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Pulsed glucocorticoids enhance dystrophic muscle performance through epigenetic-metabolic reprogramming
Mattia Quattrocelli, … , Joseph Bass, Elizabeth M. McNally
Mattia Quattrocelli, … , Joseph Bass, Elizabeth M. McNally
Published December 19, 2019
Citation Information: JCI Insight. 2019;4(24):e132402. https://doi.org/10.1172/jci.insight.132402.
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Research Article Metabolism Muscle biology

Pulsed glucocorticoids enhance dystrophic muscle performance through epigenetic-metabolic reprogramming

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Abstract

In humans, chronic glucocorticoid use is associated with side effects like muscle wasting, obesity, and metabolic syndrome. Intermittent steroid dosing has been proposed in Duchenne Muscular Dystrophy patients to mitigate the side effects seen with daily steroid intake. We evaluated biomarkers from Duchenne Muscular Dystrophy patients, finding that, compared with chronic daily steroid use, weekend steroid use was associated with reduced serum insulin, free fatty acids, and branched chain amino acids, as well as reduction in fat mass despite having similar BMIs. We reasoned that intermittent prednisone administration in dystrophic mice would alter muscle epigenomic signatures, and we identified the coordinated action of the glucocorticoid receptor, KLF15 and MEF2C as mediators of a gene expression program driving metabolic reprogramming and enhanced nutrient utilization. Muscle lacking Klf15 failed to respond to intermittent steroids. Furthermore, coadministration of the histone acetyltransferase inhibitor anacardic acid with steroids in mdx mice eliminated steroid-specific epigenetic marks and abrogated the steroid response. Together, these findings indicate that intermittent, repeated exposure to glucocorticoids promotes performance in dystrophic muscle through an epigenetic program that enhances nutrient utilization.

Authors

Mattia Quattrocelli, Aaron S. Zelikovich, Zhen Jiang, Clara Bien Peek, Alexis R. Demonbreun, Nancy L. Kuntz, Grant D. Barish, Saptarsi M. Haldar, Joseph Bass, Elizabeth M. McNally

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Figure 1

Duchenne Muscular Dystrophy (DMD) patients treated with weekend glucocorticoid steroids have reduced markers of obesity and insulin resistance compared with those receiving daily glucocorticoids.

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Duchenne Muscular Dystrophy (DMD) patients treated with weekend glucocor...
(A) Age, treatment duration, and BMI did not differ between daily (1–2.5 mg/kg/dose × 7 days/week) and high-dose weekend (1–4 mg/kg/dose × 2 consecutive days/week) cohorts. (B) Weekend dosing correlated with normalization of bone density score (DEXA scans at L1–L4 vertebrae) and less suppression of endogenous cortisol levels. (C) Compared with daily steroid treated patients, weekend steroid dosing correlated with decreased fat mass gain and increased lean mass preservation (TBLH, total body less head; DEXA scans). (D) Weekend steroid dosing, as compared with daily steroid dosing, associated with reduced serum insulin, glucose, branched chain amino acids (BCAA), and free fatty acids, consistent with reduced metabolic stress. Histograms depict single values and mean ± SEM; n = 12 patients/cohort; *P < 0.05 vs daily; Welch’s unpaired t test (2-tailed).

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