Duchenne explained Glossary of research terms Multimodal pathways There are multiple pathways which contribute to Duchenne. For example, fibrosis is involved in various pathways which lead to muscle weakness. Fibrosis can rearrange the muscle cells leading to decreased muscle force generation. Fibrosis can also leads to increased distance from blood vessels which supply the muscle cells with oxygen and nutrients. Without sufficient oxygen and nutrients the muscle cells die. In addition fibrosis perpetuates a continuous inflammatory process, which in turn generates scar tissue, instead of normal muscle tissue. It is therefore important that all these pathways are taken into account so that we can effectively treat Duchenne.