An appraisal of emerging dystrophin restoration therapies in Duchenne muscular dystrophy

Zurisadai Gonzalez Castillo , Kaitlin Batley , Leslie Nelson , Susan T. Iannaccone

Journal of Translational Genetics and Genomics ›› 2025, Vol. 9 ›› Issue (4) : 338 -51.

PDF
Journal of Translational Genetics and Genomics ›› 2025, Vol. 9 ›› Issue (4) :338 -51. DOI: 10.20517/jtgg.2025.57
review-article

An appraisal of emerging dystrophin restoration therapies in Duchenne muscular dystrophy

Author information +
History +
PDF

Abstract

Duchenne muscular dystrophy (DMD) is an X-linked, progressive muscle disorder caused by pathogenic variants in the DMD gene and resulting in a complete loss of dystrophin protein expression. As of now, there is no cure for DMD, and despite improvements in standard of care, there are significant unmet needs for disease modifying treatments. This article provides an overview of emerging therapies aimed at dystrophin restoration, emphasizing exon skipping and gene therapy, within the rapidly evolving landscape for Duchenne muscular dystrophy.

Keywords

Duchenne muscular dystrophy / dystrophin / gene therapy / exon skipping

Cite this article

Download citation ▾
Zurisadai Gonzalez Castillo, Kaitlin Batley, Leslie Nelson, Susan T. Iannaccone. An appraisal of emerging dystrophin restoration therapies in Duchenne muscular dystrophy. Journal of Translational Genetics and Genomics, 2025, 9(4): 338-51 DOI:10.20517/jtgg.2025.57

登录浏览全文

4963

注册一个新账户 忘记密码

References

[1]

Sun C,Zhang Z.Therapeutic strategies for duchenne muscular dystrophy: an update.Genes2020;11:837 PMCID:PMC7463903

[2]

Crisafulli S,Fontana A,Messina S.Global epidemiology of Duchenne muscular dystrophy: an updated systematic review and meta-analysis.Orphanet J Rare Dis2020;15:141 PMCID:PMC7275323

[3]

Landfeldt E,Sejersen T,Kirschner J.Life expectancy at birth in Duchenne muscular dystrophy: a systematic review and meta-analysis.Eur J Epidemiol2020;35:643-53 PMCID:PMC7387367

[4]

Armstrong N,Berggren KN.The early care (0-3 Years) in duchenne muscular dystrophy meeting report.J Neuromuscul Dis2024;11:525-33

[5]

Sarker S,Soorajkumar A.Mutational spectrum and phenotypic variability of Duchenne muscular dystrophy and related disorders in a Bangladeshi population.Sci Rep2023;13:21547 PMCID:PMC10700514

[6]

Selvatici R,Fortunato F.Ethnicity-related DMD genotype landscapes in European and non-European countries.Neurol Genet2021;7:e536

[7]

Amr K,El-Kamah G.Genomic insights into Duchene muscular dystrophy: analysis of 1250 patients reveals 30% novel genetic patterns and 6 novel variants.J Genet Eng Biotechnol2024;22:100436 PMCID:PMC11585756

[8]

Zinina E,Chukhrova A.Specificities of the DMD gene mutation spectrum in Russian patients.Int J Mol Sci2022;23:12710 PMCID:PMC9658738

[9]

Neri M,Trabanelli C.The genetic landscape of dystrophin mutations in Italy: a nationwide study.Front Genet2020;11:131 PMCID:PMC7063120

[10]

Bladen CL,Monges S.The TREAT-NMD DMD global database: analysis of more than 7,000 Duchenne muscular dystrophy mutations.Hum Mutat2015;36:395-402

[11]

Esposito G,Marsocci E.Precise mapping of 17 deletion breakpoints within the central hotspot deletion region (introns 50 and 51) of the DMD gene.J Hum Genet2017;62:1057-63

[12]

Oshima J,Lee JA.Regional genomic instability predisposes to complex dystrophin gene rearrangements.Hum Genet2009;126:411-23

[13]

Oudet C,Clemens P,Mandel JL.Two hot spots of recombination in the DMD gene correlate with the deletion prone regions.Hum Mol Genet1992;1:599-603

[14]

Bez Batti Angulski A,Cohen H.Duchenne muscular dystrophy: disease mechanism and therapeutic strategies.Front Physiol2023;14:1183101 PMCID:PMC10330733

[15]

Ricci G,Torri F,Pegoraro E.Therapeutic opportunities and clinical outcome measures in Duchenne muscular dystrophy.Neurol Sci2022;43:625-33 PMCID:PMC9126754

[16]

Tyler KL.Origins and early descriptions of "Duchenne muscular dystrophy".Muscle Nerve2003;28:402-22

[17]

