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Background  Duchenne muscle dystrophy (DMD) is one of the most common lethal genetic diseases of children worldwide and is 100% fatal. Steroids, the only therapy currently available, are marred by poor efficacy and a high side-effect profile. New therapeutic approaches are urgently needed.    Methods  Here, we leverage PGC-1α, a powerful transcriptional coactivator known to protect against dystrophy in the  mdx  murine model of DMD, to search for novel mechanisms of protection against dystrophy.    Results  We identify heme oxygenase-1 (HO-1) as a potential novel target for the treatment of DMD. Expression of HO-1 is blunted in the muscles from the  mdx  murine model of DMD, and further reduction of HO-1 by genetic haploinsufficiency worsens muscle damage in  mdx  mice. Conversely, induction of HO-1 pharmacologically protects against muscle damage. Mechanistically, HO-1 degrades heme into biliverdin, releasing in the process ferrous iron and carbon monoxide (CO). We show that exposure to a safe low dose of CO protects against muscle damage in  mdx  mice, as does pharmacological treatment with CO-releasing molecules.    Conclusions  These data identify HO-1 and CO as novel therapeutic agents for the treatment of DMD. Safety profiles and clinical testing of inhaled CO already exist, underscoring the translational potential of these observations.

Heme oxygenase and carbon monoxide protect from muscle dystrophy