID: 36252992 PMCID: PMC9577913 DOI: 10.1136/openhrt-2022-001977] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/26/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We provide succinct, evidence-based and/or consensus-based best practice guidance for the cardiac care of children living with Duchenne muscular dystrophy (DMD) as well as recommendations for screening and management of female carriers of mutations in the DMD-gene. METHODS Initiated by an expert working group of UK-based cardiologists, neuromuscular clinicians and DMD-patient representatives, draft guidelines were created based on published evidence, current practice and expert opinion. After wider consultation with UK-cardiologists, consensus was reached on these best-practice recommendations for cardiac care in DMD. RESULTS The resulting recommendations are presented in the form of a succinct care pathway flow chart with brief justification. The guidance signposts evidence on which they are based and acknowledges where there have been differences in opinion. Guidelines for cardiac care of patients with more advanced cardiac dystrophinopathy at any age have also been considered, based on the previous published work of Quinlivan et al and are presented here in a similar format. The recommendations have been endorsed by the British Cardiovascular Society. CONCLUSION These guidelines provide succinct, reasoned recommendations for all those managing paediatric patients with early or advanced stages of cardiomyopathy as well as females with cardiac dystrophinopathy. The hope is that this will result in more uniform delivery of high standards of care for children with cardiac dystrophinopathy, so improving heart health into adulthood through timely earlier interventions across the UK.
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Affiliation(s)
- John Bourke
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Cathy Turner
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - William Bradlow
- Department of Paediatric Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ashish Chikermane
- Department of Cardiology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Caroline Coats
- Department of Cardiology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Matthew Fenton
- Department of Paediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Maria Ilina
- Scottish Paediatric Cardiac Services, Royal Hospital for Children, Glasgow, UK
| | | | - Stam Kapetanakis
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Adrian Morley-Davies
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ros Quinlivan
- Department of Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
- Institute of Neurology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Konstantinos Savvatis
- Institute of Neurology, University College London Hospitals NHS Foundation Trust, London, UK
- Barts Heart Centre, Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Marianela Schiava
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Zaheer Yousef
- Department of Cardiology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, UK
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Guglieri M, Clemens PR, Perlman SJ, Smith EC, Horrocks I, Finkel RS, Mah JK, Deconinck N, Goemans N, Haberlova J, Straub V, Mengle-Gaw LJ, Schwartz BD, Harper AD, Shieh PB, De Waele L, Castro D, Yang ML, Ryan MM, McDonald CM, Tulinius M, Webster R, McMillan HJ, Kuntz NL, Rao VK, Baranello G, Spinty S, Childs AM, Sbrocchi AM, Selby KA, Monduy M, Nevo Y, Vilchez-Padilla JJ, Nascimento-Osorio A, Niks EH, de Groot IJM, Katsalouli M, James MK, van den Anker J, Damsker JM, Ahmet A, Ward LM, Jaros M, Shale P, Dang UJ, Hoffman EP. Efficacy and Safety of Vamorolone vs Placebo and Prednisone Among Boys With Duchenne Muscular Dystrophy: A Randomized Clinical Trial. JAMA Neurol 2022; 79:1005-1014. [PMID: 36036925 PMCID: PMC9425287 DOI: 10.1001/jamaneurol.2022.2480] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Question For steroidal anti-inflammatory drugs, can efficacy be retained while safety concerns are reduced among boys with Duchenne muscular dystrophy (DMD) with the novel partial receptor agonist vamorolone? Findings A randomized, double-blind, placebo- and prednisone-controlled trial of vamorolone (2 dose groups) was carried out in 121 patients with DMD. The trial met the primary (time to stand velocity after 24 weeks for vamorolone, 6 mg/kg per day vs placebo) and first 4 sequential secondary motor function end points; vamorolone showed loss of bone morbidities compared with prednisone, with no stunting of growth and no deleterious changes in bone biomarkers. Meaning This study found that vamorolone, a dissociative steroidal anti-inflammatory, was able to reduce bone morbidities while retaining efficacy. Importance Corticosteroidal anti-inflammatory drugs are widely prescribed but long-term use shows adverse effects that detract from patient quality of life. Objective To determine if vamorolone, a structurally unique dissociative steroidal anti-inflammatory drug, is able to retain efficacy while reducing safety concerns with use in Duchenne muscular dystrophy (DMD). Design, Setting, and Participants Randomized, double-blind, placebo- and prednisone-controlled 24-week clinical trial, conducted from June 29, 2018, to February 24, 2021, with 24 weeks of follow-up. This was a multicenter study (33 referral centers in 11 countries) and included boys 4 to younger than 7 years of age with genetically confirmed DMD not previously treated with corticosteroids. Interventions The study included 4 groups: placebo; prednisone, 0.75 mg/kg per day; vamorolone, 2 mg/kg per day; and vamorolone, 6 mg/kg per day. Main Outcomes and Measures Study outcomes monitored (1) efficacy, which included motor outcomes (primary: time to stand from supine velocity in the vamorolone, 6 mg/kg per day, group vs placebo; secondary: time to stand from supine velocity [vamorolone, 2 mg/kg per day], 6-minute walk distance, time to run/walk 10 m [vamorolone, 2 and 6 mg/kg per day]; exploratory: NorthStar Ambulatory Assessment, time to climb 4 stairs) and (2) safety, which included growth, bone biomarkers, and a corticotropin (ACTH)–challenge test. Results Among the 133 boys with DMD enrolled in the study (mean [SD] age, 5.4 [0.9] years), 121 were randomly assigned to treatment groups, and 114 completed the 24-week treatment period. The trial met the primary end point for change from baseline to week 24 time to stand velocity for vamorolone, 6 mg/kg per day (least-squares mean [SE] velocity, 0.05 [0.01] m/s vs placebo −0.01 [0.01] m/s; 95% CI, 0.02-0.10; P = .002) and the first 4 sequential secondary end points: time to stand velocity, vamorolone, 2 mg/kg per day, vs placebo; 6-minute walk test, vamorolone, 6 mg/kg per day, vs placebo; 6-minute walk test, vamorolone, 2 mg/kg per day, vs placebo; and time to run/walk 10 m velocity, vamorolone, 6 mg/kg per day, vs placebo. Height percentile declined in prednisone-treated (not vamorolone-treated) participants (change from baseline [SD]: prednisone, −1.88 [8.81] percentile vs vamorolone, 6 mg/kg per day, +3.86 [6.16] percentile; P = .02). Bone turnover markers declined with prednisone but not with vamorolone. Boys with DMD at baseline showed low ACTH-stimulated cortisol and high incidence of adrenal insufficiency. All 3 treatment groups led to increased adrenal insufficiency. Conclusions and Relevance In this pivotal randomized clinical trial, vamorolone was shown to be effective and safe in the treatment of boys with DMD over a 24-week treatment period. Vamorolone may be a safer alternative than prednisone in this disease, in which long-term corticosteroid use is the standard of care. Trial Registration ClinicalTrials.gov Identifier: NCT03439670
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Affiliation(s)
- Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle Hospitals NHS Foundation Trust and Newcastle University, Newcastle, United Kingdom
| | - Paula R Clemens
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Edward C Smith
