Clinical Application of Photobiomodulation in DMD


Clinical Management

Poster Number: T318


Elizabeth Harvey, PT, DPT, MSR, PCS, DHS, Renewal Therapeutics, Jenna Lammers, PT, MSR, PCS, NCS, CNT, Powell Gene Therapy Center, Stephanie Salabarria, BHSc, University of Florida, Julie Berthy, DNP, University of Florida, Barry J Byrne, MD, PhD, University of Florida, Glenn Walter, PhD, University of FL Department of Physiology and Aging

Introduction: Duchenne Muscular Dystrophy (DMD) is a progressive genetic disorder characterized by severe muscle wasting and inflammation due to a lack of functional dystrophin in the muscle cell wall. While many of the comorbidities associated with DMD are managed by some combination of physical therapy (PT), steroids, and disease-modifying therapies, novel approaches to providing care for DMD patients are needed.
Photobiomodulation (PBM) has delayed muscle cell degeneration in MDX mice by modulating dystrophin gene and protein expression.1 In this N=1 study, a 15-year-old DMD patient, previously dosed with gene therapy, received PBM with routine PT over 11 months.
Objectives: Three objectives were identified: (1) quantify muscle findings from MRI studies in DMD, (2) link MRI and other objective measurements to the clinical use of PBM, and (3) determine the feasibility of using PBM in this population.

Methods: Under an IRB-approved N = 1 study, the patient received PBM 2x/week for 11 months and completed the following outcomes assessments every three months: magnetic resonance imaging (MRI) with 3D multiecho (6TEs) gradient echo was used to acquire Dixon images from the upper and lower leg to calculate muscle fat fraction. In addition a multi-slice, multiecho (16TEs) was used to generate global and water T2 maps from the legs. North Star Ambulatory Assessment (NSAA), Rise from Floor (RFF), 10-meter run test (10MRW), 6-minute Walk Test (6MWT), Styku body analysis, and others were also assessed.

Results: Following interim analysis (6 months), there was a 12% increase in total NSAA score and an overall increase of 0.7s on the 10MWR time from baseline. Total distance walked on 6MWT and RFF remained stable. Styku findings revealed a 3.6% increase in bone mass, 0.9% decrease in subcutaneous fat, and a 10.8% decrease in visceral fat from baseline.

Conclusion: Photobiomodulation has the potential to benefit patients diagnosed with DMD. Future work is needed to increase the sample size and prove statistically significant benefits.

1.Albuquerque-Pontes GM, Casalechi HL, Tomazoni SS, et al. Photobiomodulation therapy protects skeletal muscle and improves muscular function of mdx mice in a dose-dependent manner through modulation of dystrophin. Lasers Med Sci. 2018;33(4):755-764. doi:10.1007/s10103-017-2405-5