Ultrasonography validation for early alteration of diaphragm echodensity and function in the mdx mouse model of Duchenne muscular dystrophy

PLoS One. 2021 Jan 12;16(1):e0245397. doi: 10.1371/journal.pone.0245397. eCollection 2021.

Abstract

The mdx mouse model of Duchenne muscular dystrophy is characterized by functional and structural alterations of the diaphragm since early stages of pathology, closely resembling patients' condition. In recent years, ultrasonography has been proposed as a useful longitudinal non-invasive technique to assess mdx diaphragm dysfunction and evaluate drug efficacy over time. To date, only a few preclinical studies have been conducted. Therefore, an independent validation of this method by different laboratories is needed to increase results reliability and reduce biases. Here, we performed diaphragm ultrasonography in 3- and 6-month-old mdx mice, the preferred age-window for pharmacology studies. The alteration of diaphragm function over time was measured as diaphragm ultrasound movement amplitude. At the same time points, a first-time assessment of diaphragm echodensity was performed, as an experimental index of progressive loss of contractile tissue. A parallel evaluation of other in vivo and ex vivo dystrophy-relevant readouts was carried out. Both 3- and 6-month-old mdx mice showed a significant decrease in diaphragm amplitude compared to wild type (wt) mice. This index was well-correlated either with in vivo running performance or ex vivo isometric tetanic force of isolated diaphragm. In addition, diaphragms from 6-month-old dystrophic mice were also highly susceptible to eccentric contraction ex vivo. Importantly, we disclosed an age-dependent increase in echodensity in mdx mice not observed in wt animals, which was independent from abdominal wall thickness. This was accompanied by a notable increase of pro-fibrotic TGF-β1 levels in the mdx diaphragm and of non-muscle tissue amount in diaphragm sections stained by hematoxylin & eosin. Our findings corroborate the usefulness of diaphragm ultrasonography in preclinical drug studies as a powerful tool to monitor mdx pathology progression since early stages.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Diaphragm / diagnostic imaging*
  • Diaphragm / pathology
  • Disease Models, Animal
  • Male
  • Mice
  • Mice, Inbred C57BL
  • Mice, Inbred mdx
  • Muscular Dystrophy, Duchenne / diagnostic imaging*
  • Muscular Dystrophy, Duchenne / pathology
  • Transforming Growth Factor beta1 / analysis
  • Ultrasonography

Substances

  • Transforming Growth Factor beta1

Grants and funding

This work was supported by PRIN-MIUR (Research Projects of National Interest – Ministry of Education, University and Research; grant n.2015MJBEM2_005 and grant n.2017FJSM9S_005) and by The Dutch Duchenne Parent Project (DPP NL; grant 2015) to Annamaria De Luca. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. In quality of expert in the field, author J.F.R. has been involved in reviewing and editing of our manuscript, as articulated in the ‘author contributions’ section. For this role, no salary was provided to the author by his affiliation Axxam S.p.A.