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Elevation of intracellular Ca2+, excessive ROS production and increased phospholipase A2 activity contribute to the pathology in dystrophin-deficient muscle. Moreover, Ca2+, ROS and phospholipase A2, in particular iPLA2, are thought to potentiate each other in positive feedback loops. NADPH oxidases (NOX) have been considered as a major source of ROS in muscle and have been reported to be overexpressed in muscles of mdx mice. We report here on our investigations regarding the effect of diapocynin, a dimer of the commonly used NOX inhibitor apocynin, on the activity of iPLA2, Ca2+ handling and ROS generation in dystrophic myotubes. We also examined the effects of diapocynin on force production and recovery ability of isolated EDL muscles exposed to eccentric contractions in vitro, a damaging procedure to which dystrophic muscle is extremely sensitive. In dystrophic myotubes, diapocynin inhibited ROS production, abolished iPLA2 activity and reduced Ca2+ influx through stretch-activated and store-operated channels, two major pathways responsible for excessive Ca2+ entry in dystrophic muscle. Diapocynin also prevented force loss induced by eccentric contractions of mdx muscle close to the value of wild-type muscle and reduced membrane damage as seen by Procion orange dye uptake. These findings support the central role played by NOX-ROS in the pathogenic cascade leading to muscular dystrophy and suggest diapocynin as an effective NOX inhibitor that might be helpful for future therapeutic approaches.

We are investigating the effects of selective estrogen receptor modulators (SERMs) in mdx5Cv dystrophic mice (Dys), a model for Duchenne muscular dystrophy (DMD). SERMs display either pro-estrogenic or anti-estrogenic activities in a tissue-dependent manner. Tamoxifen (TAM), the most well characterised SERM, has been used for over 30 years to treat estrogen-sensitive breast cancer in both women and men and has been reported to be also well tolerated in pre-pubertal boys. In 2013, we published that oral treatment of Dys mice from 3 weeks of age for 15 months with TAM (10 mg/kg/day) improved muscle force and the structure of diaphragm and heart. TAM and its metabolites were present in nanomolar concentrations in plasma and muscles, suggesting signalling through high affinity targets, likely the estrogen receptors alpha and beta that were several-fold more abundant in dystrophic muscle than in normal ones. Next, we tested TAM in adult Dys mice in order to investigate its efficacy in the low-intensity chronic stage of the disease, which resembles most closely the DMD condition. TAM at doses as low as 0.1 mg/kg/day improved motor performance of active mice and enhanced the contractile characteristics of the triceps surae. At 3 mg/kg/day, TAM corrected most endpoints close to normal values. We are currently testing other SERMs (all at 3 mg/kg/day): the chlorinated TAM analogues clomiphene and toremifene, the 3-hydroxylated TAM derivative droloxifene, the second generation SERM unrelated to TAM raloxifene (RAL), and the pure anti-estrogen fulvestrant (Faslodex). Overall, the ranked efficacy was as follows: TAM > toremifene > clomiphene > droloxifene ≈ RAL > Faslodex. Our data as well as our current understanding of estrogenic signalling in dystrophic muscle suggests that TAM and other SERMs with pro-estrogenic activities on muscle might be beneficial for DMD and maybe also for other muscular dystrophies.

Duchenne muscular dystrophy (DMD) is a severe X-linked muscular disease that causes premature death and for which no cure exists. We have shown previously that in vitro treatment of dystrophic myotubes and excised muscles with diapocynin, a dimer of the classically used NADPH oxidase inhibitor apocynin, ameliorated several molecular events involved in DMD pathogenesis, of which ROS production, phospholipase A2 activity, Ca 2+ influx and sarcolemmal integrity. Here, we report on the in vivo effects of diapocynin and apocynin in mdx 5Cv dystrophic mice, a model of DMD. Apocynin (50mg/kg/day) and diapocynin (10 and 100mg/kg/day) were given orally to mdx 5Cv mouse pups, first via the lactating mothers from post-natal day 14 to 28 and subsequently directly to the weaned pups till post-natal day 35±1 or 60±3. Diapocynin but not apocynin enhanced spontaneous locomotor activity, rescued voluntary wheel running capabilities, and ameliorated diaphragm structure of dystrophic mice. Diapocynin and apocynin were equally potent at increasing the resistance to fatigue of triceps surae muscles exposed to repeated isometric contractions in situ and at preserving sarcolemmal integrity as evidenced by Evans blue dye uptake. Furthermore, microarray analyses showed a tendency of the treatments to correct gene expression in dystrophic mice towards wild type controls. Although apocynin and diapocynin had beneficial effects in dystrophic mice, diapocynin was superior in improving locomotion.