New study suggests gout drug, colchcine, may help treat Myotonic Dystrophy DM1 in future

A new study by several major researchers in the myotonic dystrophy field had a very interesting study that identified a FDA approved drug that may help with myotonic dystrophy.  However, as usual, more research is needed to validate the approach. The study identified and validated a cell based assay screening tool that enabled the researchers to look at a number of drugs. The most promising drugs were colchicine, thiocolchcine,suprafenacine, amsacrine, azathioprine, The researchers decided to concentrate on was Colchicine an already approved FDA drug for gout and familial Mediterranean fever (FMF), 

We primarily focused on colchicine because it is an inexpensive, FDA-approved, natural therapeutic that is generally well tolerated and is currently used in the clinic to treat gout and familial mediterranean fever (FMF)“‘

The next step the researchers took was to use colchicine in mice that had been altered to have myotonic dystrophy. The drug was injected into these mice. The researchers found that the amount of mutant RNA was decreased in  the muscle cells.

“Collectively, these data demonstrate that microtuble inhibition in vivo leads to a selective reduction in expanded CUG RNA levels without broadly affecting the transcriptome”

Next the researchers tested colchicine in patient cells with myotonic dystrophy. They selected patients cells with a repeat count of 1900-3000 repeats. The results were positive

“we observed significant rescue of missplicing”

OVERALL DISCUSSION

The researchers established a cell line that enabled them to screen a large number of compounds that might help to reduce DM1 in theory. They found a list of candidates and then selected colchicine as a drug to model

“We then validated the use of a microtubule inhibitor in the HSA DM1 mouse model and in DM1 patient cells with colchicine an FDA approve natural microtubule inhibitor currently used in the clinic. Our results provide proof of principle for the identification of compounds and cellular targets selectively modulater r(CUG)exp levels in DM1 using cell-based screening.

Our Observation of a partial rescue in DM1 relevant missplicing in multiple models warrants further evaluation of colchicine. The study is NOT sufficient to address the therapeutic efficacy of colchicine or of general microtuble inhibition in the treatment of DM1, It is important to determine if there is a positive trade off between the therapeutic efficacy in reducing DM1 symptoms in  relation to known toxicity from microtuble inhibition. As an example, and although very rare, myopathy has been reported in some individuals with compromised renal function who had been treated chronically with colchicine for gout. Future Long term treatment in DM1 animal models such as HSA at clinical doses to evaluate the reversal of DM1 phenotypes are a [prerequisite to determine if any clinical studies are warranted”

Overall this is a promising approach that needs more study. However, for those in the end stages of Myotonic dytrophy disease this may be something to discuss with your medical staff.

 

 

 

NOTE:  Transcriptome definition – Wikipedia

The transcriptome can be seen as a subset of the proteome, that is, the entire set of proteins expressed by a genome.. However, the analysis of relative mRNA expression levels can be complicated by the fact that relatively small changes in mRNA expression can produce large changes in the total amount of the corresponding protein present in the cell.

 

 

colchicine-Study

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French Myotonic Dystrophy Registry

A new article gives good information on the breakdown of DM1 in the French population. 

Fig. 3 Cartography of place of residence of enrolled DM participants. a The individual representation (N = 2875). Each dot refers to one patient
place of residence and dots position is allocated to a random position in the corresponding department (top left). b The regional distribution
according to the density of population (N = 2875). Darker the green is, more the DM is prevalent in the department (top right). c Distribution of
DM-Scope Registry enrolled patients among paediatric French neuromuscular expert centres (26 centres, N = 255). The number of enrolled
patients is spot-size dependent (bottom left). d Distribution of DM-Scope Registry enrolled patients among adult French neuromuscular expert
centres (29 centres, N = 2620). The number of enrolled patients is spot-size dependent (bottom right)
French-Registry-article-dm1-myotonic-dystrophy

FastDM1 Test has High Accuracy

A New test has been available in recent time to detect myotonic dystrophy. From Websites it looks as though this is labeled “For Research Only” A study attached shows that the test seems very accurate. And a figure on one of the web sites seems to indicate that it may be used for in vitro fertilization. there seems to be two type of kits one that gives an exact sizing when the repeats are less than 180 and another that detects over 180 repeats. When you click on the pictures of the test below it takes you to a related test which can give you an idea of what 

 
 

Myotonic Dystrophy 1 FASTDM1

Sales start during ESHG-Barcelona 2016!

Myotone Dystrophy Type 1 (DM1, Steinert Disease) is the most common form of muscular dystrophies by adults. In non-molecular testing methods for DM1, there is a risk of confusion due to overlapping symptoms with other neuromuscular diseases. A clear diagnosis is only possible molecular-genetic. TNR Diagnostics develops assays to detect the size of CTG Repeat expansions on the DMPK gene. Early diagnoses and associated symptom management can bring significant relief to affected patients.

Molecular genetic testing of the DMPK gene is necessary in individuals with suspected muscle weakness. Early diagnosis of DM1 patients would allow early intervention with medications for symptoms such as heart problems, diabetes mellitus and cataract.

Brochure to download here.

 

Change of landscape for muscular dystrophy testing

The FastDM1™ are a complete series of robust molecular diagnostic kits that meet the comprehensive testing requirements. Please click on the product image for more information about the various test kits .

 

DMPK Identification Kit DMPK Sizing Kit

Possible use for FastDM1™

The CTG repeat rate in the DMPK gene is responsible for muscle weakness in the affected individuals and causes a number of symptoms, such as cardiological problems, cataracts and diabetes mellitus. FastDM1™ DMPK analysis kits enable high-throughput sample processing without compromising sensitivity.

 

FastDM1-Diagnostic-Test-article

Why do Myotonic Dystrophy Patients Die?

Myotonic Dystrophy patients have a shorter lifespan according to this study from 2016. A comprehensive review shows an average age of death at about 60 years. Lung issues and Heart Issues are the major casues of death. Sudden cardiac failure occurs in 27% of patients.

 

Causes and Predictors of Mortality in a Large U.S. Myotonic Dystrophy Type 1 Adult Cohort (P5.077)

Julian DudaYedatore VenkateshWilliam Groh
 
 

Abstract

Background: There is limited data on the causes and predictors of mortality in patients (pts) with myotonic dystrophy type 1 (DM1) evaluated and treated with modern medical therapy in the U.S. Objective: To determine the epidemiology of mortality in U.S. patients with DM1. Methods: Analysis from a U.S. registry with clinically- and genetically-verified adult DM1 pts (age at entry≥18 yrs) enrolled at MDA clinics (1997-2005) and prospectively followed (study entry-N=406; age: 42±12 yrs; male: 205 (50.5[percnt]); CTG repeats: 629±386; muscular impairment rating score (MIRS): 3.2±1.0). Causes of death were adjudicated by death certificate and medical records review. Results: By last follow-up (11.2±4.2 yrs), 170 (41.9[percnt]) of pts had died with a median age at death of 55.4 yrs. Causes of death in the 170 pts were respiratory failure (90, 52.9[percnt]), sudden unexpected possibly cardiac (47, 27.6[percnt]), non-sudden cardiac (8, 4.7[percnt]), non-sudden other (21, 12.4[percnt]), and uncertain cause (4, 2.4[percnt]). The median survival age was 60.5 yrs. Study entry characteristics predicting all-cause mortality using survival analysis included age (per decile, RR 1.5; 95[percnt] CI 1.3-1.7, p<0.001), MIRS (per 1-level increase, RR 1.7; 95[percnt] CI 1.5-2.1, p<0.001), CTG repeat length (per1-log increase, RR 1.9; 95[percnt] CI 1.2-3.0, p=0.006), cardiac diagnoses (if present, RR 2.7; 95[percnt] CI 2.0-3.7, p<0.001), and an abnormal EKG (if present, RR 2.4; 95[percnt] CI 1.7-3.3, p<0.001). Conclusions: Despite modern therapy, adult DM1 pts in the U.S. have a shortened lifespan. The most common causes of death are respiratory failure followed by cardiac causes. Predictors of death include older age, worsened muscular disability, greater CTG repeat length, and presence of cardiac issues either a diagnoses or abnormal EKG. Study Supported by: Research grant with Biogen, Inc. and Isis pharmaceuticals

Disclosure: Dr. Duda has nothing to disclose. Dr. Venkatesh has nothing to disclose. Dr. Groh has received personal compensation for activities with Isis Pharmaceuticals.

Cancer and Myotonic Dystrophy

There have been reports of increased cancer risk in patients with Myotonic Dystrophy. another study was just published highlighting the risk of cancer in this disease. The conclusion of the study was 

 

Conclusion: There is an increased risk of death, and probably cancer, in relatives with DM1 and in those whose DM1 status is unknown. This suggests a
need to perform a careful history and physical examination, supplemented by
genetic testing, to identify family members at risk for DM1 and who might
benefit from disease-specific clinical care and surveillance.

Cancer-and-Myotonic-Dystrophy-Feb-2019