- Duke University School of Medicine, Durham, North Carolina
| | - Iain Horrocks
- Royal Hospital for Children, Glasgow, United Kingdom
| | - Richard S Finkel
- Nemours Children's Hospital, Orlando, Florida.,St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jean K Mah
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Nathalie Goemans
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Paediatric Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Jana Haberlova
- Neuromuscular Centre, Department of Pediatric Neurology, Motol University Hospital, 2nd Medical School, Charles University, Prague, Czech Republic
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle Hospitals NHS Foundation Trust and Newcastle University, Newcastle, United Kingdom
| | | | | | - Amy D Harper
- Richmond Children's Hospital, Richmond, Virginia
| | | | - Liesbeth De Waele
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Paediatric Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | - Michelle L Yang
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora
| | - Monique M Ryan
- The Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Mar Tulinius
- Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Richard Webster
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, Australia
| | | | - Nancy L Kuntz
- Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Vashmi K Rao
- Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Giovanni Baranello
- The Dubowitz Neuromuscular Centre, National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health University College London, London, United Kingdom
| | - Stefan Spinty
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | | | | | - Kathryn A Selby
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | | | - Yoram Nevo
- Schneider Children's Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Andres Nascimento-Osorio
- Neuropaediatrics Department, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
| | - Erik H Niks
- Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Meredith K James
- John Walton Muscular Dystrophy Research Centre, Newcastle Hospitals NHS Foundation Trust and Newcastle University, Newcastle, United Kingdom
| | - Johannes van den Anker
- ReveraGen BioPharma, Rockville, Maryland.,Children's National Medical Center, Washington, DC
| | | | - Alexandra Ahmet
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Leanne M Ward
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | | | | | - Eric P Hoffman
- ReveraGen BioPharma, Rockville, Maryland.,Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences Binghamton University-State University of New York, Binghamton
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Muntoni F, Guglieri M, Mah JK, Wagner KR, Brandsema JF, Butterfield RJ, McDonald CM, Mayhew AG, Palmer JP, Marraffino S, Charnas L, Mercuri E. Novel approaches to analysis of the North Star Ambulatory Assessment (NSAA) in Duchenne muscular dystrophy (DMD): Observations from a phase 2 trial. PLoS One 2022; 17:e0272858. [PMID: 35998119 PMCID: PMC9397979 DOI: 10.1371/journal.pone.0272858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The North Star Ambulatory Assessment (NSAA) tool is a key instrument for measuring clinical outcomes in patients with Duchenne muscular dystrophy (DMD). To gain a better understanding of the longitudinal utility of the NSAA, we evaluated NSAA data from a phase II trial of 120 patients with DMD treated with domagrozumab or placebo. Methods The NSAA exploratory analyses included assessment of individual skills gained/lost, total skills gained/lost, cumulative loss of function, and the impact of transient loss of function due to a temporary disability on NSAA total score (temporary zero score). Results There was no significant difference in the total number of NSAA skills gained (mean 1.41 and 1.04, respectively; p = 0.3314) or lost (3.90 vs. 5.0; p = 0.0998) between domagrozumab- vs. placebo-treated patients at week 49. However, domagrozumab-treated patients were less likely to lose the ability to perform a NSAA item (hazard ratio 0.80, 95% confidence interval [CI]: 0.65–0.98, p = 0.029) over 48-weeks vs. placebo-treated patients. When temporary zero scores were changed to “not obtainable” (8 values from 7 patients), domagrozumab-treated patients scored higher on the NSAA total score versus placebo-treated patients (difference at week 49: 2.0, 95% CI: 0.1–3.9, p = 0.0359). Conclusions These exploratory analyses reveal additional approaches to interpreting the NSAA data beyond just change in NSAA total score. These observations also highlight the importance of reporting items as “not obtainable” for a patient with a temporary/transient physical disability that impacts their ability to perform the NSAA test. ClinicalTrials.gov identifier NCT02310763.
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Affiliation(s)
- Francesco Muntoni
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, London, United Kingdom
- * E-mail:
| | - Michela Guglieri
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jean K. Mah
- Cumming School of Medicine, University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Kathryn R. Wagner
- Center for Genetic Muscle Disorders, and Departments of Neurology and Neuroscience, Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - John F. Brandsema
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | | | - Craig M. McDonald
- Lawson Health Research Institute, Children’s Hospital, London, Ontario, Canada
| | - Anna G. Mayhew
- Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
| | | | | | | | - Eugenio Mercuri
- Paediatric Neurology, Catholic University, and Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Folland C, Johnsen R, Gomez AB, Trajanoski D, Davis MR, Moore U, Straub V, Barresi R, Guglieri M, Hayhurst H, Schaefer AM, Laing NG, Lamont PJ, Ravenscroft G. Identification of a novel heterozygous DYSF variant in a large family with a dominantly-inherited dysferlinopathy. Neuropathol Appl Neurobiol 2022; 48:e12846. [PMID: 35962550 DOI: 10.1111/nan.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/29/2022] [Accepted: 08/07/2022] [Indexed: 11/27/2022]
Abstract
AIMS Dysferlinopathy is an autosomal recessive muscular dystrophy, caused by bi-allelic variants in the gene encoding dysferlin (DYSF). Onset typically occurs in the second to third decade and is characterised by slowly progressive skeletal muscle weakness and atrophy of the proximal and/or distal muscles of the four limbs. There are rare cases of symptomatic DYSF variant carriers. Here, we report a large family with a dominantly inherited hyperCKaemia and late-onset muscular dystrophy. METHODS AND RESULTS Genetic analysis identified a co-segregating novel DYSF variant [NM_003494.4:c.6207del p.(Tyr2070Metfs*4)]. No secondary variants in DYSF or other dystrophy-related genes were identified on whole genome sequencing and analysis of the proband's DNA. Skeletal muscle involvement was milder and later onset than typical dysferlinopathy presentations; these clinical signs manifested in four individuals, all between the fourth and sixth decades of life. All individuals heterozygous for the c.6207del variant had hyperCKaemia. Histological analysis of skeletal muscle biopsies across three generations showed clear dystrophic signs, including inflammatory infiltrates, regenerating myofibres, increased variability in myofibre size, and internal nuclei. Muscle magnetic resonance imaging revealed fatty replacement of muscle in two individuals. Western blot and immunohistochemical analysis of muscle biopsy demonstrated consistent reduction of dysferlin staining. Allele-specific quantitative PCR analysis of DYSF mRNA from patient muscle found that the variant, localised to the extreme C-terminus of dysferlin, does not activate post-transcriptional mRNA decay. CONCLUSIONS We propose that this inheritance pattern may be underappreciated and that other late-onset muscular dystrophy cases with mono-allelic DYSF variants, particularly C-terminal premature truncation variants, may represent dominant forms of disease.
