{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T15:47:39Z","timestamp":1790524059929,"version":"4.1.0"},"reference-count":91,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,2,8]],"date-time":"2022-02-08T00:00:00Z","timestamp":1644278400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Great Ormond Street Hospital Children\u2019s Charity"},{"name":"MRC","award":["MR\/K000608\/1"],"award-info":[{"award-number":["MR\/K000608\/1"]}]},{"name":"MRC","award":["EUH2020"],"award-info":[{"award-number":["EUH2020"]}]},{"name":"MRC","award":["83245"],"award-info":[{"award-number":["83245"]}]},{"name":"Brain Involvement iN Dystrophinopathies"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Duchenne muscular dystrophy (DMD) is characterized by loss of dystrophin in muscle, however patients also have variable degree of intellectual disability and neurobehavioural co-morbidities. In contrast to muscle, in which a single full-length dystrophin isoform (Dp427) is produced, multiple isoforms are produced in the brain, and their deficiency accounts for the variability of CNS manifestations, with increased risk of comorbidities in patients carrying mutations affecting the 3\u2032 end of the gene, which disrupt expression of shorter Dp140 and Dp71 isoforms. A mouse model (mdx mouse) lacks Dp427 in muscle and CNS and exhibits exaggerated startle responses to threat, linked to the deficiency of dystrophin in limbic structures such as the amygdala, which normalize with postnatal brain dystrophin-restoration therapies. A pathological startle response is not a recognized feature of DMD, and its characterization has implications for improved clinical management and translational research.<\/jats:p>\n                  <jats:p>To investigate startle responses in DMD, we used a novel fear-conditioning task in an observational study of 56 males aged 7\u201312 years (31 affected boys, mean age 9.7 \u00b1 1.8 years; 25 controls, mean age 9.6 \u00b1 1.4 years). Trials of two neutral visual stimuli were presented to participants: one \u2018safe\u2019 cue presented alone; one \u2018threat\u2019 cue paired with an aversive noise to enable conditioning of physiological startle responses (skin conductance response and heart rate). Retention of conditioned physiological responses was subsequently tested by presenting both cues without the aversive noise in an \u2018Extinction\u2019 phase. Primary outcomes were the initial unconditioned skin conductance and change in heart rate responses to the aversive \u2018threat\u2019 and acquisition and retention of conditioned responses after conditioning. Secondary and exploratory outcomes were neuropsychological measures and genotype associations.<\/jats:p>\n                  <jats:p>The mean unconditioned skin conductance response was greater in the DMD group than controls [mean difference 3.0 \u00b5S (1.0, 5.1); P = 0.004], associated with a significant threat-induced bradycardia only in the patient group [mean difference \u20138.7 bpm (\u201316.9, \u20130.51); P = 0.04]. Participants with DMD found the task more aversive than controls, with increased early termination rates during the Extinction phase (26% of DMD group versus 0% of controls; P = 0.007).<\/jats:p>\n                  <jats:p>This study provides the first evidence that boys with DMD show similar increased unconditioned startle responses to threat to the mdx mouse, which in the mouse respond to brain dystrophin restoration. Our study provides new insights into the neurobiology underlying the complex neuropsychiatric co-morbidities in DMD and defines an objective measure of this CNS phenotype, which will be valuable for future CNS-targeted dystrophin-restoration studies.<\/jats:p>","DOI":"10.1093\/brain\/awac048","type":"journal-article","created":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T15:12:25Z","timestamp":1643987545000},"page":"252-265","source":"Crossref","is-referenced-by-count":37,"title":["Startle responses in Duchenne muscular dystrophy: a novel biomarker of brain dystrophin deficiency"],"prefix":"10.1093","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7046-122X","authenticated-orcid":false,"given":"Kate","family":"Maresh","sequence":"first","affiliation":[{"name":"Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health , London WC1N 1EH , UK"},{"name":"Queen Square Centre for Neuromuscular Diseases, University College London , London WC1N 3BG , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andriani","family":"Papageorgiou","sequence":"additional","affiliation":[{"name":"Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health , London WC1N 1EH , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Ridout","sequence":"additional","affiliation":[{"name":"Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health , London WC1N 1EH , UK"},{"name":"NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health , London WC1N 1EH , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil A","family":"Harrison","sequence":"additional","affiliation":[{"name":"Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University , Cardiff CF14 4XN , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Mandy","sequence":"additional","affiliation":[{"name":"Department of Clinical, Educational and Health Psychology, University College London , London WC1E 6BT , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Skuse","sequence":"additional","affiliation":[{"name":"Department of Behavioural and Brain Sciences, UCL Great Ormond Street Institute of Child Health , London WC1N 1EH , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Muntoni","sequence":"additional","affiliation":[{"name":"Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health , London WC1N 1EH , UK"},{"name":"Queen Square Centre for Neuromuscular Diseases, University College London , London WC1N 3BG , UK"},{"name":"NIHR Great Ormond Street Hospital Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health , London WC1N 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