Altered tissue carnitine levels in animals with hereditary muscular dystrophy

Low levels of muscle carnitine have been found in patients with Duchenne dystrophy, a case possibly of Becker dystrophy, and limb-girdle syndrome as well as in patients with the recently described muscle carnitine deficiency syndrome. Tissues of the mouse, hamster, and chicken were analyzed to determine whether tissue carnitine levels were altered in the animal models of muscular dystrophy. Significantly higher levels of carnitine were found in dystrophic mouse muscle, but carnitine levels in plasma, liver and heart were normal. Histological changes in the skeletal muscle of dystrophic hamsters were relatively mild, and both skeletal muscle and plasma levels were normal. The liver carnitine level was higher than normal levels. The dystrophic hamster also had an inherited cardiomyopathy, and interestingly its heart carnitine level was much lower than normal. The red muscle of the normal chicken contained 5 times the level of carnitine found in white muscle. The dystrophic chicken had higher than normal levels of carnitine in the white muscle, but normal levels in the red muscle. Although all 3 animal models of muscular dystrophy studied have altered levels of carnitine in some tissue, none of the animal models had the same pattern of altered tissue carnitine levels seen in human patients.     

Intracellular elemental content of cardiac and skeletal muscle of normal and dystrophic hamsters

To test the hypothesis that the genetic lesion causing muscular dystrophy might be reflected in an abnormal intracellular elemental content, the elemental content of individual cardiac and skeletal muscle fibers in 50-day-old male control and cardiomyopathic BIO 53.58 hamsters was determined. The technique of electron probe x-ray microanalysis of freeze-dried tissue was employed. No electrolyte content differences were found between control and diseased animals for nuclei, myofibrillar cytoplasm, or mitochondrially-enriched cytoplasm of cardiac myocytes. Sulfur was elevated in dystrophic cardiac myocytes and was the only element significantly different in heart tissue of control and cardiomyopathic animals. Sulfur was also elevated in dystrophic soleus muscle fibers. The pattern of electrolyte content of these cells reflected a mixture of normal cells and damaged cells with altered electrolyte content. In this hamster model, alteration of electrolyte content of myocytes appears to be a result of the disease process and not an inherent characteristic of muscular dystrophy. The elevated sulfur in dystrophic hamster myocytes reflects a biochemical lesion which deserves further study.     

Reduced sarcolemmal dystrophin distribution and upregulation of utrophin in the cardiac and skeletal muscles of CHF-146 dystrophic hamsters

Abnormalities in the dystrophic gene product, dystrophin, have been implicated in initiating the primary membrane defect and excessive intracellular calcium accumulation (EICA), which play fundamental pathogenetic roles in hereditary muscular dystrophy (HMD). Two other cytoskeletal proteins, spectrin and utrophin, bear remarkable structural and functional homologies to dystrophin. CHF-146 strain dystrophic hamsters (DH), like patients with Duchenne muscular dystrophy (DMD), die prematurely from cardiopulmonary insufficiency, focal myonecrosis, and progressive degeneration of the cardiac and skeletal muscles with EICA. Although DH present a suitable model for HMD, there are controversies concerning their dystrophin and utrophin status. Using immunocytochemistry and Western blotting, we studied dystrophin, spectrin, and utrophin anomalies in the cardiac and skeletal muscles of 6-mo-old male DH. Age- and sex-matched CHF-148 strain albino normal hamsters (NH) served as controls. Sarcolemmal dystrophin staining was much weaker and interruptive in the DH. The densitometric analysis of the immunoblots revealed that dystrophin is reduced in DH by 83% in cardiac muscle (p<0.0001), and by 50% in skeletal muscle (p<0.0001). We conclude that sarcolemmal dystrophin distribution is markedly reduced and discontinuous in the cardiac and skeletal muscles of DH, with simultaneous upregulation of utrophin and a varied degree of spectrin labeling. This observation suggests that reduced sarcolemmal dystrophin is associated with membrane hyperpermeability, which leads to progressive muscle degeneration via EICA and segmental necrosis in DH. As in DMD, utrophin appears to play an important compensatory role in hamster dystrophinopathy.     

