Abnormal splicing switch of DMD's penultimate exon compromises muscle fibre maintenance in myotonic dystrophy

International audienceMyotonic Dystrophy type 1 (DM1) is a dominant neuromuscular disease caused by nuclear-retained RNAs containing expanded CUG repeats. These toxic RNAs alter the activities of RNA splicing factors resulting in alternative splicing misregulation and muscular dysfunction. Here we show that the abnormal splicing of DMD exon 78 found in dystrophic muscles of DM1 patients is due to the functional loss of MBNL1 and leads to the re-expression of an embryonic dystrophin in place of the adult isoform. Forced expression of embryonic dystrophin in zebrafish using an exon-skipping approach severely impairs the mobility and muscle architecture. Moreover, reproducing Dmd exon 78 missplicing switch in mice induces muscle fibre remodelling and ultrastructural abnormalities including ringed fibres, sarcoplasmic masses or Z-band disorganization, which are characteristic features of dystrophic DM1 skeletal muscles. Thus, we propose that splicing misregulation of DMD exon 78 compromises muscle fibre maintenance and contributes to the progressive dystrophic process in DM

Myostatin is a key mediator between energy metabolism and endurance capacity of skeletal muscle

Myostatin (Mstn) participates in the regulation of skeletal muscle size and has emerged as a regulator of muscle metabolism. Here, we hypothesized that lack of myostatin profoundly depresses oxidative phosphorylation-dependent muscle function. Toward this end, we explored Mstn/ mice as a model for the constitutive absence of myostatin and AAV-mediated overexpression of myostatin propeptide as a model of myostatin blockade in adult wild-type mice. We show that muscles from Mstn/ mice, although larger and stronger, fatigue extremely rapidly. Myostatin deficiency shifts muscle from aerobic toward anaerobic energy metabolism, as evidenced by decreased mitochondrial respiration, reduced expression of PPAR transcriptional regulators, increased enolase activity, and exercise-induced lactic acidosis. As a consequence, constitutively reduced myostatin signaling diminishes exercise capacity, while the hypermuscular state of Mstn/ mice increases oxygen consumption and the energy cost of running. We wondered whether these results are the mere consequence of the congenital fiber-type switch toward a glycolytic phenotype of constitutive Mstn/ mice. Hence, we overexpressed myostatin propeptide in adult mice, which did not affect fiber-type distribution, while nonetheless causing increased muscle fatigability, diminished exercise capacity, and decreased Pparb/d and Pgc1a expression. In conclusion, our results suggest that myostatin endows skeletal muscle with high oxidative capacity and low fatigability, thus regulating the delicate balance between muscle mass, muscle force, energy metabolism, and endurance capacity

Skeletal Muscle Phenotypically Converts and Selectively Inhibits Metastatic Cells in Mice

Skeletal muscle is rarely a site of malignant metastasis; the molecular and cellular basis for this rarity is not understood. We report that myogenic cells exert pronounced effects upon co-culture with metastatic melanoma (B16-F10) or carcinoma (LLC1) cells including conversion to the myogenic lineage in vitro and in vivo, as well as inhibition of melanin production in melanoma cells coupled with cytotoxic and cytostatic effects. No effect is seen with non-tumorigenic cells. Tumor suppression assays reveal that the muscle-mediated tumor suppressor effects do not generate resistant clones but function through the down-regulation of the transcription factor MiTF, a master regulator of melanocyte development and a melanoma oncogene. Our findings point to skeletal muscle as a source of therapeutic agents in the treatment of metastatic cancers

Splicing misregulation of SCN5A contributes to cardiac-conduction delay and heart arrhythmia in myotonic dystrophy

Myotonic dystrophy (DM) is caused by the expression of mutant RNAs containing expanded CUG repeats that sequester muscleblind-like (MBNL) proteins, leading to alternative splicing changes. Cardiac alterations, characterized by conduction delays and arrhythmia, are the second most common cause of death in DM. Using RNA sequencing, here we identify novel splicing alterations in DM heart samples, including a switch from adult exon 6B towards fetal exon 6A in the cardiac sodium channel, SCN5A. We find that MBNL1 regulates alternative splicing of SCN5A mRNA and that the splicing variant of SCN5A produced in DM presents a reduced excitability compared with the control adult isoform. Importantly, reproducing splicing alteration of Scn5a in mice is sufficient to promote heart arrhythmia and cardiac-conduction delay, two predominant features of myotonic dystrophy. In conclusion, misregulation of the alternative splicing of SCN5A may contribute to a subset of the cardiac dysfunctions observed in myotonic dystrophy.Peer reviewe