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Affiliation(s)
- Chiara Folland
- Centre for Medical Research, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Russell Johnsen
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, Australia
| | - Adriana Botero Gomez
- Department of Diagnostic Genomics, Department of Health, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Daniel Trajanoski
- Department of Diagnostic Genomics, Department of Health, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Mark R Davis
- Department of Diagnostic Genomics, Department of Health, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Ursula Moore
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Michela Guglieri
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Hannah Hayhurst
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Andrew M Schaefer
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nigel G Laing
- Centre for Medical Research, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | | | - Gianina Ravenscroft
- Centre for Medical Research, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, WA, Australia
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Zambon AA, Ayyar Gupta V, Ridout D, Manzur A, Baranello G, Trucco F, Muntoni F, Douglas M, McFetridge J, Parasuraman D, Alhaswani Z, McMurchie H, Rabb R, Majumdar A, Vijayakumar K, Amin S, Mason F, Frimpong‐Ansah C, Gibbon F, Parson B, Naismith K, Burslem J, Baxter A, Eadie C, Horrocks I, Di Marco M, Childs A, Pallant L, Spinty S, Shillington A, Gregson S, Cheshman L, Wraige E, Gowda V, Jungbluth H, Sheehan J, Hughes I, Warner S, Straub V, Guglieri M, Mayhew A, Chow G, Williamson S, Willis T, Kulshrestha R, Emery N, Ramdas S, Ramjattan H, de Goede C, Selley A, Ong M, White K, Illingworth M, Geary M, Palmer J, White C, Greenfield K, Hewawitharana G, Julien Y, Stephens E, Tewnion J, Ambegaonkar G, Krishnakumar D, Taylor J, Ward C, Willis T, Wright E, Rylance C. Peak functional ability and age at loss of ambulation in Duchenne muscular dystrophy. Dev Med Child Neurol 2022; 64:979-988. [PMID: 35385138 PMCID: PMC9303180 DOI: 10.1111/dmcn.15176] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/04/2022]
Abstract
AIM To correlate the North Star Ambulatory Assessment (NSAA) and timed rise from floor (TRF) recorded at age of expected peak with age at loss of ambulation (LOA) in Duchenne muscular dystrophy (DMD). METHOD Male children with DMD enrolled in the UK North Start Network database were included according to the following criteria: follow-up longer than 3 years, one NSAA record between 6 years and 7 years 6 months (baseline), at least one visit when older than 8 years. Data about corticosteroid treatment, LOA, genotype, NSAA, and TRF were analysed. Age at LOA among the different groups based on NSAA and TRF was determined by log-rank tests. Cox proportional hazard models were used for multivariable analysis. RESULTS A total of 293 patients from 13 different centres were included. Mean (SD) age at first and last visit was 5 years 6 months (1 year 2 months) and 12 years 8 months (2 years 11 months) (median follow-up 7 years 4 months). Higher NSAA and lower TRF at baseline were associated with older age at LOA (p<0.001). Patients scoring NSAA 32 to 34 had a probability of 0.61 of being ambulant when older than 13 years compared with 0.34 for those scoring 26 to 31. In multivariable analysis, NSAA, TRF, and corticosteroid daily regimen (vs intermittent) were all independently associated with outcome (p=0.01). INTERPRETATION Higher functional abilities at peak are associated with older age at LOA in DMD. This information is important for counselling families. These baseline measures should also be considered when designing clinical trials.
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Affiliation(s)
- Alberto A. Zambon
- Dubowitz Neuromuscular CentreUCL Great Ormond Street Institute of Child Health & Great Ormond Street HospitalLondonUK,Neuromuscular Repair UnitInstitute of Experimental Neurology (InSpe)Division of NeuroscienceIRCCS Ospedale San RaffaeleMilanItaly
| | - Vandana Ayyar Gupta
- Dubowitz Neuromuscular CentreUCL Great Ormond Street Institute of Child Health & Great Ormond Street HospitalLondonUK
| | - Deborah Ridout
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK,NIHR Great Ormond Street Hospital Biomedical Research CentreLondonUK
| | - Adnan Y. Manzur
- Dubowitz Neuromuscular CentreUCL Great Ormond Street Institute of Child Health & Great Ormond Street HospitalLondonUK,NIHR Great Ormond Street Hospital Biomedical Research CentreLondonUK
| | - Giovanni Baranello
- Dubowitz Neuromuscular CentreUCL Great Ormond Street Institute of Child Health & Great Ormond Street HospitalLondonUK
| | - Federica Trucco
- Dubowitz Neuromuscular CentreUCL Great Ormond Street Institute of Child Health & Great Ormond Street HospitalLondonUK,Children’s Sleep MedicineEvelina Children Hospital ‐ Paediatric Respiratory Department Royal Brompton HospitalGuy’s and St Thomas’ TrustLondonUK
| | - Francesco Muntoni
- Dubowitz Neuromuscular CentreUCL Great Ormond Street Institute of Child Health & Great Ormond Street HospitalLondonUK,NIHR Great Ormond Street Hospital Biomedical Research CentreLondonUK
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Sherlock SP, Palmer J, Wagner KR, Abdel-Hamid HZ, Bertini E, Tian C, Mah JK, Kostera-Pruszczyk A, Muntoni F, Guglieri M, Brandsema JF, Mercuri E, Butterfield RJ, McDonald CM, Charnas L, Marraffino S. Quantitative magnetic resonance imaging measures as biomarkers of disease progression in boys with Duchenne muscular dystrophy: a phase 2 trial of domagrozumab. J Neurol 2022; 269:4421-4435. [PMID: 35396602 PMCID: PMC9294028 DOI: 10.1007/s00415-022-11084-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 01/14/2023]
Abstract
Duchenne muscular dystrophy (DMD) is a progressive, neuromuscular disorder caused by mutations in the DMD gene that results in a lack of functional dystrophin protein. Herein, we report the use of quantitative magnetic resonance imaging (MRI) measures as biomarkers in the context of a multicenter phase 2, randomized, placebo-controlled clinical trial evaluating the myostatin inhibitor domagrozumab in ambulatory boys with DMD (n = 120 aged 6 to < 16 years). MRI scans of the thigh to measure muscle volume, muscle volume index (MVI), fat fraction, and T2 relaxation time were obtained at baseline and at weeks 17, 33, 49, and 97 as per protocol. These quantitative MRI measurements appeared to be sensitive and objective biomarkers for evaluating disease progression, with significant changes observed in muscle volume, MVI, and T2 mapping measures over time. To further explore the utility of quantitative MRI measures as biomarkers to inform longer term functional changes in this cohort, a regression analysis was performed and demonstrated that muscle volume, MVI, T2 mapping measures, and fat fraction assessment were significantly correlated with longer term changes in four-stair climb times and North Star Ambulatory Assessment functional scores. Finally, less favorable baseline measures of MVI, fat fraction of the muscle bundle, and fat fraction of lean muscle were significant risk factors for loss of ambulation over a 2-year monitoring period. These analyses suggest that MRI can be a valuable tool for use in clinical trials and may help inform future functional changes in DMD.Trial registration: ClinicalTrials.gov identifier, NCT02310763; registered December 2014.
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Affiliation(s)
| | | | - Kathryn R Wagner
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hoda Z Abdel-Hamid
- Division of Child Neurology, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Enrico Bertini
- Unit of Neuromuscular Disease, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cuixia Tian
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Jean K Mah
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Eugenio Mercuri
- Pediatric Neurology, Catholic University, Rome, Italy
- Centro Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
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Mayhew AG, Nelson L, Guglieri M, Willis T. Editorial: Lessons Learned from Translational Research in Neuromuscular Diseases: Impact on Study Design, Outcome Measures and Managing Expectation. Front Genet 2022; 13:840074. [PMID: 35860463 PMCID: PMC9293049 DOI: 10.3389/fgene.2022.840074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna G. Mayhew
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- *Correspondence: Anna G. Mayhew,
| | - Leslie Nelson
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michela Guglieri
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Tracey Willis
- Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, England
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Dori A, Guglieri M, Scutifero M, Passamano L, Trabacca A, Politano L. Can symptomatic nmDuchenne carriers benefit from treatment with ataluren? Results of 193-month follow-up. Acta Myol 2022; 41:101. [PMID: 35919205 PMCID: PMC9299955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
[This retracts the article DOI: 10.36185/2532-1900-058.].
