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Bianchi VE, von Haehling S. The treatment of chronic anemia in heart failure: a global approach. Clin Res Cardiol 2024; 113:1117-1136. [PMID: 37660308 DOI: 10.1007/s00392-023-02275-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/24/2023] [Indexed: 09/05/2023]
Abstract
Chronic anemia is an independent risk factor for mortality in patients with heart failure (HF). Restoring physiological hemoglobin (Hb) levels is essential to increase oxygen transport capacity to tissues and improve cell metabolism as well as physical and cardiac performance. Nutritional deficits and iron deficiency are the major causes of chronic anemia, but other etiologies include chronic kidney disease, inflammatory processes, and unexplained anemia. Hormonal therapy, including erythropoietin (EPO) and anabolic treatment in chronic anemia HF patients, may contribute to improving Hb levels and clinical outcomes. Although preliminary studies showed a beneficial effect of EPO therapy on cardiac efficiency and in HF, more recent studies have not confirmed this positive impact of EPO, alluding to its side effect profile. Physical exercise significantly increases Hb levels and the response of anemia to treatment. In malnourished patients and chronic inflammatory processes, low levels of anabolic hormones, such as testosterone and insulin-like growth factor-1, contribute to the development of chronic anemia. This paper aims to review the effect of nutrition, EPO, anabolic hormones, standard HF treatments, and exercise as regulatory mechanisms of chronic anemia and their cardiovascular consequences in patients with HF.
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Affiliation(s)
- Vittorio Emanuele Bianchi
- Department of Endocrinology and Metabolism, Clinical Center Stella Maris, Strada Rovereta, 42, 47891, Falciano, San Marino.
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site, Göttingen, Germany
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2
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Arora E, Maiya GA, Devasia T, Bhat R, Kamath G. Efficacy of comprehensive structured exercise program on claudication pain and quality of life in type 2 diabetes mellitus with peripheral arterial disease. J Diabetes Metab Disord 2024; 23:1305-1313. [PMID: 38932870 PMCID: PMC11196545 DOI: 10.1007/s40200-024-01426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/21/2024] [Indexed: 06/28/2024]
Abstract
Background Peripheral arterial disease is one of the leading complications of type 2 diabetes mellitus. The primary symptom of peripheral arterial disease is claudication pain. Exercise is known to improve the claudication pain, thereby improving the quality of life. Methods A total of 74 participants were recruited in each group and a detailed demographic assessment was done for all the participants. The study group received a comprehensive structured exercise program and standard care whereas the control group received only the standard care. Progression of the exercise was made at the 6th week of the protocol. All the outcome measures were reassessed after the 12th weeks for both study and control group. Results The mean age of participants was 60.78 ± 11.29 (years) and 59.98 ± 11.42 (years) for the study and control group, respectively. There was a statistically significant difference in toe brachial index (p < 0.001), ankle brachial index (p < 0.001), 6-minute walk distance (p < 0.001), WHO-BREF quality of life questionnaire (p < 0.001), and walking ability ((p < 0.001) in the study group in comparison to the control group. Conclusion In the present study we found that comprehensive structured exercise program improves the arterial indices, quality of life, walking ability and reduces claudication pain in type 2 diabetes mellitus with peripheral arterial disease. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-024-01426-2.
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Affiliation(s)
- Esha Arora
- School of Physiotherapy, Faculty of Allied Health Professions, AIMST University, 08100 Kedah, Malaysia
| | - G. Arun Maiya
- Department of Physiotherapy, Chief- Centre for Diabetic Foot Care and Research, Dean- Manipal College of Health professions, Manipal Academy of Higher Education Manipal, 576104 Udupi, Karnataka India
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College Manipal Academy of Higher Education Manipal, 576104 Udupi, Karnataka India
| | - Ram Bhat
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education Manipal, 576104 Udupi, Karnataka India
| | - Ganesh Kamath
- Department of Cardiovascular and Thoracic Surgery, Kasturba Medical College Manipal Academy of Higher Education Manipal, 576104 Udupi, Karnataka India
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3
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Cucato G, Longano PP, Perren D, Ritti-Dias RM, Saxton JM. Effects of additional exercise therapy after a successful vascular intervention for people with symptomatic peripheral arterial disease. Cochrane Database Syst Rev 2024; 5:CD014736. [PMID: 38695785 PMCID: PMC11064885 DOI: 10.1002/14651858.cd014736.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is characterised by obstruction or narrowing of the large arteries of the lower limbs, usually caused by atheromatous plaques. Most people with PAD who experience intermittent leg pain (intermittent claudication) are typically treated with secondary prevention strategies, including medical management and exercise therapy. Lower limb revascularisation may be suitable for people with significant disability and those who do not show satisfactory improvement after conservative treatment. Some studies have suggested that lower limb revascularisation for PAD may not confer significantly more benefits than supervised exercise alone for improved physical function and quality of life. It is proposed that supervised exercise therapy as adjunctive treatment after successful lower limb revascularisation may confer additional benefits, surpassing the effects conferred by either treatment alone. OBJECTIVES To assess the effects of a supervised exercise programme versus standard care following successful lower limb revascularisation in people with PAD. SEARCH METHODS We searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, two other databases, and two trial registers, most recently on 14 March 2023. SELECTION CRITERIA We included randomised controlled trials which compared supervised exercise training following lower limb revascularisation with standard care following lower limb revascularisation in adults (18 years and older) with PAD. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were maximum walking distance or time (MWD/T) on the treadmill, six-minute walk test (6MWT) total distance, and pain-free walking distance or time (PFWD/T) on the treadmill. Our secondary outcomes were changes in the ankle-brachial index, all-cause mortality, changes in health-related quality-of-life scores, reintervention rates, and changes in subjective measures of physical function. We analysed continuous data by determining the mean difference (MD) and 95% confidence interval (CI), and dichotomous data by determining the odds ratio (OR) with corresponding 95% CI. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We identified seven studies involving 376 participants. All studies involved participants who received either additional supervised exercise or standard care after lower limb revascularisation. The studies' exercise programmes varied, and included supervised treadmill walking, combined exercise, and circuit training. The duration of exercise therapy ranged from six weeks to six months; follow-up time ranged from six weeks to five years. Standard care also varied between studies, including no treatment or advice to stop smoking, lifestyle modifications, or best medical treatment. We classified all studies as having some risk of bias concerns. The certainty of the evidence was very low due to the risk of bias, inconsistency, and imprecision. The meta-analysis included only a subset of studies due to concerns regarding data reporting, heterogeneity, and bias in most published research. The evidence was of very low certainty for all the review outcomes. Meta-analysis comparing changes in maximum walking distance from baseline to end of follow-up showed no improvement (MD 159.47 m, 95% CI -36.43 to 355.38; I2 = 0 %; 2 studies, 89 participants). In contrast, exercise may improve the absolute maximum walking distance at the end of follow-up compared to standard care (MD 301.89 m, 95% CI 138.13 to 465.65; I2 = 0 %; 2 studies, 108 participants). Moreover, we are very uncertain if there are differences in the changes in the six-minute walk test total distance from baseline to treatment end between exercise and standard care (MD 32.6 m, 95% CI -17.7 to 82.3; 1 study, 49 participants), and in the absolute values at the end of follow-up (MD 55.6 m, 95% CI -2.6 to 113.8; 1 study, 49 participants). Regarding pain-free walking distance, we are also very uncertain if there are differences in the mean changes in PFWD from baseline to treatment end between exercise and standard care (MD 167.41 m, 95% CI -11 to 345.83; I2 = 0%; 2 studies, 87 participants). We are very uncertain if there are differences in the absolute values of ankle-brachial index at the end of follow-up between the intervention and standard care (MD 0.01, 95% CI -0.11 to 0.12; I2 = 62%; 2 studies, 110 participants), in mortality rates at the end of follow-up (OR 0.92, 95% CI 0.42 to 2.00; I2 = 0%; 6 studies, 346 participants), health-related quality of life at the end of follow-up for the physical (MD 0.73, 95% CI -5.87 to 7.33; I2 = 64%; 2 studies, 105 participants) and mental component (MD 1.04, 95% CI -6.88 to 8.95; I2 = 70%; 2 studies, 105 participants) of the 36-item Short Form Health Survey. Finally, there may be little to no difference in reintervention rates at the end of follow-up between the intervention and standard care (OR 0.91, 95% CI 0.23 to 3.65; I2 = 65%; 5 studies, 252 participants). AUTHORS' CONCLUSIONS There is very uncertain evidence that additional exercise therapy after successful lower limb revascularisation may improve absolute maximal walking distance at the end of follow-up compared to standard care. Evidence is also very uncertain about the effects of exercise on pain-free walking distance, six-minute walk test distance, quality of life, ankle-brachial index, mortality, and reintervention rates. Although it is not possible to confirm the effectiveness of supervised exercise compared to standard care for all outcomes, studies did not report any harm to participants from this intervention after lower limb revascularisation. Overall, the evidence incorporated into this review was very uncertain, and additional evidence is needed from large, well-designed, randomised controlled studies to more conclusively demonstrate the role additional exercise therapy has after lower limb revascularisation in people with PAD.
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Affiliation(s)
- Gabriel Cucato
- Department of Sport, Exercise, and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Paulo Pl Longano
- Ciências da Reabilitação, Universidade Nove de Julho, São Paulo, Brazil
| | - Daniel Perren
- Department of Vascular Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | | | - John M Saxton
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
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Patil IV, Sharma P, Pisulkar G, Salwan A, Patel M. Complex Peripheral Arterial Disease in a Case of Multilevel Lesions Treated With Sequential Angioplasty. Cureus 2024; 16:e60982. [PMID: 38915963 PMCID: PMC11194135 DOI: 10.7759/cureus.60982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Peripheral artery disease (PAD) is the buildup of calcium and fatty deposits in the arterial walls (atherosclerosis). This is an important clinical issue, specifically in cases with multilevel lesions. A patient underwent sequential angioplasty treatment for major PAD, which was characterized by multilevel lesions affecting both the infrapopliteal arteries. The proximal vessels and infrapopliteal vessels are mostly observed to be affected by PAD, thus the patient likely has PAD localized to the lower leg. In the femoropopliteal segment, lower extremity artery or aortic atherosclerotic occlusive disease can lead to significant outcomes. Severe claudication and pain during rest in both legs were observed in a patient with a history of hypertension and diabetes mellitus. With an angiography, the superficial femoral, popliteal, and tibial arteries have been shown to have major stenoses and occlusions. A progressive treatment was used because of the complexity of the lesions initiating with endovascular revascularization of the superficial femoral artery. The popliteal and tibial arteries were then repaired with angioplasty and stent placement. After the treatment, the patient's symptoms significantly improved, including elimination of their rest discomfort and claudication. Measurements of the ankle-brachial index (ABI) indicated that the affected limbs' perfusion was refined. Six months later, a follow-up angiography revealed intact vessels with no restenosis. This case report shows the successful outcome of recurrent angioplasty in curing complicated multilevel PAD, giving symptomatic relief and maintaining limb perfusion. This research is required to assess the long-term outcomes and longevity of this kind of treatment in patient populations that are comparable to others.
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Affiliation(s)
- Ishiqua V Patil
- Hospital Administration, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prerit Sharma
- Interventional Radiology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gajanan Pisulkar
- Orthopedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankur Salwan
- Orthopedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Maharshi Patel
- General Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Martini R, Ageno W, Amato C, Favaretto E, Porfidia A, Visonà A. Cilostazol for peripheral arterial disease - a position paper from the Italian Society for Angiology and Vascular Medicine. VASA 2024; 53:109-119. [PMID: 38426372 DOI: 10.1024/0301-1526/a001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Cilostazol is a quinolinone-derivative selective phosphodiesterase inhibitor and is a platelet-aggregation inhibitor and arterial vasodilator for the symptomatic treatment of intermittent claudication (IC). Cilostazol has been shown to improve walking distance for patients with moderate to severe disabling intermittent claudication who do not respond to exercise therapy and who are not candidates for vascular surgical or endovascular procedures. Several studies evaluated the pharmacological effects of cilostazol for restenosis prevention and indicated a possible effect on re-endothelialization mediated by hepatocyte growth factor and endothelial precursor cells, as well as inhibiting smooth muscle cell proliferation and leukocyte adhesion to endothelium, thereby exerting an anti-inflammatory effect. These effects may suggest a potential effectiveness of cilostazol in preventing restenosis and promoting the long-term outcome of revascularization interventions. This review aimed to point out the role of cilostazol in treating patients with peripheral arterial disease, particularly with IC, and to explore its possible role in restenosis after lower limb revascularization.
