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      Functional and Morphological Improvement of Dystrophic Muscle by Interleukin 6 Receptor Blockade

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          Abstract

          The anti-inflammatory agents glucocorticoids (GC) are the only available treatment for Duchenne muscular dystrophy (DMD). However, long-term GC treatment causes muscle atrophy and wasting. Thus, targeting specific mediator of inflammatory response may be more specific, more efficacious, and with fewer side effects. The pro-inflammatory cytokine interleukin (IL) 6 is overproduced in patients with DMD and in the muscle of mdx, the animal model for human DMD. We tested the ability of inhibition of IL6 activity, using an interleukin-6 receptor (Il6r) neutralizing antibody, to ameliorate the dystrophic phenotype. Blockade of endogenous Il6r conferred on dystrophic muscle resistance to degeneration and alleviated both morphological and functional consequences of the primary genetic defect. Pharmacological inhibition of IL6 activity leaded to changes in the dystrophic muscle environment, favoring anti-inflammatory responses and improvement in muscle repair. This resulted in a functional homeostatic maintenance of dystrophic muscle.

          These data provide an alternative pharmacological strategy for treatment of DMD and circumvent the major problems associated with conventional therapy.

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          Highlights

          • Inhibition of IL6 activity leads to changes in the dystrophic muscle environment.

          • IL6R neutralizing antibody ameliorates the dystrophic phenotype.

          • IL6 blockade counters muscle decline in mdx mice.

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          Most cited references57

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          Regulatory interactions between muscle and the immune system during muscle regeneration.

          Recent discoveries reveal complex interactions between skeletal muscle and the immune system that regulate muscle regeneration. In this review, we evaluate evidence that indicates that the response of myeloid cells to muscle injury promotes muscle regeneration and growth. Acute perturbations of muscle activate a sequence of interactions between muscle and inflammatory cells. The initial inflammatory response is a characteristic Th1 inflammatory response, first dominated by neutrophils and subsequently by CD68(+) M1 macrophages. M1 macrophages can propagate the Th1 response by releasing proinflammatory cytokines and cause further tissue damage through the release of nitric oxide. Myeloid cells in the early Th1 response stimulate the proliferative phase of myogenesis through mechanisms mediated by TNF-alpha and IL-6; experimental prolongation of their presence is associated with delayed transition to the early differentiation stage of myogenesis. Subsequent invasion by CD163(+)/CD206(+) M2 macrophages attenuates M1 populations through the release of anti-inflammatory cytokines, including IL-10. M2 macrophages play a major role in promoting growth and regeneration; their absence greatly slows muscle growth following injury or modified use and inhibits muscle differentiation and regeneration. Chronic muscle injury leads to profiles of macrophage invasion and function that differ from acute injuries. For example, mdx muscular dystrophy yields invasion of muscle by M1 macrophages, but their early invasion is accompanied by a subpopulation of M2a macrophages. M2a macrophages are IL-4 receptor(+)/CD206(+) cells that reduce cytotoxicity of M1 macrophages. Subsequent invasion of dystrophic muscle by M2c macrophages is associated with progression of the regenerative phase in pathophysiology. Together, these findings show that transitions in macrophage phenotype are an essential component of muscle regeneration in vivo following acute or chronic muscle damage.
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            Interleukin‐6 myokine signaling in skeletal muscle: a double‐edged sword?

            Interleukin (IL)‐6 is a cytokine with pleiotropic functions in different tissues and organs. Skeletal muscle produces and releases significant levels of IL‐6 after prolonged exercise and is therefore considered as a myokine. Muscle is also an important target of the cytokine. IL‐6 signaling has been associated with stimulation of hypertrophic muscle growth and myogenesis through regulation of the proliferative capacity of muscle stem cells. Additional beneficial effects of IL‐6 include regulation of energy metabolism, which is related to the capacity of actively contracting muscle to synthesize and release IL‐6. Paradoxically, deleterious actions for IL‐6 have also been proposed, such as promotion of atrophy and muscle wasting. We review the current evidence for these apparently contradictory effects, the mechanisms involved and discuss their possible biological implications.
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              Serial passaging and differentiation of myogenic cells isolated from dystrophic mouse muscle.

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                Author and article information

                Contributors
                Journal
                EBioMedicine
                EBioMedicine
                EBioMedicine
                Elsevier
                2352-3964
                26 February 2015
                April 2015
                26 February 2015
                : 2
                : 4
                : 285-293
                Affiliations
                [a ]Institute Pasteur-Cenci Bolognetti, DAHFMO-Unit of Histology and Medical Embryology, IIM, Sapienza University of Rome, 00161, Italy
                [b ]Division of Rheumatology, Bambino Gesù Children's Hospital, Rome 00100, Italy
                [c ]Department of Neuroscience, Unit of Neuromuscular and Neurodegenerative Disease, Bambino Gesù Children's Hospital, Rome 00100, Italy
                [d ]Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Rome 00161, Italy
                Author notes
                [* ]Corresponding author at: Unit of Histology and Medical Embryology, Via A. Scarpa, 14, Rome 00161, Italy. antonio.musaro@ 123456uniroma1.it
                Article
                S2352-3964(15)00062-6
                10.1016/j.ebiom.2015.02.014
                4485902
                26137572
                0d6ff95d-ddb8-44b4-bd07-5b60ad9ca6fb
                © 2015 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 24 November 2014
                : 17 February 2015
                : 25 February 2015
                Categories
                Original Article

                il6,muscular dystrophy,inflammation,necrosis,therapy
                il6, muscular dystrophy, inflammation, necrosis, therapy

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