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      Cardiovascular Disease in Duchenne Muscular Dystrophy : Overview and Insight Into Novel Therapeutic Targets

      review-article
      , BA a , , , MD, PhD a , b , , , PhD a , c ,
      JACC: Basic to Translational Science
      Elsevier
      arrhythmias, cardiomyopathy, Duchenne muscular dystrophy, inflammatory modulators, myocardial fibrosis, ACE, angiotensin-converting enzyme, ApN, adiponectin, ARB, angiotensin receptor blocker, BB, beta-blocker, BDNF, brain-derived neurotrophic factor, CMR, cardiac magnetic resonance imaging, Cx, connexin, DMD, Duchenne muscular dystrophy, DPC, dystrophin-associated protein complex, FFA, free fatty acid, HF, heart failure, LNP, lipid nanoparticle, LV, left ventricular, LVEF, left ventricular ejection fraction, miR, microRNA, NIV, noninvasive ventilation, Nrf2, nuclear factor erythroid 2-related factor 2, PKA, protein kinase A, PTX3, pentraxin 3, Px, pannexin, RNP, ribonucleoprotein complexes, RT-qPCR, reverse transcription-quantitative polymerase chain reaction, RyR2, ryanodine receptor isoform 2, sgRNA, single guide RNA, SR, sarcoplasmic reticulum, TrkB, tyrosine kinase B, TRPV2, transient receptor potential cation channel, subfamily V, member 2

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          Highlights

          • Cardiomyopathy is the leading cause of death in patients with DMD.

          • DMD has no cure, and there is no current consensus for treatment of DMD cardiomyopathy.

          • This review discusses therapeutic strategies to potentially reduce or prevent cardiac dysfunction in DMD patients.

          • Additional studies are needed to firmly establish optimal treatment modalities for DMD cardiomyopathy.

          Summary

          Duchenne muscular dystrophy (DMD) is a devastating disease affecting approximately 1 in every 3,500 male births worldwide. Multiple mutations in the dystrophin gene have been implicated as underlying causes of DMD. However, there remains no cure for patients with DMD, and cardiomyopathy has become the most common cause of death in the affected population. Extensive research is under way investigating molecular mechanisms that highlight potential therapeutic targets for the development of pharmacotherapy for DMD cardiomyopathy. In this paper, the authors perform a literature review reporting on recent ongoing efforts to identify novel therapeutic strategies to reduce, prevent, or reverse progression of cardiac dysfunction in DMD.

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          Most cited references143

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          Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure

          We compared the angiotensin receptor-neprilysin inhibitor LCZ696 with enalapril in patients who had heart failure with a reduced ejection fraction. In previous studies, enalapril improved survival in such patients. In this double-blind trial, we randomly assigned 8442 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either LCZ696 (at a dose of 200 mg twice daily) or enalapril (at a dose of 10 mg twice daily), in addition to recommended therapy. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure, but the trial was designed to detect a difference in the rates of death from cardiovascular causes. The trial was stopped early, according to prespecified rules, after a median follow-up of 27 months, because the boundary for an overwhelming benefit with LCZ696 had been crossed. At the time of study closure, the primary outcome had occurred in 914 patients (21.8%) in the LCZ696 group and 1117 patients (26.5%) in the enalapril group (hazard ratio in the LCZ696 group, 0.80; 95% confidence interval [CI], 0.73 to 0.87; P<0.001). A total of 711 patients (17.0%) receiving LCZ696 and 835 patients (19.8%) receiving enalapril died (hazard ratio for death from any cause, 0.84; 95% CI, 0.76 to 0.93; P<0.001); of these patients, 558 (13.3%) and 693 (16.5%), respectively, died from cardiovascular causes (hazard ratio, 0.80; 95% CI, 0.71 to 0.89; P<0.001). As compared with enalapril, LCZ696 also reduced the risk of hospitalization for heart failure by 21% (P<0.001) and decreased the symptoms and physical limitations of heart failure (P=0.001). The LCZ696 group had higher proportions of patients with hypotension and nonserious angioedema but lower proportions with renal impairment, hyperkalemia, and cough than the enalapril group. LCZ696 was superior to enalapril in reducing the risks of death and of hospitalization for heart failure. (Funded by Novartis; PARADIGM-HF ClinicalTrials.gov number, NCT01035255.).
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            Efficient Delivery of Genome-Editing Proteins In Vitro and In Vivo

