TY  - JOUR
A1  - Walter, Maggie C.
A1  - Reilich, Peter
A1  - Thiele, Simone
A1  - Schessl, Joachim
A1  - Schreiber, Herbert
A1  - Reiners, Karlheinz
A1  - Kress, Wolfram
A1  - Müller-Reible, Clemens
A1  - Vorgerd, Matthias
A1  - Urban, Peter
A1  - Schrank, Bertold
A1  - Deschauer, Marcus
A1  - Schlotter-Weigel, Beate
A1  - Kohnen, Ralf
A1  - Lochmüller, Hans
T1  - Treatment of dysferlinopathy with deflazacort: a double-blind, placebo-controlled clinical trial
JF  - Orphanet Journal of Rare Diseases
N2  - Background: Dysferlinopathies are autosomal recessive disorders caused by mutations in the dysferlin (DYSF) gene encoding the dysferlin protein. DYSF mutations lead to a wide range of muscular phenotypes, with the most prominent being Miyoshi myopathy (MM) and limb girdle muscular dystrophy type 2B (LGMD2B). 
Methods: We assessed the one-year-natural course of dysferlinopathy, and the safety and efficacy of deflazacort treatment in a double-blind, placebo-controlled cross-over trial. After one year of natural course without intervention, 25 patients with genetically defined dysferlinopathy were randomized to receive deflazacort and placebo for six months each (1 mg/kg/day in month one, 1 mg/kg every 2nd day during months two to six) in one of two treatment sequences. Results: During one year of natural course, muscle strength declined about 2% as measured by CIDD (Clinical Investigation of Duchenne Dystrophy) score, and 76 Newton as measured by hand-held dynamometry. Deflazacort did not improve muscle strength. In contrast, there is a trend of worsening muscle strength under deflazacort treatment, which recovers after discontinuation of the study drug. During deflazacort treatment, patients showed a broad spectrum of steroid side effects. 
Conclusion: Deflazacort is not an effective therapy for dysferlinopathies, and off-label use is not warranted. This is an important finding, since steroid treatment should not be administered in patients with dysferlinopathy, who may be often misdiagnosed as polymyositis.
KW  - Deflazacort
KW  - muscle strength
KW  - gridle muscular-dystrophy
KW  - Duchenne dystrphy
KW  - Miyoshi myopathy
KW  - mutation
KW  - prednisone
KW  - gene
KW  - 2B
KW  - children
KW  - design
KW  - steroids
KW  - therapy
KW  - dysferlinopathy
KW  - Limb girdle muscular dystrophy (LGMD)
Y1  - 2013
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125663
SN  - 1750-1172
VL  - 8
IS  - 26
ER  - 
TY  - JOUR
A1  - Haarmann, Axel
A1  - Nehen, Mathias
A1  - Deiß, Annika
A1  - Buttmann, Mathias
T1  - Fumaric acid esters do not reduce inflammatory NF-\(\kappa\)B/p65 nuclear translocation, ICAM-1 expression and T-cell adhesiveness of human brain microvascular endothelial cells
JF  - International Journal of Molecular Sciences
N2  - Dimethyl fumarate (DMF) is approved for disease-modifying treatment of patients with relapsing-remitting multiple sclerosis. Animal experiments suggested that part of its therapeutic effect is due to a reduction of T-cell infiltration of the central nervous system (CNS) by uncertain mechanisms. Here we evaluated whether DMF and its primary metabolite monomethyl fumarate (MMF) modulate pro-inflammatory intracellular signaling and T-cell adhesiveness of nonimmortalized single donor human brain microvascular endothelial cells at low passages. Neither DMF nor MMF at concentrations of 10 or 50 \(\mu\)M blocked the IL-1\(\beta\)-induced nuclear translocation of NF-\(\kappa\)B/p65, whereas the higher concentration of DMF inhibited the nuclear entry of p65 in human umbilical vein endothelium cultured in parallel. DMF and MMF also did not alter the IL-1\(\beta\)-stimulated activation of p38 MAPK in brain endothelium. Furthermore, neither DMF nor MMF reduced the basal or IL-1\(\beta\)-inducible expression of ICAM-1. In accordance, both fumaric acid esters did not reduce the adhesion of activated Jurkat T cells to brain endothelium under basal or inflammatory conditions. Therefore, brain endothelial cells probably do not directly mediate a potential blocking effect of fumaric acid esters on the inflammatory infiltration of the CNS by T cells.
KW  - barrier integrity
KW  - proteins
KW  - multiple sclerosis
KW  - monomethyl fumarate
KW  - p38 mitogen-activated protein kinase
KW  - cell adhesion
KW  - NF-\(\kappa\)B
KW  - dimethyl fumarate
KW  - blood-brain barrier
KW  - endothelial cells
KW  - potent inducer
KW  - gene
KW  - drug
KW  - VCAM-1
Y1  - 2015
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-148295
VL  - 16
ER  -