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PDE5 inhibition alleviates functional muscle ischemia in boys with Duchenne muscular dystrophy.


ABSTRACT: To determine whether phosphodiesterase type 5 (PDE5) inhibition can alleviate exercise-induced skeletal muscle ischemia in boys with Duchenne muscular dystrophy (DMD).In 10 boys with DMD and 10 healthy age-matched male controls, we assessed exercise-induced attenuation of reflex sympathetic vasoconstriction, i.e., functional sympatholysis, a protective mechanism that matches oxygen delivery to metabolic demand. Reflex vasoconstriction was induced by simulated orthostatic stress, measured as the decrease in forearm muscle oxygenation with near-infrared spectroscopy, and performed when the forearm muscles were rested or lightly exercised with rhythmic handgrip exercise. Then, the patients underwent an open-label, dose-escalation, crossover trial with single oral doses of tadalafil or sildenafil.The major new findings are 2-fold: first, sympatholysis is impaired in boys with DMD-producing functional muscle ischemia-despite contemporary background therapy with corticosteroids alone or in combination with cardioprotective medication. Second, PDE5 inhibition with standard clinical doses of either tadalafil or sildenafil alleviates this ischemia in a dose-dependent manner. Furthermore, PDE5 inhibition also normalizes the exercise-induced increase in skeletal muscle blood flow (measured by Doppler ultrasound), which is markedly blunted in boys with DMD.These data provide in-human proof of concept for PDE5 inhibition as a putative new therapeutic strategy for DMD.This study provides Class IV evidence that in patients with DMD, PDE5 inhibition restores functional sympatholysis.

SUBMITTER: Nelson MD 

PROVIDER: S-EPMC4118495 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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PDE5 inhibition alleviates functional muscle ischemia in boys with Duchenne muscular dystrophy.

Nelson Michael D MD   Rader Florian F   Tang Xiu X   Tavyev Jane J   Nelson Stanley F SF   Miceli M Carrie MC   Elashoff Robert M RM   Sweeney H Lee HL   Victor Ronald G RG  

Neurology 20140507 23


<h4>Objective</h4>To determine whether phosphodiesterase type 5 (PDE5) inhibition can alleviate exercise-induced skeletal muscle ischemia in boys with Duchenne muscular dystrophy (DMD).<h4>Methods</h4>In 10 boys with DMD and 10 healthy age-matched male controls, we assessed exercise-induced attenuation of reflex sympathetic vasoconstriction, i.e., functional sympatholysis, a protective mechanism that matches oxygen delivery to metabolic demand. Reflex vasoconstriction was induced by simulated or  ...[more]

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