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Summary Increasing demands for bioactive compounds have motivated researchers to employ micro‐organisms to produce complex natural products. Currently, Bacillus subtilis has been attracting lots of attention to be developed into terpenoids cell factories due to its generally recognized safe status and high isoprene precursor biosynthesis capacity by endogenous methylerythritol phosphate (MEP) pathway. In this review, we describe the up‐to‐date knowledge of each enzyme in MEP pathway and the subsequent steps of isomerization and condensation of C5 isoprene precursors. In addition, several representative terpene synthases expressed in B. subtilis and the engineering steps to improve corresponding terpenoids production are systematically discussed. Furthermore, the current available genetic tools are mentioned as along with promising strategies to improve terpenoids in B. subtilis, hoping to inspire future directions in metabolic engineering of B. subtilis for further terpenoid cell factory development.

Engineering strategies to improve terpenoids production in Bacillus subtilis mainly focus on 2C-methyl-D-erythritol-4-phosphate (MEP) pathway overexpression. To systematically engineer the chassis strain for higher amorphadiene (precursor of artemisinin) production, a clustered regularly interspaced short palindromic repeat-Cas9 (CRISPR-Cas9) system was established in B. subtilis to facilitate precise and efficient genome editing. Then, this system was employed to engineer three more modules to improve amorphadiene production, including the terpene synthase module, the branch pathway module, and the central metabolic pathway module. Finally, our combination of all of the useful strategies within one strain significantly increased extracellular amorphadiene production from 81 to 116 mg/L after 48 h flask fermentation without medium optimization. For the first time, we attenuated the FPP-derived competing pathway to improve amorphadiene biosynthesis and investigated how the TCA cycle affects amorphadiene production in B. subtilis. Overall, this study provides a universal strategy for further increasing terpenoids' production in B. subtilis by comprehensive and systematic metabolic engineering.

Squalene synthase (SQS) catalyzes the conversion of two farnesyl pyrophosphates to squalene, an important intermediate in between isoprene and valuable triterpenoids. In this study, we have constructed a novel biosynthesis pathway for squalene in Bacillus subtilis and performed metabolic engineering aiming at facilitating further exploitation and production of squalene-derived triterpenoids. Therefore, systematic studies and analysis were performed including selection of multiple SQS candidates from various organisms, comparison of expression vectors, optimization of cultivation temperatures, and examination of rate-limiting factors within the synthetic pathway. We were, for the first time, able to obtain squalene synthesis in B. subtilis. Furthermore, we achieved a 29-fold increase of squalene yield (0.26-7.5 mg/L) by expressing SQS from Bacillus megaterium and eliminating bottlenecks within the upstream methylerythritol-phosphate pathway. Moreover, our findings showed that also ispA could positively affect the production of squalene.

The essential product of the Duchenne muscular dystrophy (DMD) gene is dystrophin1, a rod-like protein2 that protects striated myocytes from contraction-induced injury3,4. Dystrophin-related protein (or utrophin) retains most of the structural and protein binding elements of dystrophin5. Importantly, normal thymic expression in DMD patients6 should protect utrophin by central immunologic tolerance. We designed a codon-optimized, synthetic transgene encoding a miniaturized utrophin (µUtro), deliverable by adeno-associated virus (AAV) vectors. Here, we show that µUtro is a highly functional, non-immunogenic substitute for dystrophin, preventing the most deleterious histological and physiological aspects of muscular dystrophy in small and large animal models. Following systemic administration of an AAV-µUtro to neonatal dystrophin-deficient mdx mice, histological and biochemical markers of myonecrosis and regeneration are completely suppressed throughout growth to adult weight. In the dystrophin-deficient golden retriever model, µUtro non-toxically prevented myonecrosis, even in the most powerful muscles. In a stringent test of immunogenicity, focal expression of µUtro in the deletional-null German shorthaired pointer model produced no evidence of cell-mediated immunity, in contrast to the robust T cell response against similarly constructed µDystrophin (µDystro). These findings support a model in which utrophin-derived therapies might be used to treat clinical dystrophin deficiency, with a favorable immunologic profile and preserved function in the face of extreme miniaturization.

