Duchenne muscular dystrophy gene product expression is associated with survival in head and neck squamous cell carcinoma

Mutation of the Duchenne muscular dystrophy (DMD) gene causes neuromuscular disorders, but increasing evidence has implicated DMD in the development and progression of several major cancer types. This study investigates the prognostic and biological significance of DMD expression in head and neck squamous cell carcinoma (HNSCC). Analysis of The Cancer Genome Atlas (TCGA) data revealed that high DMD expression correlates with improved overall (median survival difference: 22 months, p = 0.0083) and progression-free (p = 0.0237) survival. The Dp71ab transcript is most strongly associated with better outcomes (median overall survival: 42 months, p = 0.0007). Notably, DMD expression levels stratify HPV-positive patients, identifying a DMD low/HPV-positive subgroup with poor outcomes. Immunohistochemical analysis of 50 HNSCC tissue cases confirmed dystrophin localisation in the nucleus and cytoplasm, with high nuclear expression linked to longer overall survival (mean difference: 31 months, p = 0.0497). Functional assays in HNSCC cells showed that Dp71ab overexpression disrupts nuclear morphology and reduces proliferation. Differential gene expression analysis additionally identified 388 upregulated and 30 downregulated genes, with pathways linked to muscle processes, ribosome biogenesis and non-coding RNA regulation. These findings highlight DMD as a potential biomarker and/or therapeutic target in HNSCC, warranting further mechanistic studies of Dp71 isoforms.