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Guglieri M, Bushby K, McDermott MP, Hart KA, Tawil R, Martens WB, Herr BE, McColl E, Speed C, Wilkinson J, Kirschner J, King WM, Eagle M, Brown MW, Willis T, Griggs RC. Effect of Different Corticosteroid Dosing Regimens on Clinical Outcomes in Boys With Duchenne Muscular Dystrophy: A Randomized Clinical Trial. JAMA 2022; 327:1456-1468. [PMID: 35381069 PMCID: PMC8984930 DOI: 10.1001/jama.2022.4315] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Corticosteroids improve strength and function in boys with Duchenne muscular dystrophy. However, there is uncertainty regarding the optimum regimen and dosage. OBJECTIVE To compare efficacy and adverse effects of the 3 most frequently prescribed corticosteroid regimens in boys with Duchenne muscular dystrophy. DESIGN, SETTING, AND PARTICIPANTS Double-blind, parallel-group randomized clinical trial including 196 boys aged 4 to 7 years with Duchenne muscular dystrophy who had not previously been treated with corticosteroids; enrollment occurred between January 30, 2013, and September 17, 2016, at 32 clinic sites in 5 countries. The boys were assessed for 3 years (last participant visit on October 16, 2019). INTERVENTIONS Participants were randomized to daily prednisone (0.75 mg/kg) (n = 65), daily deflazacort (0.90 mg/kg) (n = 65), or intermittent prednisone (0.75 mg/kg for 10 days on and then 10 days off) (n = 66). MAIN OUTCOMES AND MEASURES The global primary outcome comprised 3 end points: rise from the floor velocity (in rise/seconds), forced vital capacity (in liters), and participant or parent global satisfaction with treatment measured by the Treatment Satisfaction Questionnaire for Medication (TSQM; score range, 0 to 100), each averaged across all study visits after baseline. Pairwise group comparisons used a Bonferroni-adjusted significance level of .017. RESULTS Among the 196 boys randomized (mean age, 5.8 years [SD, 1.0 years]), 164 (84%) completed the trial. Both daily prednisone and daily deflazacort were more effective than intermittent prednisone for the primary outcome (P < .001 for daily prednisone vs intermittent prednisone using a global test; P = .017 for daily deflazacort vs intermittent prednisone using a global test) and the daily regimens did not differ significantly (P = .38 for daily prednisone vs daily deflazacort using a global test). The between-group differences were principally attributable to rise from the floor velocity (0.06 rise/s [98.3% CI, 0.03 to 0.08 rise/s] for daily prednisone vs intermittent prednisone [P = .003]; 0.06 rise/s [98.3% CI, 0.03 to 0.09 rise/s] for daily deflazacort vs intermittent prednisone [P = .017]; and -0.004 rise/s [98.3% CI, -0.03 to 0.02 rise/s] for daily prednisone vs daily deflazacort [P = .75]). The pairwise comparisons for forced vital capacity and TSQM global satisfaction subscale score were not statistically significant. The most common adverse events were abnormal behavior (22 [34%] in the daily prednisone group, 25 [38%] in the daily deflazacort group, and 24 [36%] in the intermittent prednisone group), upper respiratory tract infection (24 [37%], 19 [29%], and 24 [36%], respectively), and vomiting (19 [29%], 17 [26%], and 15 [23%]). CONCLUSIONS AND RELEVANCE Among patients with Duchenne muscular dystrophy, treatment with daily prednisone or daily deflazacort, compared with intermittent prednisone alternating 10 days on and 10 days off, resulted in significant improvement over 3 years in a composite outcome comprising measures of motor function, pulmonary function, and satisfaction with treatment; there was no significant difference between the 2 daily corticosteroid regimens. The findings support the use of a daily corticosteroid regimen over the intermittent prednisone regimen tested in this study as initial treatment for boys with Duchenne muscular dystrophy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01603407.
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Affiliation(s)
- Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, England
| | - Kate Bushby
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, England
| | - Michael P. McDermott
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Kimberly A. Hart
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - William B. Martens
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Barbara E. Herr
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | | | - Chris Speed
- Newcastle University, Newcastle upon Tyne, England
- NIHR Clinical Research Network North East and North Cumbria, Newcastle upon Tyne, England
| | | | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
- Department of Neuropediatrics, University Hospital Bonn, Bonn, Germany
| | | | - Michelle Eagle
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, England
| | - Mary W. Brown
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Tracey Willis
- Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, England
| | - Robert C. Griggs
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
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Mayhew AG, James MK, Moore U, Sutherland H, Jacobs M, Feng J, Lowes LP, Alfano LN, Muni Lofra R, Rufibach LE, Rose K, Duong T, Bello L, Pedrosa-Hernández I, Holsten S, Sakamoto C, Canal A, Sánchez-Aguilera Práxedes N, Thiele S, Siener C, Vandevelde B, DeWolf B, Maron E, Gordish-Dressman H, Hilsden H, Guglieri M, Hogrel JY, Blamire AM, Carlier PG, Spuler S, Day JW, Jones KJ, Bharucha-Goebel DX, Salort-Campana E, Pestronk A, Walter MC, Paradas C, Stojkovic T, Mori-Yoshimura M, Bravver E, Díaz-Manera J, Pegoraro E, Mendell JR, Straub V. Assessing the Relationship of Patient Reported Outcome Measures With Functional Status in Dysferlinopathy: A Rasch Analysis Approach. Front Neurol 2022; 13:828525. [PMID: 35359643 PMCID: PMC8961025 DOI: 10.3389/fneur.2022.828525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Dysferlinopathy is a muscular dystrophy with a highly variable functional disease progression in which the relationship of function to some patient reported outcome measures (PROMs) has not been previously reported. This analysis aims to identify the suitability of PROMs and their association with motor performance.Two-hundred and four patients with dysferlinopathy were identified in the Jain Foundation's Clinical Outcome Study in Dysferlinopathy from 14 sites in 8 countries. All patients completed the following PROMs: Individualized Neuromuscular Quality of Life Questionnaire (INQoL), International Physical Activity Questionnaire (IPAQ), and activity limitations for patients with upper and/or lower limb impairments (ACTIVLIMs). In addition, nonambulant patients completed the Egen Klassifikation Scale (EK). Assessments were conducted annually at baseline, years 1, 2, 3, and 4. Data were also collected on the North Star Assessment for Limb Girdle Type Muscular Dystrophies (NSAD) and Performance of Upper Limb (PUL) at these time points from year 2. Data were analyzed using descriptive statistics and Rasch analysis was conducted on ACTIVLIM, EK, INQoL. For associations, graphs (NSAD with ACTIVLIM, IPAQ and INQoL and EK with PUL) were generated from generalized estimating equations (GEE). The ACTIVLIM appeared robust psychometrically and was strongly associated with the NSAD total score (Pseudo R2 0.68). The INQoL performed less well and was poorly associated with the NSAD total score (Pseudo R2 0.18). EK scores were strongly associated with PUL (Pseudo R2 0.69). IPAQ was poorly associated with NSAD scores (Pseudo R2 0.09). This study showed that several of the chosen PROMs demonstrated change over time and a good association with functional outcomes. An alternative quality of life measure and method of collecting data on physical activity may need to be selected for assessing dysferlinopathy.