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Affiliation(s)
- Romeo Martini
- Unità di Angiologia AULSS 1 Dolomiti, Ospedale San Martino, Belluno, Italy
| | - Walter Ageno
- Università degli studi dell'Insubria, Varese, Italy
| | - Corrado Amato
- Unità Operativa di Angiologia, Dipartimento assistenziale integrato di medicina, Azienda ospedaliera universitaria policlinico Paolo Giaccone, Palermo, Italy
| | - Elisabetta Favaretto
- Angiology and Blood Coagulation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Angelo Porfidia
- Servizio di Angiologia Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
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Machado I, Ferreira J, Magalhães C, Sousa P, Dias L, Santarém D, Sousa N, Paredes H, Abrantes C. Six-month effects of supervised exercise on walking ability and health-related factors in peripheral arterial disease: a pilot study. INT ANGIOL 2023; 42:371-381. [PMID: 37870494 DOI: 10.23736/s0392-9590.23.05085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND In peripheral arterial disease (PAD) patients with intermittent claudication (IC), the combination of aerobic and resistance exercises could counteract muscle loss and attenuate disease progression. This study analyzed the effects of six months of a combined exercise program on walking ability, lower limb body composition, cardiovascular risk factors, and Ankle-Brachial Index (ABI). METHODS Twenty-three patients (age 63.2±1.5 years and ABI 0.58±0.07) with PAD and IC were allocated to a control group (CG) or a supervised exercise group (SUP). Ten patients underwent six months of treadmill walking combined with resistance exercises, three times a week. The CG (N.=13) received a recommendation for walking. All patients were measured at baseline (M0), after three months (M3), and six months (M6). RESULTS During constant treadmill protocol, the claudication onset time/distance (COT/COD), absolute claudication time/distance (ACT/ACD), and number of pauses of overall patients significantly improved at M3 and M6. Between groups were found significant differences in COT and COD at M6 (P=0.005 and P=0.007, respectively); and in ACT and ACD at M3 (P=0.003 for both) and at M6 (P=0.005 and P=0.005, respectively), with major improvements in the SUP. Over the six months, a significant group effect was found in fat-free mass (P=0.041) and predicted muscle mass (P=0.039) of the lower ABI leg, with greater improvements in the SUP. CONCLUSIONS A supervised exercise program that combines aerobic and resistance training improves PAD symptoms and has additional benefits for patients. Patients in the program showed improvements in walking ability, lower-limb body composition, perceived exertion, and heart rate during treadmill walking.
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Affiliation(s)
- Isabel Machado
- Department of Sports Sciences, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal -
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal -
| | - Joana Ferreira
- Department of Angiology and Vascular Surgery, Trás-os-Montes e Alto Douro Hospital Center (CHTMAD), Vila Real, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Carlos Magalhães
- Department of Physical Medicine and Rehabilitation, Trás-os-Montes e Alto Douro Hospital Center (CHTMAD), Vila Real, Portugal
| | - Pedro Sousa
- Department of Imagiology, Trás-os-Montes e Alto Douro Hospital Center (CHTMAD), Vila Real, Portugal
| | - Lúcia Dias
- Department of Physical Medicine and Rehabilitation, Trás-os-Montes e Alto Douro Hospital Center (CHTMAD), Vila Real, Portugal
| | - Daniel Santarém
- Department of Sports Sciences, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Nelson Sousa
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal
- Public Health Unit of Santo Tirso, ACES Grande Porto I-Santo Tirso/Trofa, Santo Tirso, Portugal
| | - Hugo Paredes
- Department of Engineering, School of Sciences and Technology, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Center for Human Center Computing and Information Science (HUMANISE), Porto, Portugal
| | - Catarina Abrantes
- Department of Sports Sciences, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal
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7
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Bashir AZ. Exploring telehealth interventions to monitor rehabilitation in patients with peripheral artery disease. SAGE Open Med 2023; 11:20503121231175542. [PMID: 37223670 PMCID: PMC10201137 DOI: 10.1177/20503121231175542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
Peripheral artery disease is a manifestation of systemic atherosclerosis, and these patients often have claudication pain in the legs during activity. This leads to generally adopting an inactive lifestyle; hence, even small changes in physical activity could reduce the risk of an adverse cardiovascular event. For patients with peripheral artery disease compliance with non-invasive interventions like assistive devices and long-term exercise therapy is important for improved health outcomes. Benefits to patients can only be measured if patients with peripheral artery disease adhere to the intervention and barriers are identified with improved solutions. The effect of mobile health including pedometers and smartphone technological applications in motivating the patient to continue adhering to the intervention and persist in physical activity is a new venture to be explored.
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Affiliation(s)
- Ayisha Z Bashir
- Department of Cardiology, the University of Nebraska
Medical Center, Child Health Research Institute, Children’s Hospital and Medical Center,
Omaha, NE, USA
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8
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Bethel M, Annex BH. Peripheral arterial disease: A small and large vessel problem. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 28:100291. [PMID: 38511071 PMCID: PMC10945902 DOI: 10.1016/j.ahjo.2023.100291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/22/2024]
Abstract
Peripheral arterial disease (PAD) is one clinical manifestation of systemic atherosclerosis and is very common. Despite its prevalence, PAD remains underdiagnosed, undertreated, and understudied. The most common symptom in patients with PAD is intermittent claudication (IC), or pain in the lower extremities with walking or exertion, which is relieved after a short period of rest. Many patients with confirmed PAD are asymptomatic or have symptoms other than IC. Regardless of symptoms, patients with PAD have poor cardiovascular outcomes. PAD has largely been viewed a disease of large vessel atherosclerosis but what is becoming clear is that arterial plaques and occlusions are only one piece of the puzzle. Recent work has shown that abnormalities in the microvasculature contribute to the outcome of patients with PAD. From the perspective of the leg, limitation in blood flow is not the only problem as patients have a myriad of other problems, including muscle fibrosis, neuropathic changes, changes in the cellular respiration machinery and dysfunction of the small vessels that perfuse skeletal muscle and the supporting structures. Supervised exercise training remains one of the most effective tool to treat patients with PAD, however, the mechanisms behind its effectiveness are still being elucidated and use of structured exercise programs is not widespread. Medical therapy to treat systemic atherosclerosis is underutilized in patients with PAD. Invasive therapies are used only when patients with PAD have reached an advanced stage. While invasive strategies are effective in some patients with PAD, these strategies are costly, carry risk, and many patients are not amenable to invasive therapy. Appreciating the complex pathophysiology of PAD will hopefully spur new research and development of effective therapies for PAD.
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Affiliation(s)
- Monique Bethel
- Department of Medicine, Division of Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian H. Annex
- Department of Medicine, Division of Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Vascular Biology Center, Medical College of Georgia, Augusta University, Augusta, GA, USA
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9
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Rivers RJ, Meininger CJ. The Tissue Response to Hypoxia: How Therapeutic Carbon Dioxide Moves the Response toward Homeostasis and Away from Instability. Int J Mol Sci 2023; 24:ijms24065181. [PMID: 36982254 PMCID: PMC10048965 DOI: 10.3390/ijms24065181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/30/2023] Open
Abstract
Sustained tissue hypoxia is associated with many pathophysiological conditions, including chronic inflammation, chronic wounds, slow-healing fractures, microvascular complications of diabetes, and metastatic spread of tumors. This extended deficiency of oxygen (O2) in the tissue sets creates a microenvironment that supports inflammation and initiates cell survival paradigms. Elevating tissue carbon dioxide levels (CO2) pushes the tissue environment toward "thrive mode," bringing increased blood flow, added O2, reduced inflammation, and enhanced angiogenesis. This review presents the science supporting the clinical benefits observed with the administration of therapeutic CO2. It also presents the current knowledge regarding the cellular and molecular mechanisms responsible for the biological effects of CO2 therapy. The most notable findings of the review include (a) CO2 activates angiogenesis not mediated by hypoxia-inducible factor 1a, (b) CO2 is strongly anti-inflammatory, (c) CO2 inhibits tumor growth and metastasis, and (d) CO2 can stimulate the same pathways as exercise and thereby, acts as a critical mediator in the biological response of skeletal muscle to tissue hypoxia.
