Pulsed glucocorticoids enhance dystrophic muscle performance through epigenetic-metabolic reprogramming

JCI Insight. 2019 Dec 19;4(24):e132402. doi: 10.1172/jci.insight.132402.


In humans, chronic glucocorticoid use is associated with side effects like muscle wasting, obesity, and metabolic syndrome. Intermittent steroid dosing has been proposed in Duchenne Muscular Dystrophy patients to mitigate the side effects seen with daily steroid intake. We evaluated biomarkers from Duchenne Muscular Dystrophy patients, finding that, compared with chronic daily steroid use, weekend steroid use was associated with reduced serum insulin, free fatty acids, and branched chain amino acids, as well as reduction in fat mass despite having similar BMIs. We reasoned that intermittent prednisone administration in dystrophic mice would alter muscle epigenomic signatures, and we identified the coordinated action of the glucocorticoid receptor, KLF15 and MEF2C as mediators of a gene expression program driving metabolic reprogramming and enhanced nutrient utilization. Muscle lacking Klf15 failed to respond to intermittent steroids. Furthermore, coadministration of the histone acetyltransferase inhibitor anacardic acid with steroids in mdx mice eliminated steroid-specific epigenetic marks and abrogated the steroid response. Together, these findings indicate that intermittent, repeated exposure to glucocorticoids promotes performance in dystrophic muscle through an epigenetic program that enhances nutrient utilization.

Trial registration: ClinicalTrials.gov NCT03319030.

Keywords: Metabolism; Muscle; Muscle Biology; Neuromuscular disease.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anacardic Acids / administration & dosage
  • Animals
  • Biomarkers / blood
  • Biomarkers / metabolism
  • Child
  • Cross-Sectional Studies
  • Disease Models, Animal
  • Drug Therapy, Combination
  • Epigenesis, Genetic / drug effects
  • Epigenomics
  • Gene Expression Regulation / drug effects
  • Glucocorticoids / administration & dosage*
  • Histone Acetyltransferases / antagonists & inhibitors
  • Histone Acetyltransferases / metabolism
  • Humans
  • Kruppel-Like Transcription Factors / genetics
  • Kruppel-Like Transcription Factors / metabolism
  • MEF2 Transcription Factors / metabolism
  • Male
  • Metabolomics
  • Mice
  • Mice, Inbred mdx
  • Muscle, Skeletal / drug effects*
  • Muscle, Skeletal / metabolism
  • Muscle, Skeletal / pathology
  • Muscular Dystrophy, Duchenne / blood
  • Muscular Dystrophy, Duchenne / diagnosis
  • Muscular Dystrophy, Duchenne / drug therapy*
  • Muscular Dystrophy, Duchenne / genetics
  • Nutrients / blood
  • Nutrients / metabolism
  • Prednisone / administration & dosage*
  • Pulse Therapy, Drug


  • Anacardic Acids
  • Biomarkers
  • Glucocorticoids
  • Klf15 protein, mouse
  • Kruppel-Like Transcription Factors
  • MEF2 Transcription Factors
  • Mef2c protein, mouse
  • anacardic acid
  • Histone Acetyltransferases
  • Prednisone

Associated data

  • ClinicalTrials.gov/NCT03319030