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Affiliation(s)
- Anna G. Mayhew
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- *Correspondence: Anna G. Mayhew
| | - Meredith K. James
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ursula Moore
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Helen Sutherland
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Marni Jacobs
- Center for Translational Science, Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC, United States
- Pediatrics, Epidemiology and Biostatistics, George Washington University, Washington, DC, United States
| | - Jia Feng
- Center for Translational Science, Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC, United States
| | - Linda Pax Lowes
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Lindsay N. Alfano
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Robert Muni Lofra
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Kristy Rose
- The Children's Hospital at Westmead, The University of Sydney, Sydney, NSW, Australia
| | - Tina Duong
- Cooperative International Neuromuscular Research Group (CINRG), Children's National Health System, Washington, DC, United States
- Lucile Salter Packard Children's Hospital at Stanford, Neurology, Palo Alto, CA, United States
| | - Luca Bello
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Irene Pedrosa-Hernández
- Physical Medicine and Rehabilitation, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Scott Holsten
- Neuroscience Institute, Carolinas Neuromuscular/ALS-MDA Center, Carolinas HealthCare System, Charlotte, NC, United States
| | - Chikako Sakamoto
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry Tokyo, Tokyo, Japan
| | - Aurélie Canal
- Institut de Myologie, AP-HP, GH Pitié-Salpêtrière, Paris, France
| | | | - Simone Thiele
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Catherine Siener
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Bruno Vandevelde
- Service des Maladies Neuromusculaire et de la SLA, Hôpital de La Timone, Marseille, France
| | - Brittney DeWolf
- Cooperative International Neuromuscular Research Group (CINRG), Children's National Health System, Washington, DC, United States
| | - Elke Maron
- ELAN-PHYSIO, Praxis für Physiotherapie Maron, Berlin, Germany
| | - Heather Gordish-Dressman
- Center for Translational Science, Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC, United States
- Pediatrics, Epidemiology and Biostatistics, George Washington University, Washington, DC, United States
| | - Heather Hilsden
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michela Guglieri
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jean-Yves Hogrel
- Institut de Myologie, AP-HP, GH Pitié-Salpêtrière, Paris, France
| | - Andrew M. Blamire
- Magnetic Resonance Centre, Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Pierre G. Carlier
- AIM & CEA NMR Laboratory, Institute of Myology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Simone Spuler
- Charite Muscle Research Unit, Experimental and Clinical Research Center, A Joint Cooperation of the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - John W. Day
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Kristi J. Jones
- The Children's Hospital at Westmead, The University of Sydney, Sydney, NSW, Australia
| | - Diana X. Bharucha-Goebel
- Department of Neurology Children's National Health System, Washington, DC, United States
- National Institutes of Health (NINDS), Bethesda, MD, United States
| | | | - Alan Pestronk
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Maggie C. Walter
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Carmen Paradas
- Neuromuscular Unit, Department of Neurology, Hospital U. Virgen del Rocío/Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Tanya Stojkovic
- Institut de Myologie, AP-HP, GH Pitié-Salpêtrière, Paris, France
| | - Madoka Mori-Yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry Tokyo, Tokyo, Japan
| | - Elena Bravver
- Neuroscience Institute, Carolinas Neuromuscular/ALS-MDA Center, Carolinas HealthCare System, Charlotte, NC, United States
| | - Jordi Díaz-Manera
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elena Pegoraro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Jerry R. Mendell
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Moore U, Fernandez-Torron R, Jacobs M, Gordish H, Diaz-Manera J, James MK, Mayhew AG, Harris E, Guglieri M, Rufibach LE, Feng J, Blamire AM, Carlier PG, Spuler S, Day JW, Jones KJ, Bharucha-Goebel DX, Salort-Campana E, Pestronk A, Walter MC, Paradas C, Stojkovic T, Mori-Yoshimura M, Bravver E, Pegoraro E, Lowes LP, Mendell JR, Bushby K, Bourke J, Straub V. Cardiac and pulmonary findings in dysferlinopathy: a 3-year, longitudinal study. Muscle Nerve 2022; 65:531-540. [PMID: 35179231 PMCID: PMC9311426 DOI: 10.1002/mus.27524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/05/2022] [Accepted: 02/12/2022] [Indexed: 11/15/2022]
Abstract
Introduction/Aims There is debate about whether and to what extent either respiratory or cardiac dysfunction occurs in patients with dysferlinopathy. This study aimed to establish definitively whether dysfunction in either system is part of the dysferlinopathy phenotype. Methods As part of the Jain Foundation's International Clinical Outcome Study (COS) for dysferlinopathy, objective measures of respiratory and cardiac function were collected twice, with a 3‐y interval between tests, in 188 genetically confirmed patients aged 11–86 y (53% female). Measures included forced vital capacity (FVC), electrocardiogram (ECG), and echocardiogram (echo). Results Mean FVC was 90% predicted at baseline, decreasing to 88% at year 3. FVC was less than 80% predicted in 44 patients (24%) at baseline and 48 patients (30%) by year 3, including ambulant participants. ECGs showed P‐wave abnormalities indicative of delayed trans‐atrial conduction in 58% of patients at baseline, representing a risk for developing atrial flutter or fibrillation. The prevalence of impaired left ventricular function or hypertrophy was comparable to that in the general population. Discussion These results demonstrate clinically significant respiratory impairment and abnormal atrial conduction in some patients with dysferlinopathy. Therefore, we recommend that annual or biannual follow‐up should include FVC measurement, enquiry about arrhythmia symptoms and peripheral pulse palpation to assess cardiac rhythm. However, periodic specialist cardiac review is probably not warranted unless prompted by symptoms or abnormal pulse findings.