Bioproducts made by microbial cell factories play important roles in human life ranging from food, feed, cosmetic and pharmaceutical manufacturing. Microbial hosts are required to be non-pathogenic overproducers and should be growing at low costs. Bacillus subtilis is one of the bacteria, which can fulfill these requirements. It is generally regarded as safe, easy to modify genetically and able to grow fast in simple medium. It can secrete high levels of proteins into the culture medium, and has also been reported to be a high isoprene producer. The work described in the thesis of Yafeng Song focuses on two aspects. Firstly, she engineered B. subtilis to secrete high level of β-mannanase, a major mannan-degrading enzyme that is extensively used in agriculture as feed additive. This was achieved by increasing β-mannanase synthesis levels and enhancing protein secretion capacity. Secondly, she engineered B. subtilis to produce high levels of squalene and amorphadiene. Squalene is a critical precursor of many bioactive triterpenoids, and itself can also be applied as a pharmaceutical. Biosynthesis of squalene and its production improvement in B. subtilis was realized mainly by screening suitable squalene synthases, and increasing precursor supply. Amorphadiene is the key intermediate of the antimalarial drug artemisinin. Its production was elevated by systematically engineering the precursor supply pathway, competitive pathways, terpene synthase and a central metabolic pathway of B. subtilis. Overall, studies in this thesis demonstrated the potential of B. subtilis as a versatile bioproduct platform and provide universal strategies to engineer B. subtilis for industrial applications.

Long noncoding RNA (lncRNA) colon cancer-associated transcript 2 (CCAT2) has been demonstrated to play an important role in diverse tumorigenesis. However, the biological function of lncRNAs in glioma is still unknown. In this study, we found that lncRNA CCAT2 was overexpressed in glioma tissues and cell lines and associated with tumor grade and size. Furthermore, patients with high levels of lncRNA CCAT2 had poorer survival than those with lower levels of lncRNA CCAT2. Knocking down lncRNA CCAT2 expression significantly suppressed the glioma cell growth, migration, and invasion, as well as induced early apoptosis of glioma cells in vitro. Moreover, lncRNA CCAT2 regulated epithelial‐mesenchymal transition (EMT)-associated gene expression. In conclusion, lncRNA CCAT2 plays an important role in glioma tumorigenesis and progression and may act as a potential biomarker for therapeutic strategy and prognostic prediction.

The manno endo-1,4-mannosidase (beta-mannanase, EC. 3.2.1.78) catalyzes the random hydrolysis of internal (1 -> 4)-beta-mannosidic linkages in the mannan polymers. A codon optimized beta-mannanase gene from Bacillus licheniformis DSM13 was expressed in Bacillus subtilis. When four Sec-dependent and two Tat-dependent signal peptide sequences cloned from B. subtilis were placed upstream of the target gene, the highest activity of P-mannanase was observed using SPlipA,A as a signal "peptide. Then a 1.25-fold activity beta-mannanase was obtained when another copy of groESL operon was inserted into the genome of host strain. Finally, five different promoters were separately used to enhance the synthesis of the target protein. The results showed that promoter P-mglv a modified maltose-inducible promoter, significantly elevated the production beta-mannanase. After 72 h of flask fermentation, the enzyme activity of P-mannanase in the supernatant when using locust bean gum as substrate reached 2207 U/mL. This work provided a promising beta-mannanase production strain in industrial application.

d-Psicose 3-epimerase (DPEase) converts d-fructose into d-psicose which exists in nature in limited quantities and has key physiological functions. In this study, RDPE (DPEase from Ruminococcus sp. 5_1_39BFAA) was successfully constitutively expressed in Bacillus subtilis, which is the first report of its kind. Three sugar-inducible promoters were compared, and the xylose-inducible promoter PxylA was proved to be the most efficient for RDPE production. Based on the analysis of the inducer concentration and RDPE expression, we surmised that there was an extremely close correlation between the intracellular RDPE expression and xylose accumulation level. Subsequently, after the metabolic pathway of xylose was blocked by deletion of xylAB, the intra- and extra-cellular RDPE expression was significantly enhanced. Meanwhile, the optimal xylose induction concentration was reduced from 4.0 to 0.5 %. Eventually, the secretion level of RDPE reached 95 U/mL and 2.6 g/L in a 7.5-L fermentor with the fed-batch fermentation, which is the highest production of DPEase by a microbe to date.