Blood plasma pyruvate kinase as a marker of muscular dystrophy. Properties in dystrophic chickens and hamsters

Pyruvate kinase activity rises sharply in the blood plasma of the genetically dystrophic chicken, and parallels in its timecourse during the development of the disease the appearance of other known signs. The increase in the dystrophic chicken reaches about 30-fold the normal value; in the genetically dystrophic hamster, a similar rise occurs and reaches 20-fold the normal level. A high correlation exists between the plasma pyruvate kinase and creatine phosphokinase activities in the development of dystrophy. The former appeared in the blood rather faster than the latter, despite the threefold greater molecular size of the former. Chickens heterozygous for muscular dystrophy also had plasma pyruvate kinase elevations, which were much smaller than in the homozygotes, but nevertheless significant: the values were about twofold those of the corresponding normal birds. The isoenzymes of pyruvate kinase were quantitatively analyzed by an isoelectric focusing method: dystrophic chicken muscle contains two isoenzymes, the major one being the M₁ form. It was shown thus that the isoenzymes of normal and of dystrophic chicken muscle were indistinguishable. The pyruvate kinase isoenzyme pattern in the chicken erythrocyte was established, and this, also, was identical in dystrophic and normal animals. The pyruvate kinase accumulating abnormally in the dystrophic blood was not the red cell enzyme but, by the isoelectric focusing evidence, was entirely due to enzyme escaping, unchanged, from the skeletal muscle. All our observations showed plasma pyruvate kinase to be an indicator of muscular dystrophy in these animals, and hence likely to be of value as one of the criteria for assessment of chemotherapeutic effects.     

Freeze-fracture studies of muscle plasma membrane in Fukuyama-type congenital muscular dystrophy

We used freeze-fracture to study muscle plasma membrane in six patients with Fukuyama-type congenital muscular dystrophy and six control children. In the patients, there was significantly fewer intramembranous particles (IMPs) and orthogonal arrays in the P face, with less conspicuous depletion of IMPs in E face. However, the density of caveolae was not affected.     

Possible manifestation of the dystrophic X chromosome in muscle cultures from carriers of Duchenne muscular dystrophy

Multilayer cell clusters have been observed before confluence and before myotube formation in muscle cell cultures derived from open biopsies of 7 of 14 (50%) female carriers of Duchenne muscular dystrophy, and in a high percentage of other dystrophic cultures. By contrast, this abnormality was seen in only 12 of 204 (6%) muscle biopsies from patients with other neuromuscular disorders. It appears that cluster formation is independent of the amount of connective tissue present in vivo, because histopathological analysis of the carrier biopsies showed increased endomysial connective tissue in only two cases. These results suggest that cluster formation is an expression of a myogenic defect and that it may be a manifestation of the genetic abnormality in X-linked muscular dystrophy.     

Fukutin gene mutations cause dilated cardiomyopathy with minimal muscle weakness

OBJECTIVE: The fukutin gene (FKTN) is the causative gene for Fukuyama-type congenital muscular dystrophy, characterized by rather homogeneous clinical features of severe muscle wasting and hypotonia from early infancy with mental retardation. In contrast with the severe dystrophic involvement of skeletal muscle, cardiac insufficiency is quite rare. Fukuyama-type congenital muscular dystrophy is one of the disorders associated with glycosylation defects of alpha-dystroglycan, an indispensable molecule for intra-extra cell membrane linkage. METHODS: Protein and functional analyses of alpha-dystroglycan and mutation screening of FKTN and other associated genes were performed. RESULTS: Surprisingly, we identified six patients in four families showing dilated cardiomyopathy with no or minimal limb girdle muscle involvement and normal intelligence, associated with a compound heterozygous FKTN mutation. One patient died by rapid progressive dilated cardiomyopathy at 12 years old, and the other patient received cardiac implantation at 18 years old. Skeletal muscles from the patients showed minimal dystrophic features but have altered glycosylation of alpha-dystroglycan and reduced laminin binding ability. One cardiac muscle that underwent biopsy showed altered glycosylation of alpha-dystroglycan similar to that observed in a Fukuyama-type congenital muscular dystrophy patient. INTERPRETATION: FKTN mutations could cause much wider spectrum of clinical features than previously perceived, including familial dilated cardiomyopathy and mildest limb girdle muscular dystrophy.     