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Affiliation(s)
- Ursula Moore
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK
| | - Roberto Fernandez-Torron
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK.,Neurology Department, Biodonostia Health Research Institute, Neuromuscular Area, Hospital Donostia, Basque Health Service, Doctor Begiristain, Donostia-San Sebastian, Spain
| | - Marni Jacobs
- Center for Translational Science, Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC, USA.,Pediatrics, Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | - Heather Gordish
- Center for Translational Science, Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC, USA.,Pediatrics, Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | - Jordi Diaz-Manera
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain.,Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau
| | - Meredith K James
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK
| | - Anna G Mayhew
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK
| | - Elizabeth Harris
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK
| | - Michela Guglieri
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK
| | | | - Jia Feng
- Center for Translational Science, Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC, USA
| | - Andrew M Blamire
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Pierre G Carlier
- University Paris-Saclay, CEA, DRF, Service Hospitalier Frederic Joliot, Orsay, France
| | - Simone Spuler
- Charite Muscle Research Unit, Experimental and Clinical Research Center, a joint cooperation of the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - John W Day
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine; Stanford, CA, USA
| | - Kristi J Jones
- The Children's Hospital at Westmead, and The University of Sydney, Australia
| | - Diana X Bharucha-Goebel
- Department of Neurology Children's National Health System, Washington, DC, USA.,National Institutes of Health (NINDS), Bethesda, MD, USA
| | | | - Alan Pestronk
- Department of Neurology Washington University School of Medicine, St. Louis, MO, USA
| | - Maggie C Walter
- Friedrich-Baur-Institute, Dept. of Neurology, Ludwig-Maximilians-University of Munich, Germany
| | - Carmen Paradas
- Neuromuscular Unit, Department of Neurology, Hospital U. Virgen del Rocío/Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Tanya Stojkovic
- Centre de référence des maladies neuromusculaires, Institut de Myologie, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Madoka Mori-Yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry Tokyo, Japan
| | - Elena Bravver
- Neuroscience Institute, Carolinas Neuromuscular/ALS-MDA Center, Carolinas HealthCare System, Charlotte, NC, USA
| | | | - Linda Pax Lowes
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jerry R Mendell
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kate Bushby
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK
| | | | - John Bourke
- Department of Cardiology, Freeman Hospital, NUTH NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, UK
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Mayhew AG, Moat D, McDermott MP, Eagle M, Griggs RC, James MK, Muni-Lofra R, Shillington A, Gregson S, Pallant L, Skura C, Staudt LA, Eichinger K, McMurchie H, Rabb R, Marco MD, Brown S, Zanin R, Arnoldi MT, McIntyre M, Wilson A, Alfano LN, Lowes LP, Blomgren C, Milev E, Iodice M, Pasternak A, Chiu A, Lehnert I, Claus N, Dieruf KA, Rolle E, Nicorici A, Andres B, Hobbiebrunken E, Roetmann G, Kern V, Civitello M, Vogt S, Hayes MJ, Scholtes C, Lacroix C, Gunn T, Warner S, Newman J, Barp A, Kundrat K, Kovelman S, Powers PJ, Guglieri M. Functional outcome measures in young, steroid-naïve boys with Duchenne muscular dystrophy. Neuromuscul Disord 2022; 32:460-467. [DOI: 10.1016/j.nmd.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/25/2022] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
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Schiava M, Amos R, VanRuiten H, McDermott MP, Martens WB, Gregory S, Mayhew A, McColl E, Tawil R, Willis T, Bushby K, Griggs RC, Guglieri M. Clinical and Genetic Characteristics in Young, Glucocorticoid-Naive Boys With Duchenne Muscular Dystrophy. Neurology 2022; 98:e390-e401. [PMID: 34857536 PMCID: PMC8793104 DOI: 10.1212/wnl.0000000000013122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/16/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Duchenne muscular dystrophy (DMD) is a pediatric neuromuscular disorder caused by mutations in the dystrophin gene. Genotype-phenotype associations have been examined in glucocorticoid-treated boys, but there are few data on the young glucocorticoid-naive DMD population. A sample of young glucocorticoid-naive DMD boys is described, and genotype-phenotype associations are investigated. METHODS Screening and baseline data were collected for all the participants in the Finding the Optimum Corticosteroid Regime for Duchenne Muscular Dystrophy (FOR-DMD) study, an international, multicenter, randomized, double-blind, clinical trial comparing 3 glucocorticoid regimens in glucocorticoid-naive, genetically confirmed boys with DMD between 4 and <8 years of age. RESULTS One hundred ninety-six boys were recruited. The mean ± SD age at randomization was 5.8 ± 1.0 years. The predominant mutation type was out-of-frame deletions (67.4%, 130 of 193), of which 68.5% (89 of 130) were amenable to exon skipping. The most frequent mutations were deletions amenable to exon 51 skipping (13.0%, 25 of 193). Stop codon mutations accounted for 10.4% (20 of 193). The mean age at first parental concerns was 29.8 ± 18.7 months; the mean age at genetic diagnosis was 53.9 ± 21.9 months; and the mean diagnostic delay was 25.9 ± 18.2 months. The mean diagnostic delay for boys diagnosed after an incidental finding of isolated hyperCKemia (n = 19) was 6.4 ± 7.4 months. The mean ages at independent walking and talking in sentences were 17.1 ± 4.2 and 29.0 ± 10.7 months, respectively. Median height percentiles were below the 25th percentile regardless of age group. No genotype-phenotype associations were identified expect for boys with exon 8 skippable deletions, who had better performance on time to walk/run 10 m (p = 0.02) compared to boys with deletions not amenable to skipping. DISCUSSION This study describes clinical and genetic characteristics of a sample of young glucocorticoid-naive boys with DMD. A low threshold for creatine kinase testing can lead to an earlier diagnosis. Motor and speech delays were common presenting symptoms. The effects of low pretreatment height on growth and adult height require further study. These findings may promote earlier recognition of DMD and inform study design for future clinical trials. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT01603407.
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Affiliation(s)
- Marianela Schiava
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Rachel Amos
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Henriette VanRuiten
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Michael P McDermott
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Williams B Martens
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Stephanie Gregory
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Anna Mayhew
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Elaine McColl
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Rabi Tawil
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Tracey Willis
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Kate Bushby
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Robert C Griggs
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK
| | - Michela Guglieri
- From the John Walton Muscular Dystrophy Research Centre (M.S., A.M., K.B., M.G.), Clinical and Translational Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trusts; Great North Children Hospital (R.A., H.V.R.), Newcastle Hospitals NHS Foundation Trusts, UK; Department of Biostatistics and Computational Biology (M.P.M.) and Department of Neurology (M.P.M., W.B.M., S.G., R.T., R.C.G.), University of Rochester Medical Centre, NY; Newcastle University (E.M.); and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (T.W.), Oswestry, UK.
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Mah JK, Clemens PR, Guglieri M, Smith EC, Finkel RS, Tulinius M, Nevo Y, Ryan MM, Webster R, Castro D, Kuntz NL, McDonald CM, Damsker JM, Schwartz BD, Mengle-Gaw LJ, Jackowski S, Stimpson G, Ridout DA, Ayyar-Gupta V, Baranello G, Manzur AY, Muntoni F, Gordish-Dressman H, Leinonen M, Ward LM, Hoffman EP, Dang UJ. Efficacy and Safety of Vamorolone in Duchenne Muscular Dystrophy: A 30-Month Nonrandomized Controlled Open-Label Extension Trial. JAMA Netw Open 2022; 5:e2144178. [PMID: 35076703 PMCID: PMC8790668 DOI: 10.1001/jamanetworkopen.2021.44178] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Vamorolone is a synthetic steroidal drug with potent anti-inflammatory properties. Initial open-label, multiple ascending dose-finding studies of vamorolone among boys with Duchenne muscular dystrophy (DMD) found significant motor function improvement after 6 months treatment in higher-dose (ie, ≥2.0 mg/kg/d) groups. OBJECTIVE To investigate outcomes after 30 months of open-label vamorolone treatment. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled trial was conducted by the Cooperative International Neuromuscular Research Group at 11 US and non-US study sites. Participants were 46 boys ages 4.5 to 7.5 years with DMD who completed the 6-month dose-finding study. Data were analyzed from July 2020 through November 2021. INTERVENTIONS Participants were enrolled in a 24-month, long-term extension (LTE) study with vamorolone dose escalated to 2.0 or 6.0 mg/kg/d. MAIN OUTCOMES AND MEASURES Change in time-to-stand (TTSTAND) velocity from dose-finding baseline to end of LTE study was the primary outcome. Efficacy assessments included timed function tests, 6-minute walk test, and NorthStar Ambulatory Assessment (NSAA). Participants with DMD treated with glucocorticoids from the Duchenne Natural History Study (DNHS) and NorthStar United Kingdom (NSUK) Network were matched and compared with participants in the LTE study receiving higher doses of vamorolone. RESULTS Among 46 boys with DMD who completed the dose-finding study, 41 boys (mean [SD] age, 5.33 [0.96] years) completed the LTE study. Among 21 participants treated with higher-dose (ie, ≥2.0 mg/kg/d) vamorolone consistently throughout the 6-month dose-finding and 24-month LTE studies with data available at 30 months, there was a decrease in mean (SD) TTSTAND velocity from baseline to 30 months (0.206 [0.070] rises/s vs 0.189 (0.124) rises/s), which was not a statistically significant change (-0.011 rises/s; CI, -0.068 to 0.046 rises/s). There were no statistically significant differences between participants receiving higher-dose vamorolone and matched participants in the historical control groups receiving glucocorticoid treatment (75 patients in DNHS and 110 patients in NSUK) over a 2-year period in NSAA total score change (0.22 units vs NSUK; 95% CI, -4.48 to 4.04]; P = .92), body mass index z score change (0.002 vs DNHS SD/mo; 95% CI, -0.006 to 0.010; P = .58), or timed function test change. Vamorolone at doses up to 6.0 mg/kg/d was well tolerated, with 5 of 46 participants discontinuing prematurely and for reasons not associated with study drug. Participants in the DNHS treated with glucocorticoids had significant growth delay in comparison with participants treated with vamorolone who had stable height percentiles (0.37 percentile/mo; 95% CI, 0.23 to 0.52 percentile/mo) over time. CONCLUSIONS AND RELEVANCE This study found that vamorolone treatment was not associated with a change in TTSTAND velocity from baseline to 30 months among boys with DMD aged 4 to 7 years at enrollment. Vamorolone was associated with maintenance of muscle strength and function up to 30 months, similar to standard of care glucocorticoid therapy, and improved height velocity compared with growth deceleration associated with glucocorticoid treatment, suggesting that vamorolone may be an attractive candidate for treatment of DMD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03038399.
