C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Biostatistics, Leiden University Medical Center, Leiden, The Netherlands.
Muscle Nerve. 2021 Nov;64(5):576-584. doi: 10.1002/mus.27399. Epub 2021 Aug 25.
INTRODUCTION/AIMS: Duchenne and Becker muscular dystrophies (DMD and BMD, respectively) are characterized by fat replacement of different skeletal muscles in a specific temporal order. Given the structural role of dystrophin in skeletal muscle mechanics, muscle architecture could be important in the progressive pathophysiology of muscle degeneration. Therefore, the aim of this study was to assess the role of muscle architecture in the progression of fat replacement in DMD and BMD. METHODS: We assessed the association between literature-based leg muscle architectural characteristics and muscle fat fraction from 22 DMD and 24 BMD patients. Dixon-based magnetic resonance imaging estimates of fat fractions at baseline and 12 (only DMD) and 24 months were related to fiber length and physiological cross-sectional area (PCSA) using age-controlled linear mixed modeling. RESULTS: DMD and BMD muscles with long fibers and BMD muscles with large PCSAs were associated with increased fat fraction. The effect of fiber length was stronger in muscles with larger PCSA. DISCUSSION: Muscle architecture may explain the pathophysiology of muscle degeneration in dystrophinopathies, in which proximal muscles with a larger mass (fiber length × PCSA) are more susceptible, confirming the clinical observation of a temporal proximal-to-distal progression. These results give more insight into the mechanical role in the pathophysiology of muscular dystrophies. Ultimately, this new information can be used to help support the selection of current and the development of future therapies.
简介/目的:杜氏肌营养不良症(DMD)和贝克肌营养不良症(BMD)的特征分别是不同骨骼肌以特定的时间顺序发生脂肪替代。鉴于肌营养不良蛋白在骨骼肌力学中的结构作用,肌肉结构可能在肌肉退化的进行性病理生理学中很重要。因此,本研究旨在评估肌肉结构在 DMD 和 BMD 中脂肪替代进展中的作用。
方法:我们评估了 22 名 DMD 和 24 名 BMD 患者的文献中基于腿肌结构特征和肌肉脂肪分数之间的关联。使用年龄对照线性混合建模,将基于 Dixon 的磁共振成像在基线和 12 个月(仅 DMD)和 24 个月时的脂肪分数估计值与纤维长度和生理横截面积(PCSA)相关联。
结果:长纤维的 DMD 和 BMD 肌肉和大 PCSA 的 BMD 肌肉与脂肪分数增加有关。纤维长度的影响在 PCSA 较大的肌肉中更强。
讨论:肌肉结构可以解释肌营养不良症中肌肉退化的病理生理学,其中较大质量(纤维长度×PCSA)的近端肌肉更易受影响,这证实了临床观察到的从近端到远端的时间进展。这些结果更深入地了解了肌肉病理学中的机械作用。最终,这些新信息可用于帮助支持当前治疗方法的选择和未来治疗方法的开发。
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