Siciliani Scalco, Renata; (2018) Translational Research Studies in Exercise-related Muscle Disorders. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Translational research is the process that transfers knowledge from basic sciences to the clinical setting. This PhD thesis translates knowledge gained from animal model research in hypokalaemic periodic paralysis (HypoPP) and McArdle disease to humans affected by these conditions to identify new treatment options for both diseases. The efficacy of two compounds, sodium valproate and bumetanide, were assessed for the first time in humans with McArdle disease and HypoPP, respectively. For HypoPP, the role of the McManis test as an outcome measure was explored in a randomised, double-blind, placebo-controlled phase II clinical trial with a cross-over design. For McArdle disease, several outcome measures were explored in an open-label proof-of-concept phase II study. 2 mg bumetanide was not effective to abort a focal attack of weakness in an immobilised hand in the majority of the trial participants with HypoPP, but data presented here supports further studies of bumetanide in this population of patients. Extending the isometric exercise period to 10 minutes increased the sensitivity of the McManis test, and frequent compound muscle action potential (CMAP) amplitude assessments were shown to be useful in assessing both efficacy and safety. 20 mg/kg/day sodium valproate was ineffective in stimulating the expression of the brain glycogen phosphorylase enzyme in skeletal muscle of people with McArdle disease. Based on these results, further research into VPA as a treatment for McArdle disease is discouraged. The combination of several outcome measures contributed to data interpretation and should be considered in future studies exploring treatment efficacy in McArdle disease. The results of this research should contribute to future clinical trials in the field of exercise-related muscle disorders and provide valuable insights for translational research.

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