Développement d'une thérapie génique pour la Dystrophie Myotonique de type 1

Myotonie dystrophy types 1(DM1) and 2 (DM2) are autosomal dominant multisystem diseases with a strong neuromuscular component. They are characterized by progressive myotonia, muscle weakness, cognitive impairment, and cardiac conduction defects. These diseases are caused by abnormal amplification of C(C)TG repeat sequences located in the 3'UTR region of the DMPK gene and in the intron of the CNBP gene, respectively. These expansion-containing sequences are transcribed and retained in the nucleus as riboprotein aggregates. The presence of these toxic C(C)UG RNAs induces sequestration of the MBNL family of RNA-binding proteins, leading to their loss of function and deregulation of alternative splicing events, many ofv/hich are associated with clinical symptoms in patients. There is currently no1reatment for DM. In this thesis, I have developed a gene therapy tool based on a modification of the MBNL1 protein. This C- terminal truncated MBNL derivative (MBNLΔ) acts as a decoy to release endogenous MBNL proteins sequestered by mutant RNAs. Our approach was validated in muscle cells from DM1 patients and in a mouse model of the disease after AAV virus injection. Treatment with MBNLΔ allows the delocalisation of endogenous MBNL proteins from the foci, modifies the foci dynamics, corrects the transcriptome and myotonia, which is maintained 1 year after injection.Les Dystrophies Myotoniques de type 1 (DM1) et (DM2) sont des maladies multisystémiques autosomiques dominantes avec une forte composante neuromusculaire. Ces pathologies se caractérisent essentiellement par une myotonie, une faiblesse musculaire progressives, des déficiences cognitives, et des défauts de conduction cardiaque. Ces maladies sont causées par une amplification anormale de séquences répétées C(C)TG situées respectivement dans la région 3’UTR du gène de la DMPK et dans l’intron du gène CNBP. Ces séquences contenant les expansions sont transcrites et retenues dans le noyau des cellules sous forme d’agrégats riboprotéiques. La présence de ces ARN-C(C)UG toxiques induisent la séquestration des protéines de liaisons à l’ARN de la famille MBNL conduisant à leur perte de fonction et à la dérégulation d’évènements d'épissages alternatifs dont plusieurs ont été associés à des symptômes cliniques chez les patients. A jour ce jour, il n’existe aucun traitement pour la DM. Dans ce travail de thèse, j’ai développé un outil de thérapie génique basé sur une modification de la protéine MBNL1. Ce dérivé de MBNL tronqué dans sa partie C-terminale (MBNLΔ), agit comme leurre pour libérer les protéines MBNL endogènes séquestrées par les ARN mutés. Notre approche été validée dans des cellules musculaires issue de patient DM1 et dans un modèle murin de la maladie après injection de virus AAV. Le traitement par le MBNLΔ permet la délocalisation des protéines MBNL endogènes des foci, modifie la dynamique des foci, corrige le transcriptome ainsi que la myotonie, et ce 1 an après injection

Develpment of gene therapy for Myotonic Dystropy type 1

Les Dystrophies Myotoniques de type 1 (DM1) et (DM2) sont des maladies multisystémiques autosomiques dominantes avec une forte composante neuromusculaire. Ces pathologies se caractérisent essentiellement par une myotonie, une faiblesse musculaire progressives, des déficiences cognitives, et des défauts de conduction cardiaque. Ces maladies sont causées par une amplification anormale de séquences répétées C(C)TG situées respectivement dans la région 3’UTR du gène de la DMPK et dans l’intron du gène CNBP. Ces séquences contenant les expansions sont transcrites et retenues dans le noyau des cellules sous forme d’agrégats riboprotéiques. La présence de ces ARN-C(C)UG toxiques induisent la séquestration des protéines de liaisons à l’ARN de la famille MBNL conduisant à leur perte de fonction et à la dérégulation d’évènements d'épissages alternatifs dont plusieurs ont été associés à des symptômes cliniques chez les patients. A jour ce jour, il n’existe aucun traitement pour la DM. Dans ce travail de thèse, j’ai développé un outil de thérapie génique basé sur une modification de la protéine MBNL1. Ce dérivé de MBNL tronqué dans sa partie C-terminale (MBNLΔ), agit comme leurre pour libérer les protéines MBNL endogènes séquestrées par les ARN mutés. Notre approche été validée dans des cellules musculaires issue de patient DM1 et dans un modèle murin de la maladie après injection de virus AAV. Le traitement par le MBNLΔ permet la délocalisation des protéines MBNL endogènes des foci, modifie la dynamique des foci, corrige le transcriptome ainsi que la myotonie, et ce 1 an après injection.Myotonie dystrophy types 1(DM1) and 2 (DM2) are autosomal dominant multisystem diseases with a strong neuromuscular component. They are characterized by progressive myotonia, muscle weakness, cognitive impairment, and cardiac conduction defects. These diseases are caused by abnormal amplification of C(C)TG repeat sequences located in the 3'UTR region of the DMPK gene and in the intron of the CNBP gene, respectively. These expansion-containing sequences are transcribed and retained in the nucleus as riboprotein aggregates. The presence of these toxic C(C)UG RNAs induces sequestration of the MBNL family of RNA-binding proteins, leading to their loss of function and deregulation of alternative splicing events, many ofv/hich are associated with clinical symptoms in patients. There is currently no1reatment for DM. In this thesis, I have developed a gene therapy tool based on a modification of the MBNL1 protein. This C- terminal truncated MBNL derivative (MBNLΔ) acts as a decoy to release endogenous MBNL proteins sequestered by mutant RNAs. Our approach was validated in muscle cells from DM1 patients and in a mouse model of the disease after AAV virus injection. Treatment with MBNLΔ allows the delocalisation of endogenous MBNL proteins from the foci, modifies the foci dynamics, corrects the transcriptome and myotonia, which is maintained 1 year after injection

