Duchenne muscular dystrophy (DMD) is a progressive muscle wasting disease caused by X-linked inherited mutations in the DYSTROPHIN (DMD) gene. Absence of dystrophin protein from the sarcolemma causes severe muscle degeneration, fibrosis, and inflammation, ultimately leading to cardiorespiratory failure and premature death. Although there are several promising strategies under investigation to restore dystrophin protein expression, there is currently no cure for DMD, and identification of genetic modifiers as potential targets represents an alternative therapeutic strategy. In a Brazilian golden retriever muscular dystrophy (GRMD) dog colony, two related dogs demonstrated strikingly mild dystrophic phenotypes compared with those typically observed in severely affected GRMD dogs despite lacking dystrophin. Microarray analysis of these "escaper" dogs revealed reduced expression of phosphatidylinositol transfer protein-α (PITPNA) in escaper versus severely affected GRMD dogs. Based on these findings, we decided to pursue investigation of modulation of PITPNA expression on dystrophic pathology in GRMD dogs, dystrophindeficient sapje zebrafish, and human DMD myogenic cells. In GRMD dogs, decreased expression of Pitpna was associated with increased phosphorylated Akt (pAkt) expression and decreased PTEN levels. PITPNA knockdown by injection of morpholino oligonucleotides in sapje zebrafish also increased pAkt, rescued the abnormal muscle phenotype, and improved long-term sapje mutant survival. In DMD myotubes, PITPNA knockdown by lentiviral shRNA increased pAkt and increased myoblast fusion index. Overall, our findings suggest PIPTNA as a disease modifier that accords benefits to the abnormal signaling, morphology, and function of dystrophic skeletal muscle, and may be a target for DMD and related neuromuscular diseases.Duchenne muscular dystrophy | genetic modifier | phosphatidylinositol transfer protein-α | skeletal muscle D uchenne muscular dystrophy (DMD) is a progressive, X-linked muscle wasting disease caused by mutations in the DYSTROPHIN gene (1, 2). Absence of dystrophin protein from the muscle sarcolemma disrupts the link between the cytoskeleton and extracellular matrix, causing a multitude of pathological effects on muscle mechanics, signaling, and metabolic pathways. These consequences render myofibers susceptible to contractioninduced injury and cause severe muscle degeneration, fibrosis, and inflammation. Patients with DMD typically lose ambulation by age 12, and cardiorespiratory failure leads to premature death by the third decade of life (3). Despite advances in palliative support and ongoing efforts to restore dystrophin expression, there is no cure for DMD. Therefore, identification of potential genetic modifiers, which could be targets for disease therapy and discovery, are of significant interest.Identification of genetic modifiers that reduce the pathogenic features of DMD is an emerging gateway to new therapeutic targets. Modifiers identified include osteopontin, encoded by the SPP1 gene, which ...