Electrophysiologic differences between normal and dystrophic avian muscle

In the avian model of muscular dystrophy, electrophysiologic studies have shown alterations in the action potential characteristics of dystrophic muscle in vitro, supporting the notion that a membrane defect exists in avian dystrophy. As neurogenic and vascular etiologies have also been proposed, we examined the characteristics of action potentials recorded in a novel in vivo preparation of the extensor digitorum communis muscle in 8-week-old normal and dystrophic chickens. To facilitate intracellular recording, dantrolene sodium was used to attenuate the muscle twitch. Results showed that although the resting membrane potential, action potential amplitude and the action potential maximum rate of rise were similar in normal and dystrophic cells, the action potential duration at half the maximum amplitude was increased in dystrophic cells. This observation has not been previously reported for dystrophic avian muscle and suggests that a defect in the sarcolemmal potassium conductance is an early change in dystrophic avian muscle.     

Plasma acetylcholinesterase in Duchenne muscular dystrophy

Muscle acetylcholinesterase (AChE) in unregulated in animal and human muscular dystrophies and its activity is elevated in plasma of dystrophic chickens, probably due to a leakage from affected muscles. It is possible to measure AChE activity in human plasma in spite of high butyrylcholinesterase activity if acetyl-beta-methylcholine is used as the substrate and butyrylcholinesterase is inhibited by iso-OMPA. It has been found that, unlike in chickens, the plasma AChE activity in human newborns is not higher than that in adults. The AChE activity in plasma of children afflicted by Duchenne muscular dystrophy does not differ from that found in plasma of normal boys of the same age. In this respect Duchenne muscular dystrophy differs from chicken muscular dystrophy as well as from a neurogenic muscle disease (amyotrophic lateral sclerosis) in man.     

High molecular weight kininogen, the extracellular inhibitor of thiol proteases, is deficient in hamsters with muscular dystrophy

High molecular weight kininogen has been shown to be the principal plasma inhibitor of cellular thiol proteases including cathepsins B, H and L and calpains 1 and 2. Since these same enzymes have been reported to be elevated in animals with muscular dystrophy, we studied plasmas from hamsters with muscular dystrophy and compared these to normal hamster plasma. The ability of plasma to inhibit purified platelet calpain was assayed and found to be 62% of normal. Since low molecular weight kininogen can also inhibit calpain, the coagulant activity of kininogen, an activity unique for high molecular weight kininogen, was determined in dystrophic hamster plasma and found to be 69% of normal in close agreement with the calpain inhibitory activity. The contribution of the other plasma calpain inhibitor alpha 2-macroglobulin appeared small since inactivation with methylamine did not alter the ability to inhibit calpain in either normal or dystrophic plasma. We conclude that there is a selective deficiency of plasma high molecular weight kininogen in dystrophic hamsters, an abnormality which could play a role in the pathogenesis of this disorder.     

Erythrocyte surface membrane alterations.

Electrophoretic mobility measurements were made of red blood cells obtained from patients with Duchenne and myotonic muscular dystrophy, from dystrophic mice and chickens, and from corresponding controls. Alterations in the erythrocyte surface electrokinetic properties were found in dystrophic mice and chickens and in many, but not all, patients with muscular dystrophy. The results are consistent with the concept of muscular dystrophy as a systemic membrane disease not limited to muscle.     

