TitleEffects of systemic multiexon skipping with peptide-conjugated morpholinos in the heart of a dog model of Duchenne muscular dystrophy.
Publication TypeJournal Article
Year of Publication2017
AuthorsEchigoya, Y, Nakamura, A, Nagata, T, Urasawa, N, Lim, KRowel Q, Trieu, N, Panesar, D, Kuraoka, M, Moulton, H, Saito, T, Aoki, Y, Iversen, P, Sazani, P, Kole, R, Maruyama, R, Partridge, T, Takeda, S'ichi, Yokota, T
JournalProc Natl Acad Sci U S A
Volume114
Issue16
Pagination4213-4218
Date Published2017 04 18
ISSN1091-6490
KeywordsAnimals, Cardiomyopathies, Cell-Penetrating Peptides, Disease Models, Animal, Dogs, Dystrophin, Exons, Female, Genetic Therapy, Male, Morpholinos, Muscle, Skeletal, Muscular Dystrophy, Animal, Muscular Dystrophy, Duchenne
Abstract

Duchenne muscular dystrophy (DMD) is a lethal genetic disorder caused by an absence of the dystrophin protein in bodywide muscles, including the heart. Cardiomyopathy is a leading cause of death in DMD. Exon skipping via synthetic phosphorodiamidate morpholino oligomers (PMOs) represents one of the most promising therapeutic options, yet PMOs have shown very little efficacy in cardiac muscle. To increase therapeutic potency in cardiac muscle, we tested a next-generation morpholino: arginine-rich, cell-penetrating peptide-conjugated PMOs (PPMOs) in the canine X-linked muscular dystrophy in Japan (CXMD) dog model of DMD. A PPMO cocktail designed to skip exons 6 and 8 was injected intramuscularly, intracoronarily, or intravenously into CXMD dogs. Intravenous injections with PPMOs restored dystrophin expression in the myocardium and cardiac Purkinje fibers, as well as skeletal muscles. Vacuole degeneration of cardiac Purkinje fibers, as seen in DMD patients, was ameliorated in PPMO-treated dogs. Although symptoms and functions in skeletal muscle were not ameliorated by i.v. treatment, electrocardiogram abnormalities (increased Q-amplitude and Q/R ratio) were improved in CXMD dogs after intracoronary or i.v. administration. No obvious evidence of toxicity was found in blood tests throughout the monitoring period of one or four systemic treatments with the PPMO cocktail (12 mg/kg/injection). The present study reports the rescue of dystrophin expression and recovery of the conduction system in the heart of dystrophic dogs by PPMO-mediated multiexon skipping. We demonstrate that rescued dystrophin expression in the Purkinje fibers leads to the improvement/prevention of cardiac conduction abnormalities in the dystrophic heart.

DOI10.1073/pnas.1613203114
Alternate JournalProc Natl Acad Sci U S A
PubMed ID28373570
PubMed Central IDPMC5402437
Grant ListMC_PC_12020 / / Medical Research Council / United Kingdom
/ / CIHR / Canada