Fortunato F,Falzarano MS.Innovative therapeutic approaches for Duchenne muscular dystrophy.J Clin Med2021;10:820 PMCID:PMC7922390

[18]

Szabo SM,Deighton A,Mah J.The clinical course of Duchenne muscular dystrophy in the corticosteroid treatment era: a systematic literature review.Orphanet J Rare Dis2021;16:237 PMCID:PMC8141220

[19]

Ji C,Sampaio H,Jones KJ.Newborn screening for Duchenne muscular dystrophy: the perspectives of stakeholders.Lancet Reg Health West Pac2024;45:101049 PMCID:PMC10965484

[20]

Tavakoli NP,Armstrong N.Newborn screening for Duchenne muscular dystrophy: a two-year pilot study.Ann Clin Transl Neurol2023;10:1383-96 PMCID:PMC10424650

[21]

Park S,Caggana M.Creatine kinase-MM concentration in dried blood spots from newborns and implications for newborn screening for Duchenne muscular dystrophy.Muscle Nerve2022;65:652-8 PMCID:PMC9322420

[22]

Chien YH,Weng WC.Duchenne muscular dystrophy newborn screening: the first 50,000 newborns screened in Taiwan.Neurol Sci2022;43:4563-6 PMCID:PMC9106269

[23]

Jia C,Li Y.Newborn screening and genomic analysis of duchenne muscular dystrophy in Henan, China.Clin Chim Acta2023;539:90-6

[24]

Moat SJ,Salmon R,Hartley L.Newborn bloodspot screening for Duchenne muscular dystrophy: 21 years experience in Wales (UK).Eur J Hum Genet2013;21:1049-53 PMCID:PMC3778339

[25]

Parent Project Muscular Dystrophy. Available from https://www.parentprojectmd.org/advocacy/newborn-screening-action-center/ [Last accessed on 27 Nov 2025]

[26]

Chen L,Wang H,Liu Y.Identifying inversions with breakpoints in the Dystrophin gene through long-read sequencing: report of two cases.BMC Med Genomics2024;17:227 PMCID:PMC11386109

[27]

Olivucci G,Innella G,Pippucci T.Long read sequencing on its way to the routine diagnostics of genetic diseases.Front Genet2024;15:1374860 PMCID:PMC10951082

[28]

Owusu R.Long-read sequencing improves diagnostic rate in neuromuscular disorders.Acta Myol2023;42:123-8 PMCID:PMC10883326

[29]

Ling C,Geng C.Uncovering the true features of dystrophin gene rearrangement and improving the molecular diagnosis of Duchenne and Becker muscular dystrophies.iScience2023;26:108365 PMCID:PMC10690541

[30]

Wells DJ.What is the level of dystrophin expression required for effective therapy of Duchenne muscular dystrophy?.J Muscle Res Cell Motil2019;40:141-50

[31]

Chen G,Yang H,Li H.CRISPR-based therapeutic gene editing for duchenne muscular dystrophy: advances, challenges and perspectives.Cells2022;11:2964 PMCID:PMC9564082

[32]

Eslahi A,Avan A.New advancements in CRISPR based gene therapy of Duchenne muscular dystrophy.Gene2023;867:147358

[33]

Chemello F,Bassel-Duby R.CRISPR-editing therapy for duchenne muscular dystrophy.Hum Gene Ther2023;34:379-87 PMCID:PMC10210224

[34]

Godfrey C,McClorey G.How much dystrophin is enough: the physiological consequences of different levels of dystrophin in the mdx mouse.Hum Mol Genet2015;24:4225-37 PMCID:PMC4492390

[35]

Heslop E,Irvin A,Straub V.workshop participantsGene therapy in Duchenne muscular dystrophy: identifying and preparing for the challenges ahead.Neuromuscul Disord2021;31:69-78 PMCID:PMC7564510

[36]

Roberts TC,Davies KE.Therapeutic approaches for Duchenne muscular dystrophy.Nat Rev Drug Discov2023;22:917-34

[37]

Chen SK,Zavodszky MI.Efficacy and safety of a SOD1-targeting artificial miRNA delivered by AAV9 in mice are impacted by miRNA scaffold selection.Mol Ther Nucleic Acids2023;34:102057 PMCID:PMC10622307

[38]

Xie YL,He Y.The use of melittin to enhance transgene expression mediated by recombinant adeno-associated virus serotype 2 vectors both in vitro and in vivo.J Integr Med2023;21:106-15

[39]

Mendell JR,McDonald CM.AAV gene therapy for Duchenne muscular dystrophy: the EMBARK phase 3 randomized trial.Nat Med2025;31:332-41 PMCID:PMC11750718

[40]