An endogenous inhibitor of calcium-activated neutral protease in UMX 7.1 hamster dystrophy

An endogenous inhibitor for calcium-activated neutral protease (CANP) from skeletal and cardiac muscles of muscular dystrophic hamsters (UMX 7.1) was compared with that from normal control animals at 4 and 10 weeks of age by Western blotting using antibody raised against CANP inhibitor. Fragmented CANP inhibitor was found in dystrophic skeletal muscles in all cases at both ages, while only intact inhibitor was detected in the skeletal muscle of the normal hamsters. A total absence of intact inhibitor was shown in one 10-week-old dystrophic hamster. In contrast, there was little difference in CANP inhibitor from heart between dystrophic and control hamsters at 4 weeks. However, fragmentation similar to that in skeletal muscle was seen in the heart inhibitor in a few of the 10-week-old dystrophic hamsters.     

Dystrophin-deficient cardiomyopathy in mouse: expression of Nox4 and Lox are associated with fibrosis and altered functional parameters in the heart

Duchenne muscular dystrophy (DMD; dystrophin-deficiency) causes dilated cardiomyopathy in the second decade of life in affected males. We studied the dystrophin-deficient mouse heart (mdx) using high-frequency echocardiography, histomorphometry, and gene expression profiling. Heart dysfunction was prominent at 9-10months of age and showed significantly increased LV internal diameter (end systole) and decreased posterior wall thickness. This cardiomyopathy was associated with a 30% decrease in shortening fraction. Histologically, there was a 10-fold increase in connective tissue volume (fibrosis). mRNA profiling with RT-PCR validation showed activation of key pro-fibrotic genes, including Nox4 and Lox. The Nox gene family expression differed in mdx heart and skeletal muscle, where Nox2 was specifically induced in skeletal muscle while Nox4 was specifically induced in heart. This is the first report of an altered profibrotic gene expression profile in cardiac tissue of dystrophic mice showing echocardiographic evidence of cardiomyopathy.     

Is there a maturation defect related to calcium in muscle mitochondria from dystrophic mice and Duchenne and Becker muscular dystrophy patients?

In our study, mitochondria were isolated from skeletal muscle in 2-, 3-, 4-, 6-, 8-, and 12-week-old normal (C57BL6j dy/+), and 4-, 8-, and 12-week-old dystrophic (C57BL6j dy/dy) mice and in normal subjects and patients with Duchenne or Becker muscular dystrophy. A deficit was observed in a calcium-specific mitochondrial protein in the very young control mouse, compared with the adult mouse. In the adult dystrophic mouse this deficit was found in clinically affected hindleg muscles as well as in apparently normal front leg muscles; it was also found in quadriceps muscles from patients with Duchenne and Becker muscular dystrophy. It is not observed in normal adult mice or in normal subjects. The body of our results suggests that in the forms of muscular dystrophy studied there would be a maturation defect in this calcium-binding mitochondrial protein (“calmitine”), a defect which might be generalized in the entire skeletal muscle system and conceivably could be the cause of muscle degeneration in certain myopathies such as Duchenne and Becker muscular dystrophy.     

Lipid changes in Duchenne muscular dystrophy

Thin layer chromatographic analysis of lipid extracts of rectus abdominis and gastrocnemius muscles from controls and patients with severe sex-linked Duchenne muscular dystrophy shows the dystrophic tissue to contain more sphingomyelin, less lecithin plus choline plasmalogen, and more total cholesterol than normal. Comparison of normal, dystrophic, and immature muscle suggests that these observations can be interpreted as showing a similarity between dystrophic and immature muscle and in this respect human Duchenne dystrophy resembles hereditary muscular dystrophy in the mouse. Although sphingomyelin was present in apparently normal amount in muscle biopsies from patients with various other neuromuscular disorders, it was raised in two cases showing evidence of peripheral neuropathy.     

Transplantation of extensor carpi radialis longus muscle in normal and dystrophic chicks

The etiology of avian muscular dystrophy was examined by a cross-transplantation technique. Care was taken for the transplants to regenerate and develop under neural influence, by using the small extensor carpi radialis longus (ECRL) muscle. The ECRL muscles were exchanged between normal and dystrophic chicks 2 to 3 days ex ovo, and the muscle weight, number of muscle fibers, muscle fiber size, and contractile properties of the transplanted muscles were observed 60 to 65 days after operation when the tissue reconstitution was virtually complete. The results obtained for the physiologic, anatomic, and histologic parameters strongly suggested that there exists some failure in the host environment of the dystrophic chicken. The analyses of the histologic parameters suggested that a genetic disorder may also reside in the muscle tissue itself. The myotonic nature of the muscle membrane, however, probably does not contribute significantly to the abnormal behavior of dystrophic chickens. The importance of some neurogenic abnormalities in avian muscular dystrophy is discussed in relation to the results reported by other investigators.     

