title: Dual AAV therapy ameliorates exercise-induced muscle injury and functional ischemia in murine models of Duchenne muscular dystrophy.
abstract: Neuronal nitric oxide synthase (nNOS) membrane delocalization contributes to the pathogenesis of Duchenne muscular dystrophy (DMD) by promoting functional muscle ischemia and exacerbating muscle injury during exercise. We have previously shown that supra-physiological expression of nNOS-binding mini-dystrophin restores normal blood flow regulation and prevents functional ischemia in transgenic mdx mice, a DMD model. A critical next issue is whether systemic dual adeno-associated virus (AAV) gene therapy can restore nNOS-binding mini-dystrophin expression and mitigate muscle activity-related functional ischemia and injury. Here, we performed systemic gene transfer in mdx and mdx4cv mice using a pair of dual AAV vectors that expressed a 6 kb nNOS-binding mini-dystrophin gene. Vectors were packaged in tyrosine mutant AAV-9 and co-injected (5 × 10(12) viral genome particles/vector/mouse) via the tail vein to 1-month-old dystrophin-null mice. Four months later, we observed 30-50% mini-dystrophin positive myofibers in limb muscles. Treatment ameliorated histopathology, increased muscle force and protected against eccentric contraction-induced injury. Importantly, dual AAV therapy successfully prevented chronic exercise-induced muscle force drop. Doppler hemodynamic assay further showed that therapy attenuated adrenergic vasoconstriction in contracting muscle. Our results suggest that partial transduction can still ameliorate nNOS delocalization-associated functional deficiency. Further evaluation of nNOS binding mini-dystrophin dual AAV vectors is warranted in dystrophic dogs and eventually in human patients.
authors.affiliation: Department of Molecular Microbiology and Immunology, The University of Missouri, Columbia, MO 65212, USA.
authors.forename: Yadong
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yongping
authors.initials: Y
authors.lastname: Yue
authors.forename: Liang
authors.initials: L
authors.lastname: Li
authors.forename: Chady H
authors.initials: CH
authors.lastname: Hakim
authors.forename: Keqing
authors.initials: K
authors.lastname: Zhang
authors.forename: Gail D
authors.initials: GD
authors.lastname: Thomas
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Duan
mesh_terms: D000818:Animals; D000229:Dependovirus / Q000235:genetics*; D004285:Dogs; D016189:Dystrophin / Q000235:genetics* / Q000378:metabolism; D015316:Genetic Therapy; D005822:Genetic Vectors; D006801:Humans; D007511:Ischemia / Q000628:therapy; D008297:Male; D051379:Mice; D008822:Mice, Transgenic; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000201:enzymology / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D009137:Muscular Dystrophy, Animal / Q000235:genetics / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D020388:Muscular Dystrophy, Duchenne / Q000235:genetics / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D052248:Nitric Oxide Synthase Type I / Q000378:metabolism*; D010805:Physical Conditioning, Animal / Q000009:adverse effects*; D012508:Sarcolemma / Q000201:enzymology
chemical_list: D016189:Dystrophin; D052248:Nitric Oxide Synthase Type I