            Efficient intracellular delivery of proteins is needed to fully realize the potential of protein therapeutics. Current methods of protein delivery commonly suffer from low tolerance for serum, poor endosomal escape, and limited in vivo efficacy. Here we report that common cationic lipid nucleic acid transfection reagents can potently deliver proteins that are fused to negatively supercharged proteins, that contain natural anionic domains, or that natively bind to anionic nucleic acids. This approach mediates the potent delivery of nM concentrations of Cre recombinase, TALE- and Cas9-based transcriptional activators, and Cas9:sgRNA nuclease complexes into cultured human cells in media containing 10% serum. Delivery of Cas9:sgRNA complexes resulted in up to 80% genome modification with substantially higher specificity compared to DNA transfection. This approach also mediated efficient delivery of Cre recombinase and Cas9:sgRNA complexes into the mouse inner ear in vivo, achieving 90% Cre-mediated recombination and 20% Cas9-mediated genome modification in hair cells.
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              The P2X7 Receptor in Infection and Inflammation.

              Adenosine triphosphate (ATP) accumulates at sites of tissue injury and inflammation. Effects of extracellular ATP are mediated by plasma membrane receptors named P2 receptors (P2Rs). The P2R most involved in inflammation and immunity is the P2X7 receptor (P2X7R), expressed by virtually all cells of innate and adaptive immunity. P2X7R mediates NLRP3 inflammasome activation, cytokine and chemokine release, T lymphocyte survival and differentiation, transcription factor activation, and cell death. Ten human P2RX7 gene splice variants and several SNPs that produce complex haplotypes are known. The P2X7R is a potent stimulant of inflammation and immunity and a promoter of cancer cell growth. This makes P2X7R an appealing target for anti-inflammatory and anti-cancer therapy. However, an in-depth knowledge of its structure and of the associated signal transduction mechanisms is needed for an effective therapeutic development.
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                Author and article information

                Contributors
                Journal
                JACC Basic Transl Sci
                JACC Basic Transl Sci
                JACC: Basic to Translational Science
                Elsevier
                2452-302X
                09 March 2022
                June 2022
                09 March 2022
                : 7
                : 6
                : 608-625
                Affiliations
                [a ]Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, Virginia, USA
                [b ]Department of Pediatric Cardiology, Children's Hospital of Richmond at Virginia Commonwealth University Hospital System, Richmond, Virginia, USA
                [c ]Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University Hospital System, Richmond, Virginia, USA
                Author notes
                [] Address for correspondence: Dr Fadi N. Salloum, Division of Cardiology, Box 980204, Virginia Commonwealth University Hospital System, 1101 East Marshall Street, Room 7-070, Richmond, Virginia 23298, USA. fadi.salloum@ 123456vcuhealth.org
                [∗]

                Ms Schulz and Dr Raucci contributed equally to this work.

                Article
                S2452-302X(21)00365-X
                10.1016/j.jacbts.2021.11.004
                9270569
                35818510
                cba8af48-796a-479c-a53b-140df559cc28
                © 2022 The Authors

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

                History
                : 4 November 2021
                : 6 November 2021
                Categories
                State-of-the-Art Review

                arrhythmias,cardiomyopathy,duchenne muscular dystrophy,inflammatory modulators,myocardial fibrosis,ace, angiotensin-converting enzyme,apn, adiponectin,arb, angiotensin receptor blocker,bb, beta-blocker,bdnf, brain-derived neurotrophic factor,cmr, cardiac magnetic resonance imaging,cx, connexin,dmd, duchenne muscular dystrophy,dpc, dystrophin-associated protein complex,ffa, free fatty acid,hf, heart failure,lnp, lipid nanoparticle,lv, left ventricular,lvef, left ventricular ejection fraction,mir, microrna,niv, noninvasive ventilation,nrf2, nuclear factor erythroid 2-related factor 2,pka, protein kinase a,ptx3, pentraxin 3,px, pannexin,rnp, ribonucleoprotein complexes,rt-qpcr, reverse transcription-quantitative polymerase chain reaction,ryr2, ryanodine receptor isoform 2,sgrna, single guide rna,sr, sarcoplasmic reticulum,trkb, tyrosine kinase b,trpv2, transient receptor potential cation channel, subfamily v, member 2

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