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Affiliation(s)
- Jean K. Mah
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Paula R. Clemens
- University of Pittsburgh and Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Richard S. Finkel
- Nemours Children’s Hospital, Orlando, Florida
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Mar Tulinius
- Queen Silvia Children’s Hospital, Gothenburg, Sweden
| | - Yoram Nevo
- Schneider Children’s Medical Center of Israel, Tel Aviv University, Petah Tikvah, Israel
| | - Monique M. Ryan
- Royal Children’s Hospital and Murdoch Children’s Research Institute, Melbourne, Australia
| | | | | | - Nancy L. Kuntz
- Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | | | | | | | | | - Stefan Jackowski
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- University of Saskatchewan, Saskatoon, Canada
| | - Georgia Stimpson
- Dubowitz Neuromuscular Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Deborah A. Ridout
- Dubowitz Neuromuscular Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Vandana Ayyar-Gupta
- Dubowitz Neuromuscular Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Giovanni Baranello
- Dubowitz Neuromuscular Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Adnan Y. Manzur
- Dubowitz Neuromuscular Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | | | - Leanne M. Ward
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Eric P. Hoffman
- ReveraGen BioPharma, Rockville, Maryland
- Binghamton University-State University of New York, Binghamton
| | - Utkarsh J. Dang
- Binghamton University-State University of New York, Binghamton
- Carleton University, Ottawa, Canada
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43
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Dori A, Guglieri M, Scutifero M, Passamano L, Trabacca A, Politano L. Can symptomatic nmDuchenne carriers benefit from treatment with ataluren? Results of 193-month follow-up. Acta Myol 2021; 40:152-157. [PMID: 35047755 PMCID: PMC8744011 DOI: 10.36185/2532-1900-058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/12/2021] [Indexed: 11/03/2022]
Abstract
Duchenne's muscular dystrophy (DMD) is an X-linked neuromuscular disorder caused by deletions (75%), duplications (15-20%) and point mutations (5-10%) in the dystrophin gene. Among the latter, stop-codon point mutations are rare. Female carriers of dystrophin gene mutations are usually asymptomatic as they are "protected" by the second X-chromosome, which produces a normal dystrophin protein. However, about 8-10% of them can present symptoms that set the clinical picture of the manifesting or symptomatic carrier. Although no causative cure there is for DMD, therapies are available to slow the decline of muscle weakness and delay the onset of heart and respiratory involvement. However, there is limited data in the literature documenting the treatment of symptomatic carriers, often entrusted to the sensitivity of individual doctors. In this paper, we report the follow-up outcomes of four European symptomatic nmDMD carriers treated with ataluren, overall followed for 193 months. Annual assessment of muscle strength, pulmonary lung function tests, and echocardiography, indicate a mild attenuation of disease progression under treatment.. There were no adverse clinical effects or relevant abnormalities in routine laboratory tests. We can conclude that ataluren appears to stabilize, if not slightly improve, the clinical course of patients with a good safety profile, especially if we consider that the treatment was late for 3/4 patients, at a mean age of 36.6 ± 10.6 years.
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Affiliation(s)
- Amir Dori
- Department of Neurology, Talpiot Medical Leadership Program, Chaim Sheba Medical Center, HaShomer, and Joseph Sagol Neuroscience Center, Sackler Faculty of Medicine, Aviv University, Aviv, Israel
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University, United Kingdom
| | - Marianna Scutifero
- Cardiomyology and Medical Genetics, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luigia Passamano
- Cardiomyology and Medical Genetics, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Trabacca
- Unit for serious disabilities of developmental and young adult age, Developmental Neurology and Neurorehabilitation, IRCCS “E. Medea” - “Our Family” Association, Brindisi, Italy
| | - Luisa Politano
- Cardiomyology and Medical Genetics, University of Campania “Luigi Vanvitelli”, Naples, Italy,“G. Torre” Association for Muscular Dystrophies Research Unit, Naples, Italy,Correspondence Luisa Politano Associazione Centro Gaetano Torre per Le Malattie Muscolari, Unità di Ricerca, via C. Guerra 10, Marano di Napoli, (NA) Italy. E-mail:
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Bourke JP, Watson G, Spinty S, Bryant A, Roper H, Chadwick T, Wood R, McColl E, Bushby K, Muntoni F, Guglieri M. Preventing Cardiomyopathy in DMD: A Randomized Placebo-Controlled Drug Trial. Neurol Clin Pract 2021; 11:e661-e668. [PMID: 34840880 DOI: 10.1212/cpj.0000000000001023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 11/06/2020] [Indexed: 12/28/2022]
Abstract
Objective To determine whether a combination of 2 heart medications would be tolerated and could prevent/delay the onset of cardiomyopathy in boys with Duchenne muscular dystrophy (DMD) compared with placebo. Methods This multicenter, parallel group, 1:1 patient randomized, placebo-controlled study of prophylactic perindopril and bisoprolol recruited boys with DMD aged 5-13 years, with normal ventricular function. Repeat assessments of left ventricular (LV) function, electrocardiogram, and adverse event reporting were performed 6 monthly. The primary outcome was change in ejection fraction between arms after 36 months. The study was approved by the National Research Ethics Service Committee East Midlands-Derby. Results Eighty-five boys were recruited (76% on steroid therapy) and randomized to combination heart drugs or matched placebo. Group change in left ventricular ejection fraction (LVEF%) at 36 months from baseline was -2.2% ± 6.0% and -2.9% ± 6.1% in active and placebo arms (adjusted mean difference: -2.1, 95% CI -5.2 to 1.1). There was no difference between treatment arms over repeated assessments (analysis of variance) up to 36 months (trial arms p = 0.53); arm-over-time (p = 0.44). Four participants on placebo but none on active therapy were withdrawn due to deteriorations in LV function. Secondary outcomes did not differ between arms either. Thirty-six serious adverse events occurred none due to cardiac events or trial medication. Conclusions Combination therapy was well tolerated. Consistent with the previous prophylactic perindopril heart study, there was no evidence of group benefit after 36-month treatment. Classification of Evidence This study provides Class I evidence that combination perindopril-bisoprolol therapy was well tolerated but did not change decline in LVEF significantly in boys with DMD.
