title: The neuromuscular impact of symptomatic SMN restoration in a mouse model of spinal muscular atrophy.
abstract: BACKGROUND
  Significant advances in the development of SMN-restoring therapeutics have occurred since 2010 when very effective biological treatments were reported in mouse models of spinal muscular atrophy. As these treatments are applied in human clinical trials, there is pressing need to define quantitative assessments of disease progression, treatment stratification, and therapeutic efficacy. The electrophysiological measures Compound Muscle Action Potential and Motor Unit Number Estimation are reliable measures of nerve function. In both the SMN∆7 mouse and a pig model of spinal muscular atrophy, early SMN restoration results in preservation of electrophysiological measures. Currently, clinical trials are underway in patients at post-symptomatic stages of disease progression. In this study, we present results from both early and delayed SMN restoration using clinically-relevant measures including electrical impedance myography, compound muscle action potential, and motor unit number estimation to quantify the efficacy and time-sensitivity of SMN-restoring therapy.
  
  
  METHODS
  SMA∆7 mice were treated via intracerebroventricular injection with antisense oligonucleotides targeting ISS-N1 to increase SMN protein from the SMN2 gene on postnatal day 2, 4, or 6 and compared with sham-treated spinal muscular atrophy and control mice. Compound muscle action potential and motor unit number estimation of the triceps surae muscles were performed at day 12, 21, and 30 by a single evaluator blinded to genotype and treatment. Similarly, electrical impedance myography was measured on the biceps femoris muscle at 12days for comparison.
  
  
  RESULTS
  Electrophysiological measures and electrical impedance myography detected significant differences at 12days between control and late-treated (4 or 6days) and sham-treated spinal muscular atrophy mice, but not in mice treated at 2days (p<0.01). EIM findings paralleled and correlated with compound muscle action potential and motor unit number estimation (r=0.61 and r=0.50, respectively, p<0.01). Longitudinal measures at 21 and 30days show that symptomatic therapy results in reduced motor unit number estimation associated with delayed normalization of compound muscle action potential.
  
  
  CONCLUSIONS
  The incomplete effect of symptomatic treatment is accurately identified by both electrophysiological measures and electrical impedance myography. There is strong correlation between these measures and with weight and righting reflex. This study predicts that measures of compound muscle action potential, motor unit number estimation, and electrical impedance myography are promising biomarkers of treatment stratification and effect for future spinal muscular atrophy trials. The ease of application and simplicity of electrical impedance myography compared with standard electrophysiological measures may be particularly valuable in future pediatric clinical trials.
authors.affiliation: Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, Columbus, OH 43210, United States; Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, 480 Medical Center Drive, Columbus, OH 43210, United States; Department of Neuroscience, The Ohio State University Wexner Medical Center, 480 Medical Center Drive, Columbus, OH 43210, United States.
authors.forename: W
authors.initials: W
authors.lastname: Arnold
authors.affiliation: Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, 363 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210, United States.
authors.forename: Vicki L
authors.initials: VL
authors.lastname: McGovern
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sanchez
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States.
authors.forename: Jia
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, 363 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210, United States.
authors.forename: Kaitlyn M
authors.initials: KM
authors.lastname: Corlett
authors.affiliation: Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, Columbus, OH 43210, United States; Department of Neuroscience, The Ohio State University Wexner Medical Center, 480 Medical Center Drive, Columbus, OH 43210, United States; Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, 363 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210, United States.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kolb
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States.
authors.forename: Seward B
authors.initials: SB
authors.lastname: Rutkove
authors.affiliation: Department of Neurology, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, Columbus, OH 43210, United States; Department of Biological Chemistry and Pharmacology, The Ohio State University Wexner Medical Center, 363 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210, United States.
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Burghes
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001284:Atrophy; D004195:Disease Models, Animal; D017097:Electric Impedance; D015316:Genetic Therapy / Q000379:methods; D008137:Longitudinal Studies; D008822:Mice, Transgenic; D018482:Muscle, Skeletal / Q000503:physiopathology; D009134:Muscular Atrophy, Spinal / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D009213:Myography; D016376:Oligonucleotides, Antisense / Q000008:administration & dosage; D012018:Reflex / Q000502:physiology; D016019:Survival Analysis
chemical_list: D016376:Oligonucleotides, Antisense
keywords: Antisense oligonucleotide; Biomarker; Clinical trials; Electrical impedance myography; Electromyography; Gene therapy; Motor unit number estimation; Pharmacodynamics; Spinal muscular atrophy; Survival motor neuron