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Affiliation(s)
- Richard J Rivers
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Cynthia J Meininger
- Department of Medical Physiology, Texas A&M University School of Medicine, Bryan, TX 77807, USA
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10
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Bapat GM, Bashir AZ, Malcolm P, Johanning JM, Pipinos II, Myers SA. A biomechanical perspective on walking in patients with peripheral artery disease. Vasc Med 2023; 28:77-84. [PMID: 36759931 PMCID: PMC9997455 DOI: 10.1177/1358863x221146207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The most common symptom of peripheral artery disease (PAD) is intermittent claudication, which consists of debilitating leg pain during walking. In clinical settings, the presence of PAD is often noninvasively evaluated using the ankle-brachial index and imaging of the arterial supply. Furthermore, various questionnaires and functional tests are commonly used to measure the severity and negative effect of PAD on quality of life. However, these evaluations only provide information on vascular insufficiency and severity of the disease, but not regarding the complex mechanisms underlying walking impairments in patients with PAD. Biomechanical analyses using motion capture and ground reaction force measurements can provide insight into the underlying mechanisms to walking impairments in PAD. This review analyzes the application of biomechanics tools to identify gait impairments and their clinical implications on rehabilitation of patients with PAD. A total of 18 published journal articles focused on gait biomechanics in patients with PAD were studied. This narriative review shows that the gait of patients with PAD is impaired from the first steps that a patient takes and deteriorates further after the onset of claudication leg pain. These results point toward impaired muscle function across the ankle, knee, and hip joints during walking. Gait analysis helps understand the mechanisms operating in PAD and could also facilitate earlier diagnosis, better treatment, and slower progression of PAD.
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Affiliation(s)
- Ganesh M Bapat
- Department of Mechanical Engineering, BITS Pilani K K Birla Goa Campus, Goa, India
| | - Ayisha Z Bashir
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Philippe Malcolm
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Jason M Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.,Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
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11
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Numaga-Tomita T, Shimauchi T, Kato Y, Nishiyama K, Nishimura A, Sakata K, Inada H, Kita S, Iwamoto T, Nabekura J, Birnbaumer L, Mori Y, Nishida M. Inhibition of transient receptor potential cation channel 6 promotes capillary arterialization during post-ischaemic blood flow recovery. Br J Pharmacol 2023; 180:94-110. [PMID: 36068079 PMCID: PMC10092707 DOI: 10.1111/bph.15942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Capillary arterialization, characterized by the coverage of pre-existing or nascent capillary vessels with vascular smooth muscle cells (VSMCs), is critical for the development of collateral arterioles to improve post-ischaemic blood flow. We previously demonstrated that the inhibition of transient receptor potential 6 subfamily C, member 6 (TRPC6) channels facilitate contractile differentiation of VSMCs under ischaemic stress. We here investigated whether TRPC6 inhibition promotes post-ischaemic blood flow recovery through capillary arterialization in vivo. EXPERIMENTAL APPROACH Mice were subjected to hindlimb ischaemia by ligating left femoral artery. The recovery rate of peripheral blood flow was calculated by the ratio of ischaemic left leg to non-ischaemic right one. The number and diameter of blood vessels were analysed by immunohistochemistry. Expression and phosphorylation levels of TRPC6 proteins were determined by western blotting and immunohistochemistry. KEY RESULTS Although the post-ischaemic blood flow recovery is reportedly dependent on endothelium-dependent relaxing factors, systemic TRPC6 deletion significantly promoted blood flow recovery under the condition that nitric oxide or prostacyclin production were inhibited, accompanying capillary arterialization. Cilostazol, a clinically approved drug for peripheral arterial disease, facilitates blood flow recovery by inactivating TRPC6 via phosphorylation at Thr69 in VSMCs. Furthermore, inhibition of TRPC6 channel activity by pyrazole-2 (Pyr2; BTP2; YM-58483) promoted post-ischaemic blood flow recovery in Apolipoprotein E-knockout mice. CONCLUSION AND IMPLICATIONS Suppression of TRPC6 channel activity in VSMCs could be a new strategy for the improvement of post-ischaemic peripheral blood circulation.
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Affiliation(s)
- Takuro Numaga-Tomita
- National Institute for Physiological Sciences (NIPS), National Institutes of Natural Sciences, Aichi, Japan.,Exploratory Research Center on Life and Living Systems (ExCELLS), National Institutes of Natural Sciences, Aichi, Japan.,SOKENDAI (School of Life Science, The Graduate University for Advanced Studies), Aichi, Japan.,Shinshu University School of Medicine, Nagano, Japan
| | - Tsukasa Shimauchi
- National Institute for Physiological Sciences (NIPS), National Institutes of Natural Sciences, Aichi, Japan.,Exploratory Research Center on Life and Living Systems (ExCELLS), National Institutes of Natural Sciences, Aichi, Japan.,Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan.,Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuri Kato
- Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiro Nishiyama
- Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiyuki Nishimura
- National Institute for Physiological Sciences (NIPS), National Institutes of Natural Sciences, Aichi, Japan.,Exploratory Research Center on Life and Living Systems (ExCELLS), National Institutes of Natural Sciences, Aichi, Japan.,SOKENDAI (School of Life Science, The Graduate University for Advanced Studies), Aichi, Japan
| | - Kosuke Sakata
- Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Inada
- National Institute for Physiological Sciences (NIPS), National Institutes of Natural Sciences, Aichi, Japan
| | - Satomi Kita
- Faculty of Medicine, Fukuoka University, Fukuoka, Japan.,Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima, Japan
| | | | - Junichi Nabekura
- National Institute for Physiological Sciences (NIPS), National Institutes of Natural Sciences, Aichi, Japan
| | - Lutz Birnbaumer
- NIEHS, NIH, Research Triangle Park, North Carolina, USA.,Institute for Biomedical Research (BIOMED), Catholic University of Argentina, Buenos Aires, Argentina
| | - Yasuo Mori
- Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Motohiro Nishida
- National Institute for Physiological Sciences (NIPS), National Institutes of Natural Sciences, Aichi, Japan.,Exploratory Research Center on Life and Living Systems (ExCELLS), National Institutes of Natural Sciences, Aichi, Japan.,SOKENDAI (School of Life Science, The Graduate University for Advanced Studies), Aichi, Japan.,Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
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12
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Fallahtafti F, Salamifar Z, Hassan M, Rahman H, Pipinos I, Myers SA. Joint Angle Variability Is Altered in Patients with Peripheral Artery Disease after Six Months of Exercise Intervention. ENTROPY (BASEL, SWITZERLAND) 2022; 24:1422. [PMID: 37420442 PMCID: PMC9602135 DOI: 10.3390/e24101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/23/2022] [Accepted: 10/01/2022] [Indexed: 07/09/2023]
Abstract
Supervised exercise therapy (SET) is a conservative non-operative treatment strategy for improving walking performance in patients with peripheral artery disease (PAD). Gait variability is altered in patients with PAD, but the effect of SET on gait variability is unknown. Forty-three claudicating patients with PAD underwent gait analysis before and immediately after a 6-month SET program. Nonlinear gait variability was assessed using sample entropy, and the largest Lyapunov exponent of the ankle, knee, and hip joint angle time series. Linear mean and variability of the range of motion time series for these three joint angles were also calculated. Two-factor repeated measure analysis of variance determined the effect of the intervention and joint location on linear and nonlinear dependent variables. After SET, walking regularity decreased, while the stability remained unaffected. Ankle nonlinear variability had increased values compared with the knee and hip joints. Linear measures did not change following SET, except for knee angle, in which the magnitude of variations increased after the intervention. A six-month SET program produced changes in gait variability toward the direction of healthy controls, which indicates that in general, SET improved walking performance in individuals with PAD.
