title: Prospect of gene therapy for cardiomyopathy in hereditary muscular dystrophy.
abstract: BACKGROUND
  Cardiac involvement is a common feature in muscular dystrophies. It presents as heart failure and/or arrhythmia. Traditionally, dystrophic cardiomyopathy is treated with symptom-relieving medications. Identification of disease-causing genes and investigation on pathogenic mechanisms have opened new opportunities to treat dystrophic cardiomyopathy with gene therapy. Replacing/repairing the mutated gene and/or targeting the pathogenic process/mechanisms using alternative genes may attenuate heart disease in muscular dystrophies.
  
  
  METHODS
  Duchenne muscular dystrophy is the most common muscular dystrophy. Duchenne cardiomyopathy has been the primary focus of ongoing dystrophic cardiomyopathy gene therapy studies. Here, we use Duchenne cardiomyopathy gene therapy to showcase recent developments and to outline the path forward. We also discuss gene therapy status for cardiomyopathy associated with limb-girdle and congenital muscular dystrophies, and myotonic dystrophy.
  
  
  CONCLUSIONS
  Gene therapy for dystrophic cardiomyopathy has taken a slow but steady path forward. Preclinical studies over the last decades have addressed many fundamental questions. Adeno-associated virus-mediated gene therapy has significantly improved the outcomes in rodent models of Duchenne and limb girdle muscular dystrophies. Validation of these encouraging results in large animal models will pave the way to future human trials.
authors.affiliation: Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri.
authors.forename: Yongping
authors.initials: Y
authors.lastname: Yue
authors.affiliation: Department of Child Health, School of Medicine, University of Missouri.
authors.forename: Ibrahim M
authors.initials: IM
authors.lastname: Binalsheikh
authors.affiliation: Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri.
authors.forename: Stacey B
authors.initials: SB
authors.lastname: Leach
authors.affiliation: Department of Medical Physiology and Pharmacology, School of Medicine, University of Missouri.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Domeier
authors.affiliation: Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri; Department of Neurology, School of Medicine, University of Missouri.
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Duan
keywords: AAV; DMD; Duchenne muscular dystrophy; adeno-associated virus; capsid; capsid engineering; cardiomyopathy; congenital muscular dystrophy; dystrophin; gene therapy; heart failure; limb-girdle muscular dystrophy; muscular dystrophy; myotonic dystrophy; vector