Oskoui M,Parsons JA.Delandistrogene Moxeparvovec gene therapy in individuals with duchenne muscular dystrophy: evidence in focus: report of the AAN guidelines subcommittee.Neurology2025;104:e213604

[41]

Manini A,Nuredini A,Comi GP.Adeno-associated virus (AAV)-mediated gene therapy for duchenne muscular dystrophy: the issue of transgene persistence.Front Neurol2021;12:814174 PMCID:PMC8797140

[42]

Wasala NB,Hu B.Lifelong outcomes of systemic adeno-associated virus micro-dystrophin gene therapy in a murine duchenne muscular dystrophy model.Hum Gene Ther2023;34:449-58 PMCID:PMC10210228

[43]

Shen W,Ou L.rAAV immunogenicity, toxicity, and durability in 255 clinical trials: a meta-analysis.Front Immunol2022;13:1001263

[44]

Mollard A,Forand A.Muscle regeneration affects adeno associated Virus 1 mediated transgene transcription.Sci Rep2022;12:9674 PMCID:PMC9188557

[45]

Duan D.Systemic AAV micro-dystrophin gene therapy for duchenne muscular dystrophy.Mol Ther2018;26:2337-56 PMCID:PMC6171037

[46]

Kumar SRP,Herzog RW.Immune responses to muscle-directed adeno-associated viral gene transfer in clinical studies.Hum Gene Ther2023;34:365-71 PMCID:PMC10210217

[47]

Zaiss AK,White LR.Complement is an essential component of the immune response to adeno-associated virus vectors.J Virol2008;82:2727-40

[48]

Martino AT,Markusic DM.The genome of self-complementary adeno-associated viral vectors increases Toll-like receptor 9-dependent innate immune responses in the liver.Blood2011;117:6459-68 PMCID:PMC3123017

[49]

U.S Food and Drug Administration. FDA investigating deaths due to acute liver failure in non-ambulatory duchenne muscular dystrophy patients following ELEVIDYS. Available from https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/fda-investigating-deaths-due-acute-liver-failure-non-ambulatory-duchenne-muscular-dystrophy-patients [Last accessed on 19 Nov 2025]

[50]

Bengtsson NE,Chamberlain JS.The road toward AAV-mediated gene therapy of Duchenne muscular dystrophy.Mol Ther2025;33:2035-51 PMCID:PMC12126791

[51]

Larrey D,Meunier L,De Martin E.Drug-induced liver injury related to gene therapy: a new challenge to be managed.Liver Int2024;44:3121-37

[52]

Spathis R,Narvesen S.Enhancing AAV-microdystrophin gene therapy after repeat dosing by blocking phagocytosis.Front Immunol2025;16:1527840 PMCID:PMC11911185

[53]

Pinto MS,Fernandez-Alarcon J.Polymer-based coating of adeno-associated viral particles as a new strategy to evade immune response for DMD treatment.J Control Release2025;384:113896

[54]

Bertolini TB,Zolotukhin I.Effect of CpG depletion of vector genome on CD8+ T cell responses in AAV gene therapy.Front Immunol2021;12:672449 PMCID:PMC8200677

[55]

Li C.Engineering adeno-associated virus vectors for gene therapy.Nat Rev Genet2020;21:255-72

[56]

Bönnemann CG,Braun S,Singh T.Dystrophin immunity after gene therapy for duchenne's muscular dystrophy.N Engl J Med2023;388:2294-6

[57]

Potter RA,Khan S.Immunologic investigations into transgene directed immune-mediated myositis following delandistrogene moxeparvovec gene therapy.Sci Rep2025;15:4 PMCID:PMC11696689

[58]

Verma S,Razdan R.Seroprevalence of adeno-associated virus neutralizing antibodies in males with duchenne muscular dystrophy.Hum Gene Ther2023;34:430-8 PMCID:PMC10210220

[59]

Leckie J,Yokota T.An updated analysis of exon-skipping applicability for Duchenne muscular dystrophy using the UMD-DMD database.Genes2024;15:1489 PMCID:PMC11593839

[60]

Iff J,Tuttle E.Survival among patients receiving eteplirsen for up to 8 years for the treatment of Duchenne muscular dystrophy and contextualization with natural history controls.Muscle Nerve2024;70:60-70

[61]

Patterson G,Groneman M,Parmar MS.Duchenne muscular dystrophy: current treatment and emerging exon skipping and gene therapy approach.Eur J Pharmacol2023;947:175675

[62]

Aartsma-Rus A.The future of exon skipping for Duchenne muscular dystrophy.Hum Gene Ther2023;34:372-8

[63]

Matsuo M.30 years since the proposal of exon skipping therapy for Duchenne muscular dystrophy and the future of pseudoexon skipping.Int J Mol Sci2025;26:1303 PMCID:PMC11818380