Freeze-fracture analysis of plasma membranes in Duchenne muscular dystrophy. A study using cultured skin fibroblasts

Quantitative freeze-fracture studies of the numercial density and distribution of intramembrane particles (IMP) were carried out on the plasma membrane of cultured skin fibroblasts from 4 patients with Duchenne muscular dystrophy and 3 normal controls. Analysis of P and E fracture faces of the fibroblast plasma membrane failed to show any significant differences in either IMP density or distribution between normal and dystrophic specimens. In contrast to previous reports, our results indicate that an altered IMP density is not a characteristic feature of the dystrophic cell membrane.     

Excessive intracellular zinc accumulation in cardiac and skeletal muscles of dystrophic hamsters

Zinc has been reported to be important in protein synthesis, collagen crosslinking, membrane structure and function, cellular necrosis, muscle glycolysis, and cardiac dysfunction. As all these processes are affected by muscular dystrophy, we studied the Zn concentrations in the cardiac and skeletal muscles of 7-month-old male dystrophic hamsters with advanced hypertrophic cardiomyopathy. Age- and sex-matched normal hamsters served as controls. Calcium, magnesium, and copper concentrations were also measured in the dystrophic and normal tissues. Flame atomic absorption spectrophotometry was used for mineral quantitation of the nitric acid tissue extracts. Zn concentrations in the myocardium (P less than 0.002), diaphragm (P less than 0.005), and rectus femoris muscles (P less than 0.001) were significantly elevated with concomitant elevations of Ca in dystrophic compared with normal hamsters. Although no appreciable changes in Cu or Mg concentrations were noted in the myocardium, slight depletions of Cu in the dystrophic diaphragm (P less than 0.025) and Mg in the dystrophic rectus femoris (P less than 0.05) were present. The intracellular Zn and Ca accumulations in the cardiac and skeletal muscles of dystrophic hamsters correlated with other dystrophic features such as increased rates of protein synthesis, significant myocardial enlargement, characteristic electrocardiographic and mechanophysiologic abnormalities, and classical histopathologic changes. We hypothesize that Zn2+ may be cotransported with Ca2+ across the cellular membrane or substituted for Ca2+ in certain pathways. These mechanisms may be affected by the high-energy ATP-pump and/or the sodium-potassium exchange system at the cellular level. Our observations suggest a possible pathogenetic involvement of Zn in muscular dystrophy which may be associated with an accelerated effort by the cellular system to repair the damaged cardiac and skeletal muscles.     

Evidence against a lymphocyte-mediated autoimmune etiology for murine muscular dystrophy

The hypothesis that murine muscular dystrophy (MMD) is a lymphocyte-mediated autoimmune disease was tested by orthotopically transplanting normal and dystrophic muscle into normal or dystrophic hosts immunosuppressed with antilymphocyte serum (ALS). Normal serum (NS)-treated animals served as controls. Allograft conditions revealed that both normal and dystrophic muscle were antigenic and were rejected by NS-treated hosts, with the myofiber component of the muscle implant being rejected before the fibroblast portion. New muscle regenerated in a host receiving ALS therapy and was retained by the host until 30 days after the withdrawal of the ALS therapy. Normal muscle isografted into dystrophic hosts regenerated irrespective of whether the host was treated with ALS or NS. In the reciprocal experiment, dystrophic muscle regenerated in normal hosts, but the myofibers were gradually eliminated and replaced by connective tissue, thus behaving as they would have in the donor animal. These observations are incompatible with a lymphocyte-mediated autoimmune etiology for MMD. Furthermore, they raise some question about the claims of muscular dystrophy being attributable to a neural or vascular lesion, and imply that the lesion may be intrinsic to the muscle.