Drăgoi Andrei-Lucian, Nemeș Roxana-Maria
Medical Doctoral School, University of "Titu Maiorescu", Targoviste 130056, Romania.
World J Methodol. 2025 Sep 20;15(3):100840. doi: 10.5662/wjm.v15.i3.100840.
Duchenne muscular dystrophy (DMD) is a severe lethal X-linked monogenic recessive congenital muscular dystrophy caused by various types of mutations in the dystrophin gene (DG). It is one of the most common human genetic diseases and the most common type of muscular dystrophy, in part because DG is one of the largest protein-coding genes in the human genome with a relatively high risk of being affected by a large palette of mutations. Long-term corticosteroid therapy (LTCT) with started at age 4 is the most accessible and used pharmacological therapy for DMD in Romania. "" (ARS) is an approved dietary supplement in the European Union. Several studies have shown that it is a very potent selective NRF2 activator, and thus a very potent, albeit indirect, antioxidant, with no toxicity up to high doses, in contrast to LTCT.
This paper presents a 3-case series on the effects of ARS in a 4-year-old, 5-year-old and 3-year-old boy all with DMD from Bucharest or Slobozia (Romania). This is the first report of this type worldwide. The parents of these boys had refused LTCT. They were treated with relatively high doses of ARS (3-7 mL/kg/day). For two patients, ARS was administered in combination with medium doses of L-carnitine and omega-3 fatty acids for various intellectual disabilities. Periodic consults and assessments for rhabdomyolysis, medullar and liver toxicity markers (blood count, gamma-glutamyl transferase, aspartate aminotransferase, alanine transaminase, lactate dehydrogenase, creatine kinase, creatine kinase-MB and serum myoglobin) were performed. studies showed that ARS is a very potent and selective NRF2 activator, and thus a very potent indirect antioxidant. The studies also support this main pharmacological mechanism of ARS, with no toxicity at high doses, in contrast with much more toxic corticosteroids which are often refused by parents for their children with DMD. Although they were three distinct ages and carried three distinct DG mutations, from the first months of ARS-based treatment, the children responded similarly to ARS. The rhabdomyolysis markers, which were initially very high, significantly dropped, and there was no evidence for medullar and/or hepatic toxicity in any of the 3 patients.
ARS has significant indirect antioxidant effects NRF2 and deserves extensive trials in children with DMD, as an adjuvant to corticoids or as a substitute in DMD patients who refuse corticoids. Future trials should also focus on ARS as an adjuvant in many types of acute/chronic infectious/non-infectious diseases where cellular oxidative stress is involved.
杜氏肌营养不良症(DMD)是一种严重的致死性X连锁单基因隐性先天性肌营养不良症,由肌营养不良蛋白基因(DG)的各种类型突变引起。它是最常见的人类遗传疾病之一,也是最常见的肌营养不良症类型,部分原因是DG是人类基因组中最大的蛋白质编码基因之一,受大量突变影响的风险相对较高。在罗马尼亚,4岁开始的长期皮质类固醇疗法(LTCT)是DMD最容易获得且使用的药物疗法。“”(ARS)是欧盟批准的膳食补充剂。多项研究表明,它是一种非常有效的选择性NRF2激活剂,因此是一种非常有效的间接抗氧化剂,与LTCT相比,高剂量时也无毒性。
本文介绍了3例来自布加勒斯特或斯洛博齐亚(罗马尼亚)的患有DMD的4岁、5岁和3岁男孩使用ARS的效果。这是全球首例此类报告。这些男孩的父母拒绝了LTCT。他们接受了相对高剂量的ARS治疗(3 - 7 mL/kg/天)。对于两名患者,ARS与中等剂量的左旋肉碱和ω-3脂肪酸联合使用,用于治疗各种智力障碍。定期进行横纹肌溶解、骨髓和肝脏毒性标志物(血细胞计数、γ-谷氨酰转移酶、天冬氨酸转氨酶、丙氨酸转氨酶、乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶MB和血清肌红蛋白)的咨询和评估。研究表明,ARS是一种非常有效且选择性的NRF2激活剂,因此是一种非常有效的间接抗氧化剂。这些研究还支持ARS的这一主要药理机制,与毒性大得多的皮质类固醇不同,高剂量时ARS无毒性,而皮质类固醇常被DMD患儿的父母拒绝。尽管这三个孩子年龄不同,携带的DG突变也不同,但从基于ARS治疗的最初几个月起,他们对ARS的反应相似。最初非常高的横纹肌溶解标志物显著下降,且3例患者中均无骨髓和/或肝脏毒性的证据。
ARS通过NRF2具有显著的间接抗氧化作用,值得在DMD患儿中进行广泛试验,作为皮质类固醇的辅助药物或作为拒绝皮质类固醇的DMD患者的替代药物。未来的试验还应关注ARS作为许多涉及细胞氧化应激的急性/慢性感染性/非感染性疾病的辅助药物。