The well-characterized gram-positive bacterium Bacillus subtilis is an outstanding industrial candidate for protein expression owing to its single membrane and high capacity of secretion, simplifying the downstream processing of secretory proteins. During the last few years, there has been continuous progress in the illustration of secretion mechanisms and application of this robust host in various fields of life science, such as enzyme production, feed additives, and food and pharmaceutical industries. Here, we review the developments of Bacillus subtilis as a highly promising expression system illuminating strong chemical- and temperatureinducible and other types of promoters, strategies for ribosome-binding-site utilization, and the novel approach of signal peptide selection. Furthermore, we outline the main steps of the Sec pathway and the relevant elements as well as their interactions. In addition, we introduce the latest discoveries of Tat-related complex structures and functions and the countless applications of this full-folded protein secretion pathway. This review also lists some of the current understandings of ATP-binding cassette transporters. According to the extensive knowledge on the genetic modification strategies and molecular biology of Bacillus subtilis, we propose some suggestions and strategies for improving the yield of intended productions. We expect this to promote striking future developments in the optimization and application of this bacterium.

The objective of this study is to investigate the role of Calmodulin-dependent protein kinase IV (CaMKIV) in Cardiotoxin (CTX)-induced mice muscle inflammation. CTX injection i.m. was performed to induce B6 mice acute tibialis anterior (TA) muscle injury. The mice were then injected i.p. with the recombinant CaMKIV protein or its antagonist KN-93. Immunoblotting was used to assess Calmodulin (CaM) and CaMKIV levels. Immunofluorescence was used to detect intramuscular infiltration or major histocompatibility complex (MHC)-I expression in damaged muscle. The extent of infiltration was evaluated by fluorescent intensity analysis. Cytokines/chemokines levels were determined by qPCR. CaMKIV gene knockdown in C2C12 cells was performed in order to evaluate the effects of CaMKIV on immuno-behavior of muscle cells. CTX administration induced a strong up-regulation of CaM and p-CaMKIV levels in infiltrated mononuclear cells and regenerated myofibers. In vivo adding of the recombinant CaMKIV protein enhanced intramuscular infiltration of monocytes/macrophages in damaged muscle and increased the number of proinflammatory Ly-6C+F4/80+ macrophage cells. CaMKIV protein treatment induced a striking up-regulation of mRNA levels of IL-1, IL-6, MCP-1, and MCP-3 in CD45+ cells sorted from damaged muscle; increased the infiltration of CD8+ T cells; and induced the up-regulation of MHC-I in partial regenerated myofibers, which was rarely observed in muscle damage alone. Additionally, CaMKIV protein treatment diminished the regulatory T cells (Tregs) number and led to the damaged TA muscle repair delay. In vitro CaMKIV gene knockdown reversed IFN-γ-induced up-regulation of MHC-I/II and TLR3 in the differentiated C2C12 myotubes. CaMKIV can act as an immunostimulation molecule and enhances the acute muscle inflammatory responses.

Superfast muscles (SFMs) are extremely fast synchronous muscles capable of contraction rates up to 250 Hz, enabling precise motor execution at the millisecond time scale. SFM phenotypes have been discovered in most major vertebrate lineages, but it remains unknown whether all SFMs share excitation-contraction coupling pathway adaptations for speed, and if SFMs arose once, or from independent evolutionary events. Here, we demonstrate that to achieve rapid actomyosin crossbridge kinetics bat and songbird SFM express myosin heavy chain genes that are evolutionarily and ontologically distinct. Furthermore, we show that all known SFMs share multiple functional adaptations that minimize excitation-contraction coupling transduction times. Our results suggest that SFM evolved independently in sound-producing organs in ray-finned fish, birds, and mammals, and that SFM phenotypes operate at a maximum operational speed set by fundamental constraints in synchronous muscle. Consequentially, these constraints set a fundamental limit to the maximum speed of fine motor control., eLife digest Across animals, different muscle types have evolved to perform vastly different tasks at different speeds. For example, tortoise leg muscles move slowly over several seconds, while the flight muscles of a hummingbird move quickly dozens of times per second. The speed record holders among vertebrates are the so-called superfast muscles, which can move up to 250 times per second. Superfast muscles power the alarming rattle of rattlesnakes, courtship calls in fish, rapid echolocation calls in bats and the elaborate vocal gymnastics of songbirds. Thus these extreme muscles are all around us and are always involved in sound production. Did superfast muscles evolve from a common ancestor? And how do different superfast muscles achieve their extreme behavior? To answer these questions, Mead et al. studied the systems known to limit contraction speed in all currently known superfast muscles found in rattlesnakes, toadfish, bats and songbirds. This revealed that all the muscles share certain specific adaptations that allow superfast contractions. Furthermore, the three fastest examples – toadfish, songbird and bat – have nearly identical maximum speeds. Although this appears to support the idea that the adaptations all evolved from a shared ancestor, Mead et al. found evidence that suggests otherwise. Each of the three superfast muscles are powered by a different motor protein, which argues strongly in favor of the muscles evolving independently. The existence of such similar mechanisms and performance in independently evolved muscles raises the possibility that the fastest contraction rates measured by Mead et al. represent a maximum speed limit for all vertebrate muscles. Any technical failure in a racecar most likely will slow it down, while the same failure in a robustly engineered family car may not be so noticeable. Similarly in superfast muscle many cellular and molecular systems need to perform maximally. Therefore by understanding how these extreme muscles work, we also gain a better understanding of how normal muscles contract.

