{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:37:29Z","timestamp":1791221849206,"version":"4.1.0"},"reference-count":60,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2012,7,18]],"date-time":"2012-07-18T00:00:00Z","timestamp":1342569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["pathsocjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Pathology"],"published-print":{"date-parts":[[2012,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy caused by mutations in the dystrophin gene. Loss of dystrophin initiates a progressive decline in skeletal muscle integrity and contractile capacity which weakens respiratory muscles including the diaphragm, culminating in respiratory failure, the leading cause of morbidity and mortality in DMD patients. At present, corticosteroid treatment is the primary pharmacological intervention in DMD, but has limited efficacy and adverse side effects. Thus, there is an urgent need for new safe, cost\u2010effective, and rapidly implementable treatments that slow disease progression. One promising new approach is the amplification of nitric oxide\u2013cyclic guanosine monophosphate (NO\u2013cGMP) signalling pathways with phosphodiesterase 5 (PDE5) inhibitors. PDE5 inhibitors serve to amplify NO signalling that is attenuated in many neuromuscular diseases including DMD. We report here that a 14\u2010week treatment of the\n                    <jats:italic>mdx<\/jats:italic>\n                    mouse model of DMD with the PDE5 inhibitor sildenafil (Viagra\n                    <jats:sup>\u00ae<\/jats:sup>\n                    , Revatio\n                    <jats:sup>\u00ae<\/jats:sup>\n                    ) significantly reduced\n                    <jats:italic>mdx<\/jats:italic>\n                    diaphragm muscle weakness without impacting fatigue resistance. In addition to enhancing respiratory muscle contractility, sildenafil also promoted normal extracellular matrix organization. PDE5 inhibition slowed the establishment of\n                    <jats:italic>mdx<\/jats:italic>\n                    diaphragm fibrosis and reduced matrix metalloproteinase\u201013 (MMP\u201013) expression. Sildenafil also normalized the expression of the pro\u2010fibrotic (and pro\u2010inflammatory) cytokine tumour necrosis factor \u03b1 (TNF\u03b1). Sildenafil\u2010treated\n                    <jats:italic>mdx<\/jats:italic>\n                    diaphragms accumulated significantly less Evans Blue tracer dye than untreated controls, which is also indicative of improved diaphragm muscle health. We conclude that sildenafil\u2010mediated PDE5 inhibition significantly reduces diaphragm respiratory muscle dysfunction and pathology in the\n                    <jats:italic>mdx<\/jats:italic>\n                    mouse model of Duchenne muscular dystrophy. This study provides new insights into the therapeutic utility of targeting defects in NO\u2013cGMP signalling with PDE5 inhibitors in dystrophin\u2010deficient muscle. Copyright \u00a9 2012 Pathological Society of Great Britain and Ireland. Published by John Wiley &amp; Sons, Ltd.\n                  <\/jats:p>","DOI":"10.1002\/path.4054","type":"journal-article","created":{"date-parts":[[2012,5,31]],"date-time":"2012-05-31T07:57:38Z","timestamp":1338451058000},"page":"77-87","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":135,"title":["Sildenafil reduces respiratory muscle weakness and fibrosis in the\n                    <i>mdx<\/i>\n                    mouse model of Duchenne muscular dystrophy"],"prefix":"10.1002","volume":"228","author":[{"given":"Justin M","family":"Percival","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas P","family":"Whitehead","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvin E","family":"Adams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candace 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