DAB2 as a biomarker and mechanistic link between lipid dysregulation and disease progression in LGMD R2

Limb-girdle muscular dystrophy R2 (LGMD R2) is an autosomal recessive disorder caused by dysferlin deficiency, leading to progressive muscle weakness and wasting. Despite advances in understanding the mechanisms linking dysferlin loss to membrane fragility and muscle degeneration, the lack of robust clinical biomarkers has limited disease monitoring and therapeutic evaluation. Here, we identify Disabled-2 (DAB2) as a molecular and clinical biomarker for LGMD R2. Transcriptomic profiling revealed a significant upregulation of DAB2 in induced pluripotent stem cell (iPSC)-derived myotubes from patients with LGMD R2. Its expression correlated with disease severity in muscle biopsies from a cohort of 14 dysferlin-deficient individuals and in dysferlin knockout Bla/J mice, where levels increased with disease progression. Crucially, we demonstrate that DAB2 upregulation in muscle is normalized following treatment with AAV gene therapy expressing full-length dysferlin, positioning DAB2 as a dynamic biomarker for both disease monitoring and therapeutic response. Based on the role of DAB2 in lipid trafficking and the reported pathological lipid accumulation in LGMD R2, we then investigated its contribution to disease-associated lipid dysregulation. Consistent with this hypothesis, we show that high DAB2 levels paralleled lipid deposition in affected patients, iPSC-derived myotubes and mouse muscles, while siRNA- mediated DAB2 knockdown reduced lipid accumulation in LGMD R2 myotubes. Together, our findings establish DAB2 as a mechanistic link between disease severity and lipid dysregulation, and highlight its potential as a key prognostic marker, opening new avenues for precision medicine approaches in LGMD R2 and other related muscular dystrophies.