Abstract

Duchenne muscular dystrophy (DMD) is an X-linked recessive progressive lethal disorder caused by the lack of dystrophin, which determines myofibers mechanical instability, oxidative stress, inflammation, and susceptibility to contraction-induced injuries. Unfortunately, at present, there is no efficient therapy for DMD. Beyond several promising gene- and stem cells-based strategies under investigation, physical activity may represent a valid noninvasive therapeutic approach to slow down the progression of the pathology. However, ethical issues, the limited number of studies in humans and the lack of consistency of the investigated training interventions generate loss of consensus regarding their efficacy, leaving exercise prescription still questionable. By an accurate analysis of data about the effects of different protocol of exercise on muscles of mdx mice, the most widely-used pre-clinical model for DMD research, we found that low intensity exercise, especially in the form of low speed treadmill running, likely represents the most suitable exercise modality associated to beneficial effects on mdx muscle. This protocol of training reduces muscle oxidative stress, inflammation, and fibrosis process, and enhances muscle functionality, muscle regeneration, and hypertrophy. These conclusions can guide the design of appropriate studies on human, thereby providing new insights to translational therapeutic application of exercise to DMD patients.

Highlights

  • This review examines the role of exercise in the modulation of muscle plasticity and oxidative stress in the mdx mouse, the most widely used pre-clinical animal model for Duchenne muscular dystrophy (DMD), a fatal X-linked disorders characterized by progressive muscle weakness

  • Chronic low intensity treadmill running, at a speed less than or equal to 9 m/min, might represent the most suitable exercise modality associated to beneficial effects on mdx muscle, especially hind limb muscles

  • When considering exercise as a therapy for DMD patients, it is essential to take into account the overall effect on patients and to heart and respiratory muscles, whose failure is typically responsible of DMD patient death

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Summary

Introduction

This review examines the role of exercise in the modulation of muscle plasticity and oxidative stress in the mdx mouse, the most widely used pre-clinical animal model for Duchenne muscular dystrophy (DMD), a fatal X-linked disorders characterized by progressive muscle weakness. Beyond the current medication, such as steroids, which show many side effects and can only slow down disease progression, and new geneand stem cells-based strategies, still under experimentation [1,2], physical activity may represent an effective noninvasive therapeutic approach for DMD. Other therapeutic approaches can improve muscle functionality by targeting pathways involved in the pathogenesis of DMD, such as inflammation and oxidative stress [1,2,29,30]. Gene- and stem cells-based therapies, physical exercise, by inducing muscle plastic remodeling, represents a potential therapeutic approach for improving DMD patient outcomes and quality of life [5,9,32]

The mdx Model
Effects of Exercise on Plastic Remodeling of mdx Muscle
Effects of Forced Running on Plastic Remodeling of mdx Muscle
Effects of Swimming Exercise on Plastic Remodeling of mdx Muscle
Effects of Voluntary Running on Plastic Remodeling of mdx Muscle
Mitochondria Impairment and Redox Equilibrium in DMD Muscles
Exercise Modulation of mdx Muscle Oxidative Stress and Inflammation
Conclusions and Future Perspectives
Chronic Exercise
Findings
Acute exercise
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