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2004 ), prior to the age when denervation becomes prevalent, suggesting that
denervation is only a single component of the overall sarcopenia response.
Additional factors that are likely to contribute to sarcopenia include aging-
associated reductions in endogenous GH and anabolic steroids; the activa-
tion of
B and TNF-alpha; and
increased apoptosis ( Sakuma and Yamaguchi, 2012 ). Additionally, increased
activity of the ubiquitin-proteasome system, which controls degradation of
protein, may be a causative factor in sarcopenia ( Altun et al., 2010 ). Skeletal
muscle mass also diminishes in certain diseases including cancer and HIV, a
process termed cachexia ( Shum and Polly, 2012 ); the similarities between
sarcopenia and cachexia are numerous, suggesting that they may be regu-
lated by similar molecular pathways ( Lenk et al., 2010 ).
inflammation pathways, such as NF-
k
2.6. Muscular dystrophies
Mutations in several genes lead to progressive weakening and degeneration
of the skeletal muscle. The most common form is Duchenne's muscular dys-
trophy (DMD), which occurs with an incidence of 1 in 3600 males ( Ouyang
et al., 2008 ). The average life expectancy for patients with DMD is approx-
imately 25 years, and there is no known cure. DMD is due to mutation of
the dystrophin gene, with loss of expression of dystrophin ( Hoffman and
Kunkel, 1989; Le Rumeur et al., 2010 ). A related, but less severe form, ter-
med Becker's muscular dystrophy is due to mutations which result in trun-
cation or misfolding of dystrophin ( Acsadi et al., 2012 ). Loss or mutation of
dystrophin causes instability in sarcolemma-extracellular matrix interaction,
such that contractile function damages the fibers, leading to loss of the fibers
due to necrosis and other processes. There are canine (Golden Retriever
muscular dystrophy; Miyazato et al., 2011 ) and murine (mdx mice)
( Grounds et al., 2008 ) animal models that somewhat recapitulate the key fea-
tures of the human disease. Therapeutic strategies currently being consid-
ered for DMD/Becker muscular dystrophy include pharmacological
agents, which may reduce symptoms ( D'Angelo et al., 2012 ), as well as gene
therapy ( Odom et al., 2010; Tedesco et al., 2011 ) and regenerative
medicine-based approaches ( Kazuki et al., 2010 ).
Muscular dystrophies also arise from mutations affecting proteins other
than dystrophin. Congenital muscular dystrophies (CMD, considered con-
genital as the symptoms appear in infants), correspond to mutations in a vari-
ety of structural, nuclear, and endoplasmic reticulum proteins ( Bertini et al.,
2011; Clement et al., 2012 ). In a recent study, the majority of the CMD
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