G.P.105

We are investigating the effects of selective estrogen receptor modulators (SERMs) in mdx 5Cv dystrophic mice (Dys), a model for Duchenne muscular dystrophy (DMD). SERMs display either pro-estrogenic or anti-estrogenic activities in a tissue-dependent manner. Tamoxifen (TAM), the most well characterised SERM, has been used for over 30 years to treat estrogen-sensitive breast cancer in both women and men and has been reported to be also well tolerated in pre-pubertal boys. In 2013, we published that oral treatment of Dys mice from 3 weeks of age for 15 months with TAM (10 mg/kg/day) improved muscle force and the structure of diaphragm and heart. TAM and its metabolites were present in nanomolar concentrations in plasma and muscles, suggesting signalling through high affinity targets, likely the estrogen receptors alpha and beta that were several-fold more abundant in dystrophic muscle than in normal ones. Next, we tested TAM in adult Dys mice in order to investigate its efficacy in the low-intensity chronic stage of the disease, which resembles most closely the DMD condition. TAM at doses as low as 0.1 mg/kg/day improved motor performance of active mice and enhanced the contractile characteristics of the triceps surae. At 3 mg/kg/day, TAM corrected most endpoints close to normal values. We are currently testing other SERMs (all at 3 mg/kg/day): the chlorinated TAM analogues clomiphene and toremifene, the 3-hydroxylated TAM derivative droloxifene, the second generation SERM unrelated to TAM raloxifene (RAL), and the pure anti-estrogen fulvestrant (Faslodex). Overall, the ranked efficacy was as follows: TAM > toremifene > clomiphene  > droloxifene ≈ RAL > Faslodex. Our data as well as our current understanding of estrogenic signalling in dystrophic muscle suggests that TAM and other SERMs with pro-estrogenic activities on muscle might be beneficial for DMD and maybe also for other muscular dystrophies.