Femoral intra-arterial injection: a tool to deliver and assess recombinant AAV constructs in rodents whole hind limb

International audienc

Phenotypic correction of alpha-sarcoglycan deficiency by intra-arterial injection of a muscle-specific serotype 1 rAAV vector

International audiencealpha-Sarcoglycanopathy (limb-girdle muscular dystrophy type 2D, LGMD2D) is a recessive muscular disorder caused by deficiency in alpha-sarcoglycan, a transmembrane protein part of the dystrophin-associated complex. To date, no treatment exists for this disease. We constructed recombinant pseudotype-1 adeno-associated virus (rAAV) vectors expressing the human alpha-sarcoglycan cDNA from a ubiquitous or a muscle-specific promoter. Evidence of specific immune response leading to disappearance of the vector was observed with the ubiquitous promoter. In contrast, efficient and sustained transgene expression with correct sarcolemmal localization and without evident toxicity was obtained with the muscle-specific promoter after intra-arterial injection into the limbs of an LGMD2D murine model. Transgene expression resulted in restoration of the sarcoglycan complex, histological improvement, membrane stabilization, and correction of pseudohypertrophy. More importantly, alpha-sarcoglycan transfer produced full rescue of the contractile force deficits and stretch sensibility and led to an increase of the global activity of the animals when both posterior limbs are injected. Our results establish the feasibility for AAV-mediated alpha-sarcoglycan gene transfer as a therapeutic approach

Low-dose of peptide-conjugate antisense oligonucleotides targeting CUGexp-RNA in murine skeletal muscles normalizes Myotonic Dystrophy 1 phenotype

Antisense oligonucleotides (ASOs) targeting pathologic RNAs have shown promising therapeutic corrections for many genetic diseases including Myotonic Dystrophy type 1 (DM1). DM1 is a dominant neuromuscular disease caused by the abnormal amplification of a CTG repeated sequence in the 3’UTR of the DMPK gene. Expression of mutant transcripts containing expanded CUG repeats (CUGexp) leads to a deleterious RNA gain-of-function mechanism, in which CUGexp-transcripts are retained within the nucleus and alter the function of RNA-binding proteins such as MBNL splicing factors, leading to splicing defects and muscular dysfunction. ASO strategies can reverse the RNA toxicity induced by the expression of CUGexp-RNA. However systemic use of ASOs remains challenging for this muscular dystrophy because of the poor skeletal muscle uptake as pointed out by a recent clinical trial. Here, we show that advanced Pip6a-conjugate peptides strongly enhanced morpholino phosphorodiamidate oligomer (PMO) delivery into skeletal muscles of a DM1 mouse model (HSA-LR) after systemic administration in comparison to naked PMO. Antisense Pip6a-PMOs targeting pathologic CUGexp repeats inhibit the detrimental sequestration of MBNL1 splicing factor by nuclear CUGexp-RNA foci and consequently its functional loss. Thus low-dose of Pip6a-CAG ASOs induces a complete normalization of the myotonia in treated HSA-LR mice along with the correction of splicing defects and altered gene expression. Long-term studies reveal than the compound is still active six months after injection. In addition, the beneficial effect of the Pip6-CAG treatment was confirmed in human DM1 patient-derived muscle cells containing >2000 CTG repeats. This study demonstrates that pip6a-PMO treatment allows a lasting normalization of DM1-associated phenotypes at both molecular and functional levels supporting the use of advanced pip-conjugates for enhanced ASO systemic delivery in DM1 skeletal muscles

Gene Therapy via Trans-Splicing for LMNA-Related Congenital Muscular Dystrophy

We assessed the potential of Lmna-mRNA repair by spliceosome-mediated RNA trans-splicing as a therapeutic approach for LMNA-related congenital muscular dystrophy. This gene therapy strategy leads to reduction of mutated transcript expression for the benefit of corresponding wild-type (WT) transcripts. We developed 5′-RNA pre-trans-splicing molecules containing the first five exons of Lmna and targeting intron 5 of Lmna pre-mRNA. Among nine pre-trans-splicing molecules, differing in the targeted sequence in intron 5 and tested in C2C12 myoblasts, three induced trans-splicing events on endogenous Lmna mRNA and confirmed at protein level. Further analyses performed in primary myotubes derived from an LMNA-related congenital muscular dystrophy (L-CMD) mouse model led to a partial rescue of the mutant phenotype. Finally, we tested this approach in vivo using adeno-associated virus (AAV) delivery in newborn mice and showed that trans-splicing events occurred in WT mice 50 days after AAV delivery, although at a low rate. Altogether, while these results provide the first evidence for reprogramming LMNA mRNA in vitro, strategies to improve the rate of trans-splicing events still need to be developed for efficient application of this therapeutic approach in vivo