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Affiliation(s)
- Farahnaz Fallahtafti
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
| | - Zahra Salamifar
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
| | - Mahdi Hassan
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Hafizur Rahman
- School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA
| | - Iraklis Pipinos
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68105, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
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13
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Liu Y, Tang Q, Feng J, Liu J, Tang C, Yan M, Zhou S, Liu L, Zhou J, Zhang J. Effects of molecular weight on intestinal anti-inflammatory activities of β-D-glucan from Ganoderma lucidum. Front Nutr 2022; 9:1028727. [PMID: 36245525 PMCID: PMC9557179 DOI: 10.3389/fnut.2022.1028727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
To investigate the influence of molecular weight (Mw) on the anti-inflammatory activity of β-D-glucan from Ganoderma lucidum, ultrasonic irradiation was applied to treat the β-D-glucan (GLP, 2.42 × 106 g/mol) solution to obtain two degraded fractions with molecular weight of 6.53 × 105 g/mol (GLPC) and 3.49 × 104 g/mol (GLPN). Structural analysis proved that the degraded fractions possessed similar repeated units with the original β-D-glucan. The in vitro anti-inflammatory activity studies showed that all fractions could significantly inhibit LPS-induced expression of cytokines including TNF-α, IL-8, MIF and MCP-1 in Caco-2 cells at certain concentrations. Moreover, GLPC and GLPN exhibited better anti-inflammatory activity than GLPC. The intestinal anti-inflammatory activity evaluated by dextran sulfate sodium (DSS)—induced colitis mice model showed that intragastric administration of GLPN (lower Mw fraction) could significantly recover inflamed tissues of mice. Compared with GLP and GLPC, GLPN exhibited stronger ability to inhibit the secretion of pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6). The results revealed that Mw of β-D-glucan influenced its anti-inflammatory activity and decreasing of Mw would improve the activity, which provided evidence for the potential use of β-D-glucan from G. lucidum as anti-colitis ingredients.
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Affiliation(s)
- Yanfang Liu
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, Ministry of Agriculture, Shanghai, China
- Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, China
- National Engineering Research Center of Edible Fungi, Shanghai, China
| | - Qingjiu Tang
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, Ministry of Agriculture, Shanghai, China
- Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, China
- National Engineering Research Center of Edible Fungi, Shanghai, China
| | - Jie Feng
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, Ministry of Agriculture, Shanghai, China
- Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, China
- National Engineering Research Center of Edible Fungi, Shanghai, China
| | - Jing Liu
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, Ministry of Agriculture, Shanghai, China
- Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, China
- National Engineering Research Center of Edible Fungi, Shanghai, China
| | - Chuanhong Tang
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, Ministry of Agriculture, Shanghai, China
- Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, China
- National Engineering Research Center of Edible Fungi, Shanghai, China
| | - Mengqiu Yan
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, Ministry of Agriculture, Shanghai, China
- Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, China
- National Engineering Research Center of Edible Fungi, Shanghai, China
| | - Shuai Zhou
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, Ministry of Agriculture, Shanghai, China
- Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, China
- National Engineering Research Center of Edible Fungi, Shanghai, China
| | - Liping Liu
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, Ministry of Agriculture, Shanghai, China
- Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, China
- National Engineering Research Center of Edible Fungi, Shanghai, China
| | - Jing Zhou
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, Ministry of Agriculture, Shanghai, China
- Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, China
- National Engineering Research Center of Edible Fungi, Shanghai, China
- Shanghai Baixin Bio-Tech Co., Ltd., Shanghai, China
| | - Jingsong Zhang
- Institute of Edible Fungi, Shanghai Academy of Agricultural Sciences, Ministry of Agriculture, Shanghai, China
- Key Laboratory of Edible Fungi Resources and Utilization (South), Ministry of Agriculture, Shanghai, China
- National Engineering Research Center of Edible Fungi, Shanghai, China
- *Correspondence: Jingsong Zhang
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14
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Englund EK, Langham MC, Wehrli FW, Fanning MJ, Khan Z, Schmitz KH, Ratcliffe SJ, Floyd TF, Mohler ER. Impact of supervised exercise on skeletal muscle blood flow and vascular function measured with MRI in patients with peripheral artery disease. Am J Physiol Heart Circ Physiol 2022; 323:H388-H396. [PMID: 35802515 PMCID: PMC9359664 DOI: 10.1152/ajpheart.00633.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/21/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Supervised exercise is a common therapeutic intervention for patients with peripheral artery disease (PAD), however, the mechanism underlying the improvement in claudication symptomatology is not completely understood. The hypothesis that exercise improves microvascular blood flow is herein tested via temporally resolved magnetic resonance imaging (MRI) measurement of blood flow and oxygenation dynamics during reactive hyperemia in the leg with the lower ankle-brachial index. One hundred and forty-eight subjects with PAD were prospectively assigned to standard medical care or 3 mo of supervised exercise therapy. Before and after the intervention period, subjects performed a graded treadmill walking test, and MRI data were collected with Perfusion, Intravascular Venous Oxygen saturation, and T2* (PIVOT), a method that simultaneously quantifies microvascular perfusion, as well as relative oxygenation changes in skeletal muscle and venous oxygen saturation in a large draining vein. The 3-mo exercise intervention was associated with an improvement in peak walking time (64% greater in those randomized to the exercise group at follow-up, P < 0.001). Significant differences were not observed in the MRI measures between the subjects randomized to exercise therapy versus standard medical care based on an intention-to-treat analysis. However, the peak postischemia perfusion averaged across the leg between baseline and follow-up visits increased by 10% (P = 0.021) in participants that were adherent to the exercise protocol (completed >80% of prescribed exercise visits). In this cohort of adherent exercisers, there was no difference in the time to peak perfusion or oxygenation metrics, suggesting that there was no improvement in microvascular function nor changes in tissue metabolism in response to the 3-mo exercise intervention.NEW & NOTEWORTHY Supervised exercise interventions can improve symptomatology in patients with peripheral artery disease, but the underlying mechanism remains unclear. Here, MRI was used to evaluate perfusion, relative tissue oxygenation, and venous oxygen saturation in response to cuff-induced ischemia. Reactive hyperemia responses were measured before and after 3 mo of randomized supervised exercise therapy or standard medical care. Those participants who were adherent to the exercise regimen had a significant improvement in peak perfusion.