Duchenne muscular dystrophy (DMD) is a progressive primary myodegenerative disease caused by a genetic deficiency of the 427-kDa cytoskeletal protein dystrophin. Despite its single-gene etiology, DMD’s complex pathogenesis remains poorly understood, complicating the extrapolation from results of preclinical studies in genetic homologs to the design of informative clinical trials. Here we describe novel phenotypic assays which when applied to the mdx mouse resemble recently used primary end points for DMD clinical trials. By coupling force transduction, high-precision motion tracking, and respiratory measurements, we have achieved a suite of integrative physiological tests that provide novel insights regarding normal and pathological responses to muscular exertion. A common feature of these physiological assays is the precise tracking and analysis of volitional movement, thereby optimizing the relevance to clinical tests. Unexpectedly, the measurable biological distinction between dystrophic and control mice at early time points in the disease process is better resolved with these tests than with the majority of previously used, labor-intensive studies of individual muscle function performed ex vivo. For example, the dramatic loss of volitional movement following a novel, standardized grip test distinguishes control mice from mdx mice by a 17.4-fold difference of the means (3.5 ± 2.2 vs. 60.9 ± 12.1 units of activity, respectively; effect size 1.99). The findings have both mechanistic and translational implications of potential significance to the fields of basic myology and neuromuscular therapeutics. NEW & NOTEWORTHY This study uses novel phenotypic assays which when applied to the mdx mouse resemble recently used primary end points for DMD clinical trials. A measurable distinction between dystrophic and control mice was seen at early time points in vivo compared with invasive muscle studies performed ex vivo. These assays shed light on normal and pathological responses to muscular exertion and have significant mechanistic and translational implications for the fields of basic myology and neuromuscular therapeutics.

The use of Bacillus subtilis in synthetic biology and metabolic engineering is highly desirable to take advantage of the unique metabolic pathways present in this organism. To do this, an evaluation of B. subtilis' intrinsic biological parts is required to determine the best strategies to accurately regulate metabolic circuits and expression of target proteins. The strengths of promoter candidates were evaluated by measuring relative fluorescence units of a green fluorescent protein reporter, integrated into B. subtilis' chromosome. A total of 84 predicted promoter sequences located upstream of different classes of proteins including heat shock proteins, cell-envelope proteins, and proteins resistant against toxic metals (based on similarity) and other kinds of genes were tested. The expression levels measured ranged from 0.0023 to 4.53-fold of the activity of the well-characterized strong promoter P43. No significant shifts were observed when strains, carrying different promoter candidates, were cultured at high temperature or in media with ethanol, but some strains showed increased activity when cultured under high osmotic pressure. Randomly selected promoter candidates were tested and found to activate transcription of thermostable β-galactosidase (bgaB) at a similar level, implying the ability of these sequences to function as promoter elements in multiple genetic contexts. In addition, selected promoters elevated the final production of both cytoplasmic bgaB and secreted protein α-amylase to about fourfold and twofold, respectively. The generated data allows a deeper understanding of B. subtilis' metabolism and will facilitate future work to develop this organism for synthetic biology.

The mdx mouse carries a naturally occurring nonsense mutation in the dystrophin gene and has become a critical animal model for research on Duchenne Muscular Dystrophy (DMD). Despite the extensive published studies on muscle structure and function in this model, we still lack appropriate protocols for evaluation of functional rescue in mdx mice using non-invasive tests relevant to the clinically relevant symptoms of DMD. Here we present for the first time results of a complex approach for the evaluation of locomotor and behavioral patterns of mdx mice during running wheel performance in a modified open field monitoring system. These results are examined in the same mice with force grip measurements and serum enzyme biomarker creatine kinase (CK) measurement. The comparison between juvenile congenic wild type (C57Bl10) and mdx mice indicates similarity in parameters such as rest time and the number of times entering and initiating use of the running wheel per day, but highly significant differences with regard to running wheel-associated locomotor activity characteristics including velocity, time, distance per run, and total distance per day. This suggests that exploratory behavior at low work rate is unaffected by dystrophin deficiency, but that the animals respond to as yet uncharacterized sensory inputs that limit their running speed and duration without preventing the desire to re-initiate after rest. This may be viewed as analogous to the early loss of function and metabolic reserve in the juvenile period of DMD disease progression, where boys are described by parents as frustrated at first being unable to keep pace with their friends. As presented in another poster by our group, blinded studies of the response to gene therapy indicates that it is unlikely that this phenotypic difference reflects the mislocalization of neuronal nitric oxide synthase (nNOS) in dystrophin deficiency. In further blinded studies, the open field data correlate with the differences in testing results between the two mouse strains observed in the force grip evaluation and serum levels of CK, offering possible leads for a further mechanistic dissection. These results demonstrate strong evidence in support of the running wheel open field system as a reliable and reproducible approach to assess the therapeutic efficacy in the mouse model of DMD. This approach also provides a platform for dissecting the physiological roles of dystrophin in supporting precisely measurable volitional activities in unrestricted animals, thereby offering potential improvements in the predictive power of preclinical studies of therapeutic efficacy to inform clinical trials.

Background We have previously observed, in studies on an experimental overuse model, that the tachykinin system may be involved in the processes of muscle inflammation (myositis) and other muscle tissue alterations. To further evaluate the significance of tachykinins in these processes, we have used inhibitors of neutral endopeptidase (NEP) and angiotensin-converting enzyme (ACE), substances which are known to terminate the activity of various endogenously produced substances, including tachykinins. Methods Injections of inhibitors of NEP and ACE, as well as the tachykinin substance P (SP), were given locally outside the tendon of the triceps surae muscle of rabbits subjected to marked overuse of this muscle. A control group was given NaCl injections. Evaluations were made at 1 week, a timepoint of overuse when only mild inflammation and limited changes in the muscle structure are noted in animals not treated with inhibitors. Both the soleus and gastrocnemius muscles were examined morphologically and with immunohistochemistry and enzyme immunoassay (EIA). Results A pronounced inflammation (myositis) and changes in the muscle fiber morphology, including muscle fiber necrosis, occurred in the overused muscles of animals given NEP and ACE inhibitors. The morphological changes were clearly more prominent than for animals subjected to overuse and NaCl injections (NaCl group). A marked SP-like expression, as well as a marked expression of the neurokinin-1 receptor (NK-1R) was found in the affected muscle tissue in response to injections of NEP and ACE inhibitors. The concentration of SP in the muscles was also higher than that for the NaCl group. Conclusions The observations show that the local injections of NEP and ACE inhibitors led to marked SP-like and NK-1R immunoreactions, increased SP concentrations, and an amplification of the morphological changes in the tissue. The injections of the inhibitors thus led to a more marked myositis process and an upregulation of the SP system. Endogenously produced substances, out of which the tachykinins conform to one substance family, may play a role in mediating effects in the tissue in a muscle that is subjected to pronounced overuse.

TNF-alphais known to be involved in muscle damage and inflammation (myositis). Therelationships between the TNF-alpha system and muscle fibernecrosis/regeneration and the tachykinin system in this ...

Golden Retriever Muscular Dystrophy (GRMD) dogs frequently develop severe restriction to mouth opening, a condition known as trismus, as one of their earliest physical signs of the disease. Trismus is generally due to fibrosis and/or tonic contraction of the muscles of mastication, the temporalis and the masseter muscle. These muscles are primarily composed of unique myofibers exhibiting a masticatory myosin heavy chain encoded by the MYH 16 gene (M fibers). M fibers have been shown to produce the highest specific force among mammalian myofibers, based on their atypical crossbridge kinetics. Here, we show for a first time a morphological analysis of M fibers for the purposes of their classification, distribution and proportion in the masticatory muscles in normal and GRMD dogs based on immunofluorescence staining by a highly specific anti-MYH16 antibody. Our data demonstrate that in both temporalis and masseter muscles, the predominant M fibers are larger in size when compared to any other striated myofiber. A comparative histological analysis of these and other muscles in GRMD dogs demonstrates a significant relative increase in the proportion of injured, hypercontracted M fibers, a highly significant relative abundance of regenerating fibers expressing the embryonic myosin isoform encoded by the MYH3 gene, and prominent fibrosis when compared to the other affected striated muscles. These results suggest that the higher specific force developed by M fibers, due to the MYH16 encoded MyHC isoform, accelerates the fibers’ rate of degeneration in response to myonecrotizing sarcolemmal injury in the absence of dystrophin. Trismus is not seen in Duchenne MD, suggesting that the deletional frameshift in the human MYH16 gene (Nature 428: 373-4, 415-8) dramatically reduces the relative rate of sarcolemmal injury. These observations may offer novel insights into the physiological role of dystrophin in striated muscles, and provide an especially sensitive test for use in experimental therapeutics in the canine models for DMD.

The majority of mutations causing Duchenne muscular dystrophy (DMD) are multi-exon, frameshifting deletions in the dystrophin gene. Expression of recombinant dystrophin in DMD therefore risks chronic immune recognition of the “non-self” protein. Early developmental expression of the paralogous protein utrophin in the thymus may confer central immunological tolerance to its peptide sequence. Here we address previously unanswered questions about the therapeutic efficacy and immunogenicity of “µutrophins” encoded by synthetic minigenes suitable for use in AAV. First we used a comparative phylogenomic approach to address a deceptively simple question with critical implications for this field: “which came first-dystrophin or the sarcomere”. This analysis provided evidence that the long rod-like domain of utrophin and dystrophin was “coopted” from a higher molecular weight protein in dynein-propelled animals lacking striated muscle. When considered in light of recent crystalographic studies, these results suggest that the full functionality of native dystrophin may be conferred by recombinant mini-utrophins with internally deleted rod domains that preserve inter-repeat folding and hence maximal tensile strength. We maximized recombinant µUtrophin (µU) expression from synthetic open reading frames by using the codon bias of striated myosin. Our blinded studies of mdx mice injected with a µU transgene are the first to show COMPLETE recovery of peripheral myofiber nucleation following a single systemic injection of an AAV vector. Sarcoglycan expression, as measured by western blot in the µU-treated mice, are restored to control levels throughout growth to skeletal maturity. To investigate the correlation between our histological findings and functionality, we validated a novel open field cage and attached running wheel system. Our blinded data show remarkable functional rescue in µU-treated mdx mice using this non-invasive test with relevance to the clinical assessment of disease progression in DMD. These data also strongly correlate with those derived from in vivo force grip and ex vivo force transducer measurements. Remarkably, a majority of mdx mice show complete normalization of serum creatine kinase (CK), a first for single-dose treatment by any clinically translatable modality. In dystrophic puppies, intravenous injection of a 30-fold lower relative dose of AAV9U fully restored sarcoglycan levels and normalized the myofiber size-distribution following a threefold increase in muscle mass. Interferon-gamma ELISpot assays using utrophin-derived peptides revealed no reactivity in injected dogs, consistent with central immunological tolerance. These findings suggest a rationale for neonatal gene therapy using utrophin as an internally deleted “self” protein in DMD to minimize the risk of chronic immunotoxicity. We outline a rigorous translational approach using escalating vector doses in GSHPMD dogs harboring a newly defined 5 megabase deletion encompassing the dystrophin ORF.

The clinical progression of Duchenne Muscular Dystrophy (DMD) begins with locomotive symptoms in childhood but eventually includes symptoms of severe cardiorespiratory failure. Our studies in mdx mice and GRMD dogs have reavealed surprisingly large early deficits in physiological reserve, attributable to the deficiency of dystrophin. In young GRMD dogs, the findings of diaphragmatic fibrosis and myofiber shortening correlated strongly with non-invasively measured abnormalities in respiratory muscle recruitment. In juvenile GRMD dogs without clinical signs of heart failure, detailed studies of cardiac mechanics revealed profoundly abnormal Frank-Starling and inotropic responses. Thus, submaximal exercise loading has the capactiy to reveal very early, otherwise subclinical deficits in physiological reserve. We have utilized several non-invasive systems to measure integrative cardiopulmonary mechanics in animals trained to undertake submaximal volitional exercise. Our findings demonstrate the possibility of continuous non-invasive monitoring of cardiac output, stroke volume, systemic vascular resistance, and several ventilatory parameters in young dogs and children during treadmill exercise, as well as upright and recumbent bicycling at work outputs appropriate for low risk serial testing in the earliest stages of DMD. As the field contemplates primary endpoints for use in trials of systemic gene therapy, these metrics hold promise as the most sensitive measurements of the earliest functional deficits in organ systems eventually responsible for the lethality of DMD.

The majority of mutations causing Duchenne muscular dystrophy (DMD) are multi-exon, frameshifting deletions, complicating therapy with recombinant dystrophin because of the potential for chronic immune recognition of the “non-self” protein. The paralogous protein utrophin is ubiquitously expressed at levels insufficient to prevent myonecrosis in animal models for DMD, but may confer central immunological tolerance through early developmental expression in the thymus. Here we show for a first time histological evidence for the complete prevention of myonecrosis in dystrophin-deficient striated muscles following systemic administration of an AAV9 vector carrying a 3.5 kb synthetic utrophin transgene (AAVµU). The cDNA was miniaturized by removal of domains least conserved in a comprehensive evolutionary comparison, and further optimized for maximal expression in striated muscle by using the codon bias of mammalian genes encoding contractile proteins. Administration of 1015 AAVµU vector genomes (vg) per kg to neonatal mice prevented centronucleation and saturated global recovery of the sarcoglycan complex, despite a subsequent tenfold increase in striated muscle mass with growth. In neonatal dystrophic dogs, intravenous injection of 1013.5 AAVµU vg/kg without immunosuppression restored sarcoglycan levels and normalized the myofiber size-distribution following a fourfold increase in muscle mass. Interferon-gamma ELISpot assays using utrophin-derived peptides revealed no reactivity in injected dogs, consistent with central immunological tolerance. These findings provide a rationale for high dose, neonatal gene therapy using utrophin as a “self” protein to forestall disability and mortality in DMD, while minimizing the risk of chronic immunotoxicity.

It is well established that unilateral exercise can produce contralateral effects. However, it is unclear whether unilateral exercise that leads to muscle injury and inflammation also affects the homologous contralateral muscles. To test the hypothesis that unilateral muscle injury causes contralateral muscle changes, an experimental rabbit model with unilateral muscle overuse caused by a combination of electrical muscle stimulation and exercise (EMS/E) was used. The soleus and gastrocnemius muscles of both exercised and non-exercised legs were analyzed with enzyme- and immunohistochemical methods after 1, 3 and 6 weeks of repeated EMS/E. After 1 w of unilateral EMS/E there were structural muscle changes such as increased variability in fiber size, fiber splitting, internal myonuclei, necrotic fibers, expression of developmental MyHCs, fibrosis and inflammation in the exercised soleus muscle. Only limited changes were found in the exercised gastrocnemius muscle and in both non-exercised contralateral muscles. After 3 w of EMS/E, muscle fiber changes, presence of developmental MyHCs, inflammation, fibrosis and affections of nerve axons and AChE production were observed bilaterally in both the soleus and gastrocnemius muscles. At 6 w of EMS/E, the severity of these changes significantly increased in the soleus muscles and infiltration of fat was observed bilaterally in both the soleus and the gastrocnemius muscles. The affections of the muscles were in all three experimental groups restricted to focal regions of the muscle samples. We conclude that repetitive unilateral muscle overuse caused by EMS/E overtime leads to both degenerative and regenerative tissue changes and myositis not only in the exercised muscles, but also in the homologous non-exercised muscles of the contralateral leg. Although the mechanism behind the contralateral changes is unclear, we suggest that the nervous system is involved in the cross-transfer effects.