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Affiliation(s)
- John P Bourke
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
| | - Gillian Watson
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
| | - Stefan Spinty
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
| | - Andrew Bryant
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
| | - Helen Roper
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
| | - Thomas Chadwick
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
| | - Ruth Wood
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
| | - Elaine McColl
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
| | - Kate Bushby
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
| | - Francesco Muntoni
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
| | - Michela Guglieri
- Department of Cardiology (JPB), Freeman Hospital, NUTH NHS Hospitals Foundation Trust; Clinical Trials Unit (MC, RW), Newcastle University, Newcastle upon Tyne; Department of Paediatric Neurology (SS), Alder Hey Children's NHS Foundation Trust, Liverpool; Population Health Sciences Institute (AB, TC, EM), Newcastle University, Newcastle upon Tyne; Department of Paediatrics (HR), Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust; John Walton Muscular Dystrophy Research Centre (KB, MG), Newcastle University and Newcastle upon Tyne, NHS Hospitals Foundation Trust, Newcastle upon Tyne; and NIHR Great Ormond Street Hospital Biomedical Research Centre (FM), Great Ormond Street Institute of Child Health, University College London, & Great Ormond Street Hospital Trust, UK
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Servais L, Mercuri E, Straub V, Guglieri M, Seferian AM, Scoto M, Leone D, Koenig E, Khan N, Dugar A, Wang X, Han B, Wang D, Muntoni F. Long-Term Safety and Efficacy Data of Golodirsen in Ambulatory Patients with Duchenne Muscular Dystrophy Amenable to Exon 53 Skipping: A First-in-human, Multicenter, Two-Part, Open-Label, Phase 1/2 Trial. Nucleic Acid Ther 2021; 32:29-39. [PMID: 34788571 PMCID: PMC8817703 DOI: 10.1089/nat.2021.0043] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The aim of this Phase 1/2, 2-part, multicenter trial was to report clinical safety and efficacy of long-term golodirsen treatment among ambulatory patients with exon 53 skip-amenable Duchenne muscular dystrophy (DMD). Part 1 was a 12-week, randomized, double-blind, placebo-controlled, dose-titration study followed by 9-week safety review. Part 2 was a 168-week, open-label evaluation of golodirsen 30 mg/kg. Part 1 primary endpoint was safety. Part 2 primary endpoints were dystrophin protein expression and 6-minute walk test (6MWT); secondary endpoints were percent predicted forced vital capacity (FVC%p) and safety. Post hoc ambulation analyses used mutation-matched external natural history controls. All patients from Part 1 (golodirsen, n = 8; placebo, n = 4) plus 13 additional patients entered Part 2; 23 completed the study. Adverse events were generally mild, nonserious, and unrelated to golodirsen, with no safety-related discontinuations or deaths. Golodirsen increased dystrophin protein (16.0-fold; P < 0.001) and exon skipping (28.9-fold; P < 0.001). At 3 years, 6MWT change from baseline was −99.0 m for golodirsen-treated patients versus −181.4 m for external controls (P = 0.067), and loss of ambulation occurred in 9% versus 26% (P = 0.21). FVC%p declined 8.4% over 3 years in golodirsen-treated patients, comparing favorably with literature-reported rates. This study provides evidence for golodirsen biologic activity and long-term safety in a declining DMD population and suggests functional benefit versus external controls. Clinical Trial Registration number: NCT02310906.
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Affiliation(s)
- Laurent Servais
- I-Motion Institute, Hôpital Armand Trousseau, Paris, France.,Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège & University of Liège, Liège, Belgium.,MDUK Oxford Neuromuscular Centre, University of Oxford, Oxford, United Kingdom
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore Roma, Rome, Italy.,Nemo Clinical Centre, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Mariacristina Scoto
- Dubowitz Neuromuscular Centre, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Daniela Leone
- Nemo Clinical Centre, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Erica Koenig
- Sarepta Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - Navid Khan
- Sarepta Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - Ashish Dugar
- Sarepta Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - Xiaodong Wang
- Sarepta Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - Baoguang Han
- Sarepta Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - Dan Wang
- Sarepta Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
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Broomfield J, Hill M, Guglieri M, Crowther M, Abrams K. Life Expectancy in Duchenne Muscular Dystrophy: Reproduced Individual Patient Data Meta-analysis. Neurology 2021; 97:e2304-e2314. [PMID: 34645707 PMCID: PMC8665435 DOI: 10.1212/wnl.0000000000012910] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives Duchenne muscular dystrophy (DMD) is a rare progressive disease that is often diagnosed in early childhood and leads to considerably reduced life expectancy; because of its rarity, research literature and patient numbers are limited. To fully characterize the natural history, it is crucial to obtain appropriate estimates of the life expectancy and mortality rates of patients with DMD. Methods A systematic review of the published literature on mortality in DMD up to July 2020 was undertaken, specifically focusing on publications in which Kaplan-Meier (KM) survival curves with age as a timescale were presented. These were digitized, and individual patient data (IPD) were reconstructed. The pooled IPD were analyzed with the KM estimator and parametric survival analysis models. Estimates were also stratified by birth cohort. Results Of 1,177 articles identified, 14 publications met the inclusion criteria and provided data on 2,283 patients, of whom 1,049 had died. Median life expectancy was 22.0 years (95% confidence interval [CI] 21.2, 22.4). Analyses stratified by 3 time periods in which patients were born showed markedly increased life expectancy in more recent patient populations; patients born after 1990 have a median life expectancy of 28.1 years (95% CI 25.1, 30.3). Discussion This article presents a full overview of mortality across the lifetime of a patient with DMD and highlights recent improvements in survival. In the absence of large-scale prospective cohort studies or trials reporting mortality data for patients with DMD, extraction of IPD from the literature provides a viable alternative to estimating life expectancy for this patient population.
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Affiliation(s)
| | - Micki Hill
- Department of Health Sciences, University of Leicester
| | | | - Michael Crowther
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute
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Segovia S, Ambrosini A, Campbell C, Diaz-Manera J, S. Study Group, Guglieri M. LGMD. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ogden C, Simon S, McKenna J, Cardiff S, Wilkins J, Watling B, Bullivant J, Das J, Leary B, Turner C, Tye B, Fowler M, Owens P, Braithwaite L, Woods S, Osredkar D, Palmafy B, Chamora T, Guglieri M, Campbell C, Ambrosini A. REGISTRIES AND CARE OF NMD. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Broomfield J, Hill M, Guglieri M, Crowther M, Larkindale J, Godfrey J, Chandler F, Abrams K. DMD/BMD – OUTCOME MEASURES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Pietrusz A, Guglieri M, Astin R, Desikan M, Muni-Lofra R, Mayhew A, Waller K, Chapman S, Ramdharry G, Quinlivan R. DMD – CLINICAL CARE. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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