[64]

Chwalenia K,Roberts TC.Progress and prospects in antisense oligonucleotide-mediated exon skipping therapies for Duchenne muscular dystrophy.J Muscle Res Cell Motil2025; PMCID:PMC7617802

[65]

Politano L.Read-through approach for stop mutations in Duchenne muscular dystrophy. An update.Acta Myol2021;40:43-50 PMCID:PMC8033424

[66]

Ng MY,Ghelfi MD,Cooperman BS.Ataluren and aminoglycosides stimulate read-through of nonsense codons by orthogonal mechanisms.Proc Natl Acad Sci USA2021;118:e2020599118 PMCID:PMC7812769

[67]

Mercuri E,Muntoni F.Safety and effectiveness of ataluren in patients with nonsense mutation DMD in the STRIDE Registry compared with the CINRG Duchenne Natural History Study (2015-2022): 2022 interim analysis.J Neurol2023;270:3896-913 PMCID:PMC10141820

[68]

Péladeau C.Identifying FDA-approved drugs that upregulate utrophin a as a therapeutic strategy for duchenne muscular dystrophy. In: Maruyama R, Yokota T, editors. Muscular dystrophy therapeutics. New York: Springer; 2023. pp. 495-510.

[69]

Soblechero-Martín P,de la Puente-Ovejero L,Arechavala-Gomeza V.Utrophin modulator drugs as potential therapies for Duchenne and Becker muscular dystrophies.Neuropathol Appl Neurobiol2021;47:711-23 PMCID:PMC8518368

[70]

Kashoki M,Yordanova S.A comparison of EMA and FDA decisions for new drug marketing applications 2014-2016: concordance, discordance, and why.Clin Pharmacol Ther2020;107:195-202 PMCID:PMC6977394

[71]

Vokinger KN,Glaus CEG.Therapeutic value assessments of novel medicines in the US and Europe, 2018-2019.JAMA Netw Open2022;5:e226479 PMCID:PMC8987900

[72]

Mazzone E,Berardinelli A.North Star Ambulatory assessment, 6-minute walk test and timed items in ambulant boys with Duchenne muscular dystrophy.Neuromuscul Disord2010;20:712-6

[73]

Mayhew AG,Scott E.Detecting meaningful change using the North Star Ambulatory assessment in Duchenne muscular dystrophy.Dev Med Child Neurol2013;55:1046-52

[74]

McDonald CM,Abresch RT.The 6-minute walk test and other clinical endpoints in duchenne muscular dystrophy: reliability, concurrent validity, and minimal clinically important differences from a multicenter study.Muscle Nerve2013;48:357-68 PMCID:PMC3826053

[75]

Henricson E,Han JJ.The 6-minute walk test and person-reported outcomes in boys with Duchenne muscular dystrophy and typically developing controls: longitudinal comparisons and clinically-meaningful changes over one year.PLoS Curr2013;5:ecurrents PMCID:PMC3712467

[76]

Ayyar Gupta V,Domingos J.Determining minimal clinically important differences in the North Star Ambulatory Assessment (NSAA) for patients with Duchenne muscular dystrophy.PLoS One2023;18:e0283669 PMCID:PMC10132589

[77]

Muntoni F,Sajeev G.Meaningful changes in motor function in Duchenne muscular dystrophy (DMD): a multi-center study.PLoS One2024;19:e0304984 PMCID:PMC11236155

[78]

Henricson E,Han JJ.Percent-predicted 6-minute walk distance in duchenne muscular dystrophy to account for maturational influences.PLoS Curr2012;4:RRN1297

[79]

Mayhew A,Eagle M.Development of the performance of the upper limb module for duchenne muscular dystrophy.Dev Med Child Neurol2013;55:1038-45

[80]

Mayhew AG,Mazzone ES.Performance of upper limb module for duchenne muscular dystrophy.Dev Med Child Neurol2020;62:633-9

[81]

Bushby K,Wong B.Safety and effectiveness of ataluren in patients with nonsense mutation Duchenne muscular dystrophy: 2022 interim analysis from the STRIDE Registry compared with the CINRG Duchenne Natural History Study.J Neurol2023;270:2885-95

[82]

Henricson EK,Cnaan A.The cooperative international neuromuscular research group Duchenne natural history study: Glucocorticoid treatment preserves clinically meaningful functional milestones and reduces rate of disease progression as measured by manual muscle testing and other commonly used clinical trial outcome measures.Muscle Nerve2013;48:55-67

[83]

Horrow C.Confronting high costs and clinical uncertainty: innovative payment models for gene therapies.Health Aff2023;42:1532-40

AI Summary AI Mindmap
PDF

155

Accesses

0

Citation

Detail

Sections
Recommended

AI思维导图

/