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Affiliation(s)
- Erin K Englund
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael C Langham
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Molly J Fanning
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zeeshan Khan
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Penn State University, University Park, Pennsylvania
| | - Sarah J Ratcliffe
- Department of Biostatistics, University of Virginia, Charlottesville, Virginia
| | - Thomas F Floyd
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas
| | - Emile R Mohler
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Integrative Analysis of Bulk RNA-Seq and Single-Cell RNA-Seq Unveils the Characteristics of the Immune Microenvironment and Prognosis Signature in Prostate Cancer. JOURNAL OF ONCOLOGY 2022; 2022:6768139. [PMID: 35909899 PMCID: PMC9325591 DOI: 10.1155/2022/6768139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 12/01/2022]
Abstract
The immune microenvironment is a culmination of the collaborative effort of immune cells and is important in cancer development. The underlying mechanisms of the tumor immune microenvironment in regulating prostate cancer (PRAD) are unclear. In the current study, 144 natural killer cell-related genes were identified using differential expression, single-sample gene set enrichment analysis, and weighted gene coexpression network analysis. Furthermore, VCL, ACTA2, MYL9, MYLK, MYH11, TPM1, ACTG2, TAGLN, and FLNC were selected as hub genes via the protein-protein interaction network. Based on the expression patterns of the hub genes, endothelial, epithelial, and tissue stem cells were identified as key cell subpopulations, which could regulate PRAD via immune response, extracellular signaling, and protein formation. Moreover, 27 genes were identified as prognostic signatures and used to construct the risk score model. Receiver operating characteristic curves revealed the good performance of the risk score model in both the training and testing datasets. Different chemotherapeutic responses were observed between the low- and high-risk groups. Additionally, a nomogram based on the risk score and other clinical features was established to predict the 1-, 3-, and 5-year progression-free interval of patients with PRAD. This study provides novel insights into the molecular mechanisms of the immune microenvironment and its role in the pathogenesis of PARD. The identification of key cell subpopulations has a potential therapeutic and prognostic use in PRAD.
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16
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Bronas UG, Regensteiner JG. Connecting the past to the present: A historical review of exercise training for peripheral artery disease. Vasc Med 2022; 27:174-185. [DOI: 10.1177/1358863x211073620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Peripheral artery disease (PAD), a prevalent manifestation of atherosclerosis, is associated with increased cardiovascular morbidity and mortality as well as decreased functional ability. Exercise training for PAD is acknowledged to be a highly effective treatment, which improves walking ability and cardiovascular risk. The historical development of this treatment has not been the focus of a report. Therefore, we present a historical review of research on exercise training for PAD. Overall, this body of knowledge has provided strong evidence of the efficacy of supervised exercise training (SET) to improve walking ability for patients with claudication due to PAD. SET, using intermittent bouts of walking exercise to moderate claudication pain on a treadmill, is considered the most efficacious mode of exercise to improve walking ability in patients with claudication. This compelling evidence published over the past 60 years was evaluated by the Centers for Medicare & Medicaid Services in 2017, which culminated in a national coverage determination for SET to improve symptomatic PAD. Future directions include determining optimal delivery strategies for SET and further elucidation of the mechanisms of improvement in walking ability resulting from SET. In addition, alternative forms of exercise should be evaluated and effective home- and community-based exercise interventions should be assessed. There is an enormous need to increase the inclusion of women and racial and ethnic minority groups in studies. It is to be hoped that researchers will continue with new innovative research and persistence in the treatment of claudication due to PAD.
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Affiliation(s)
- Ulf G Bronas
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois – Chicago, Chicago, IL, USA
| | - Judith G Regensteiner
- Ludeman Family Center for Women’s Health Research; Divisions of General Internal Medicine and Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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17
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Gómez-García M, Torrado J, Bia D, Zócalo Y. Influence of Epoch Length and Recording Site on the Relationship Between Tri-Axial Accelerometry-Derived Physical Activity Levels and Structural, Functional, and Hemodynamic Properties of Central and Peripheral Arteries. Front Sports Act Living 2022; 4:799659. [PMID: 35280222 PMCID: PMC8909126 DOI: 10.3389/fspor.2022.799659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
BackgroundIt remains to be established to what extent physical activity (PA) levels among individuals are independently associated with deviations from the “optimal” state of the arterial system. Accelerometers have been proposed as means to obtain reliable, objective, and more comprehensive data of PA. Decisions at the time of data collection/processing could influence the association between accelerometry-derived indices and arterial properties.Objectives(i) To identify to what extent the strength of association between arterial properties and accelerometer-derived indices depend on the recording site and/or the epoch length; (ii) to determine whether some arterial characteristics (hemodynamic vs. structural vs. functional) or regions (elastic vs. transitional vs. muscular arteries; central vs. peripheral) have higher levels of association with accelerometry-derived indices.MethodsPhysical activity (PA), cardiovascular risk factors (CRFs), and cardiovascular properties were evaluated in 60 volunteers (general population; age: 23–62 years; women: 43%). PA was measured daily for 7 days (free-living situation; triaxial-accelerometers ActiGraph-GT3X+; hip and wrist; “Worn-to-wrist” option) and raw data was converted at epoch lengths of 1, 5, 10, 30, and 60-s. PA-related energy expenditure, daily time in moderate-to-vigorous PA, steps/minute, and counts-per-minute for vector magnitude were calculated. The cardiovascular evaluation included hemodynamic (central and peripheral pressure), structural (diameters and intima-media thickness), and functional (local and regional stiffness) parameters of carotids, femoral, and brachial arteries, and carotid-femoral and carotid-radial pathways. Arterial z-scores were obtained using age-related equations derived from healthy participants not exposed to CRFs (n = 1,688; age: 2–84 years; female: 51.2%) to evaluate at which degree each parameter deviates from the “optimal” value.MethodsIn general, hip recordings outperformed those obtained on the wrist regarding the strength of association with arterial parameters. Accelerometer-derived indices and their association with arterial properties vary depending on the recording site and epoch length. PA indices are stronger associated with functional (local) than structural variables and with central than peripheral arteries.ConclusionsRegardless of the PA index, there were independent associations with central artery characteristics, which reinforces that these territories would be the most related to PA levels. Differences in data acquisition and processing could lead to differences in conclusions when addressing the association between accelerometer-derived indices and the cardiovascular system.
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Affiliation(s)
- Mariana Gómez-García
- Departamento de Educación Física y Salud, Instituto Superior de Educación Física, Universidad de la República, Montevideo, Uruguay
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
| | - Juan Torrado
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
| | - Daniel Bia
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
| | - Yanina Zócalo
- Grupo “Centro Universitario de Investigación, Innovación y Diagnóstico Arterial – Movimiento, Actividad, Salud” (CUiiDARTE-MAS), Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República, Montevideo, Uruguay
- Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo, Uruguay
- *Correspondence: Yanina Zócalo
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18
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Hamid HA, Sarmadi VH, Prasad V, Ramasamy R, Miskon A. Electromagnetic field exposure as a plausible approach to enhance the proliferation and differentiation of mesenchymal stem cells in clinically relevant scenarios. J Zhejiang Univ Sci B 2022; 23:42-57. [PMID: 35029087 PMCID: PMC8758935 DOI: 10.1631/jzus.b2100443] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mesenchymal stem/stromal cell (MSC)-based therapy has been regarded as one of the most revolutionary breakthroughs in the history of modern medicine owing to its myriad of immunoregulatory and regenerative properties. With the rapid progress in the fields of osteo- and musculoskeletal therapies, the demand for MSC-based treatment modalities is becoming increasingly prominent. In this endeavor, researchers around the world have devised new and innovative techniques to support the proliferation of MSCs while minimizing the loss of hallmark features of stem cells. One such example is electromagnetic field (EMF) exposure, which is an alternative approach with promising potential. In this review, we present a critical discourse on the efficiency, practicability, and limitations of some of the relevant methods, with insurmountable evidence backing the implementation of EMF as a feasible strategy for the clinically relevant expansion of MSCs.
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Affiliation(s)
- Haslinda Abdul Hamid
- Bio-artificial Organ and Regenerative Medicine Unit, National Defense University of Malaysia, Kuala Lumpur 57000, Malaysia
| | - Vahid Hosseinpour Sarmadi
- Cellular and Molecular Research Centre, Iran University of Medical Sciences, Tehran 144961 4535, Iran.,Institutes of Regenerative Medicine, Iran University of Medical Sciences, Tehran 199671 4353, Iran
| | - Vivek Prasad
- Stem Cell and Immunity Research Group, Immunology Laboratory, Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Selangor 43400, Malaysia
| | - Rajesh Ramasamy
- Stem Cell and Immunity Research Group, Immunology Laboratory, Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Selangor 43400, Malaysia
| | - Azizi Miskon
- Bio-artificial Organ and Regenerative Medicine Unit, National Defense University of Malaysia, Kuala Lumpur 57000, Malaysia.
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19
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Fu X, Qi Y, Han P, Chen X, Jin F, Shen Z, Mou Y, Qi Z, Zhu J, Chen Y, Zhou W, Zheng Y, Zhang Z, Li M, Guo Q. Relationship Between Physical Performance and Peripheral Arterial Diseases in Different Age Groups of Chinese Community-Dwelling Older Adults. J Atheroscler Thromb 2022. [DOI: 10.5551/jat.63697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Xiya Fu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital
| | - Yiqiong Qi
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital
| | - Xiaoyu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital
| | - Feng Jin
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital
| | - Zezhuo Shen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences
| | - Yikai Mou
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences
| | - Zhengwei Qi
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences
| | - Jiacheng Zhu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences
| | - Yangyi Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences
| | - Wenjing Zhou
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences
| | | | | | - Ming Li
- Office of the President, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital
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20
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Zhang Y, Wang H, Oliveira RHM, Zhao C, Popel AS. Systems biology of angiogenesis signaling: Computational models and omics. WIREs Mech Dis 2021; 14:e1550. [PMID: 34970866 PMCID: PMC9243197 DOI: 10.1002/wsbm.1550] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 01/10/2023]
Abstract
Angiogenesis is a highly regulated multiscale process that involves a plethora of cells, their cellular signal transduction, activation, proliferation, differentiation, as well as their intercellular communication. The coordinated execution and integration of such complex signaling programs is critical for physiological angiogenesis to take place in normal growth, development, exercise, and wound healing, while its dysregulation is critically linked to many major human diseases such as cancer, cardiovascular diseases, and ocular disorders; it is also crucial in regenerative medicine. Although huge efforts have been devoted to drug development for these diseases by investigation of angiogenesis‐targeted therapies, only a few therapeutics and targets have proved effective in humans due to the innate multiscale complexity and nonlinearity in the process of angiogenic signaling. As a promising approach that can help better address this challenge, systems biology modeling allows the integration of knowledge across studies and scales and provides a powerful means to mechanistically elucidate and connect the individual molecular and cellular signaling components that function in concert to regulate angiogenesis. In this review, we summarize and discuss how systems biology modeling studies, at the pathway‐, cell‐, tissue‐, and whole body‐levels, have advanced our understanding of signaling in angiogenesis and thereby delivered new translational insights for human diseases. This article is categorized under:Cardiovascular Diseases > Computational Models Cancer > Computational Models
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Affiliation(s)
- Yu Zhang
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanwen Wang
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebeca Hannah M Oliveira
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chen Zhao
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Aleksander S Popel
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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21
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Therapy of Pseudoxanthoma Elasticum: Current Knowledge and Future Perspectives. Biomedicines 2021; 9:biomedicines9121895. [PMID: 34944710 PMCID: PMC8698611 DOI: 10.3390/biomedicines9121895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
Pseudoxanthoma elasticum (PXE) is a rare, genetic, metabolic disease with an estimated prevalence of between 1 per 25,000 and 56,000. Its main hallmarks are characteristic skin lesions, development of choroidal neovascularization, and early-onset arterial calcification accompanied by a severe reduction in quality-of-life. Underlying the pathology are recessively transmitted pathogenic variants of the ABCC6 gene, which results in a deficiency of ABCC6 protein. This results in reduced levels of peripheral pyrophosphate, a strong inhibitor of peripheral calcification, but also dysregulation of blood lipids. Although various treatment options have emerged during the last 20 years, many are either already outdated or not yet ready to be applied generally. Clinical physicians often are left stranded while patients suffer from the consequences of outdated therapies, or feel unrecognized by their attending doctors who may feel uncertain about using new therapeutic approaches or not even know about them. In this review, we summarize the broad spectrum of treatment options for PXE, focusing on currently available clinical options, the latest research and development, and future perspectives.
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Stavres J, Wang J, Sica CT, Blaha C, Herr M, Pai S, Cauffman A, Vesek J, Yang QX, Sinoway LI. Diffusion tensor imaging indices of acute muscle damage are augmented after exercise in peripheral arterial disease. Eur J Appl Physiol 2021; 121:2595-2606. [PMID: 34106324 PMCID: PMC10445221 DOI: 10.1007/s00421-021-04711-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/05/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Although it is known that peripheral arterial disease (PAD) is associated with chronic myopathies, the acute muscular responses to exercise in this population are less clear. This study used diffusion tensor imaging (DTI) to compare acute exercise-related muscle damage between PAD patients and healthy controls. METHODS Eight PAD patients and seven healthy controls performed graded plantar flexion in the bore of a 3T MRI scanner. Exercise began at 2 kg and increased by 2 kg every 2 min until failure, or completion of 10 min of exercise. DTI images were acquired from the lower leg pre- and post-exercise, and were analyzed for mean diffusivity, fractional anisotropy (FA), and eigenvalues 1-3 (λ1-3) of the medial gastrocnemius (MG) and tibialis anterior (TA). RESULTS Results indicated a significant leg by time interaction for mean diffusivity, explained by a significantly greater increase in diffusivity of the MG in the most affected legs of PAD patients (11.1 × 10-4 ± 0.5 × 10-4 mm2/s vs. 12.7 × 10-4 ± 1.2 × 10-4 mm2/s at pre and post, respectively, P = 0.02) compared to healthy control subjects (10.8 × 10-4 ± 0.3 × 10-4 mm2/s vs. 11.2 × 10-4 ± 0.5 × 10-4 mm2/s at pre and post, respectively, P = 1.0). No significant differences were observed for the TA, or λ1-3 (all P ≥ 0.06). Moreover, no reciprocal changes were observed for FA in either group (all P ≥ 0.29). CONCLUSION These data suggest that calf muscle diffusivity increases more in PAD patients compared to controls after exercise. These findings are consistent with the notion that acute exercise results in increased muscle damage in PAD.
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Affiliation(s)
- Jon Stavres
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Jianli Wang
- Department of Radiology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christopher T Sica
- Department of Radiology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Cheryl Blaha
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Michael Herr
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Samuel Pai
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Aimee Cauffman
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jeffrey Vesek
- Department of Molecular Biology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Qing X Yang
- Department of Radiology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Lawrence I Sinoway
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
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23
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Seed SA, Harwood AE, Sinclair J, Pymer S, Caldow E, Ingle L, Egun A, Birkett ST. A Systematic Review of Exercise Prescription in Patients with Intermittent Claudication: Does Pain Matter? Ann Vasc Surg 2021; 77:315-323. [PMID: 34464728 DOI: 10.1016/j.avsg.2021.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Current guidelines for intermittent claudication advocate exercise at moderate to maximal claudication pain. However, adherence rates to supervised exercise programmes (SEP) remain poor and claudication pain is a contributing factor. Limited evidence suggests that moderate or pain-free exercise may be just as beneficial and may be better tolerated. However, it remains unclear what 'level' of claudication pain is optimal for improving functional outcomes. We therefore conducted a systematic review to synthesise the evidence for exercise prescribed at different levels of claudication pain. METHODS The CENTRAL, MEDLINE, Embase and CINAHL databases were searched up to October 2020. Randomized controlled trials (RCTs) that directly compared at least 2 different intensities of claudication pain were included. Outcome measures included walking performance, adherence, quality of life and vascular function. RESULTS Of 1,543 search results, 2 studies were included. Maximal walking distance improved by 100-128% in the moderate-pain SEP groups, and by 77-90% in the pain-free SEP groups. Importantly, there were no significant differences between the moderate-pain and pain-free SEP groups in either study for improvements in walking performance, though comparison to a maximal-pain SEP group was not made. CONCLUSIONS The efficacy of SEPs for patients with intermittent claudication is irrefutable, though there is no consensus on the optimal level of pain. Therefore, adequately powered RCTs are required to compare the effect of pain-free SEPs, moderate-pain SEPs and maximal-pain SEPs on functional outcomes. (PROSPERO ID: CRD42020213684).
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Affiliation(s)
- Sally A Seed
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK.
| | - Amy E Harwood
- Centre for Sports, Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Jonathan Sinclair
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Sean Pymer
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Edward Caldow
- School of Health and Society, University of Salford, Salford, UK
| | - Lee Ingle
- Department of Sport, Health and Exercise Science, University of Hull, Hull, UK
| | - Anselm Egun
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Stefan T Birkett
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
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Li Q, Gao B, Siqin B, He Q, Zhang R, Meng X, Zhang N, Zhang N, Li M. Gut Microbiota: A Novel Regulator of Cardiovascular Disease and Key Factor in the Therapeutic Effects of Flavonoids. Front Pharmacol 2021; 12:651926. [PMID: 34220497 PMCID: PMC8241904 DOI: 10.3389/fphar.2021.651926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/23/2021] [Indexed: 01/30/2023] Open
Abstract
Cardiovascular disease is the main cause of death worldwide, and traditional cardiovascular risk factors cannot fully explain the occurrence of the disease. In recent years, the relationship between gut microbiota and its metabolites and cardiovascular disease has been a hot study topic. The changes in gut microbiota and its metabolites are related to the occurrence and development of atherosclerosis, myocardial infarction, heart failure, and hypertension. The mechanisms by which gut microbiota and its metabolites influence cardiovascular disease have been reported, although not comprehensively. Additionally, following ingestion, flavonoids are decomposed into phenolic acids that are more easily absorbed by the body after being processed by enzymes produced by intestinal microorganisms, which increases flavonoid bioavailability and activity, consequently affecting the onset of cardiovascular disease. However, flavonoids can also inhibit the growth of harmful microorganisms, promote the proliferation of beneficial microorganisms, and maintain the balance of gut microbiota. Hence, it is important to study the relationship between gut microbiota and flavonoids to elucidate the protective effects of flavonoids in cardiovascular diseases. This article will review the role and mechanism of gut microbiota and its metabolites in the occurrence and development of atherosclerosis, myocardial infarction, heart failure, and hypertension. It also discusses the potential value of flavonoids in the prevention and treatment of cardiovascular disease following their transformation through gut microbiota metabolism.
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Affiliation(s)
- Qinyu Li
- Department of Pharmacy, Baotou Medical College, Baotou, China
| | - