Genetic modifiers of upper limb function in Duchenne muscular dystrophy.

Genetic modifiers of upper limb function in Duchenne muscular dystrophy.
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DOI:
10.1007/s00415-022-11133-8
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发表时间:
2022-09
影响因子:
6
通讯作者:
--
中科院分区:
医学2区
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杜氏肌营养不良症(DMD)的遗传修饰因子是位于与致病基因DMD不同的基因中的变体,但与疾病发作、进展或对治疗的反应的差异相关。到目前为止,所描述的修饰剂主要用于测试与行走功能的关联,而它们对上肢功能的影响,尤其是与非行走患者的生活质量和独立性相关的影响,尚不清楚。我们在几个已知的修饰基因座上检测了基因型(SPP 1、LTBP 4、CD 40、ACTN 3)与意大利多中心队列中上肢功能版本1.2评分的相关性,以及与合作国际神经肌肉组Duchenne自然史研究中的布鲁克量表评分的相关性(CINRG-DNHS),使用纵向收集数据的广义估计方程(GEE)模型,以年龄和糖皮质激素治疗为协变量。CD 40 rs 1883832,以前与早期的Ambal丧失相关,作为上肢功能的修饰剂出现,对意大利队列中PUL的肩部和远端区域(分别为p = 0.023和0.018)以及CINRG-DNHS中的布鲁克评分(p = 0.018)产生负面影响。这些发现将有助于DMD临床试验的设计和解释,特别是对非卧床人群。在线版本包含补充材料,可通过10.1007/s 00415 -022-11133-8获得。
Genetic modifiers of Duchenne muscular dystrophy (DMD) are variants located in genes different from the disease-causing gene DMD, but associated with differences in disease onset, progression, or response to treatment. Modifiers described so far have been tested mainly for associations with ambulatory function, while their effect on upper limb function, which is especially relevant for quality of life and independence in non-ambulatory patients, is unknown. We tested genotypes at several known modifier loci (SPP1, LTBP4, CD40, ACTN3) for association with Performance Upper Limb version 1.2 score in an Italian multicenter cohort, and with Brooke scale score in the Cooperative International Neuromuscular Group Duchenne Natural History Study (CINRG-DNHS), using generalized estimating equation (GEE) models of longitudinally collected data, with age and glucocorticoid treatment as covariates. CD40 rs1883832, previously linked to earlier loss of ambulation, emerged as a modifier of upper limb function, negatively affecting shoulder and distal domains of PUL (p = 0.023 and 0.018, respectively) in the Italian cohort, as well as of Brooke score (p = 0.018) in the CINRG-DNHS. These findings will be useful for the design and interpretation of clinical trials in DMD, especially for non-ambulatory populations. The online version contains supplementary material available at 10.1007/s00415-022-11133-8.
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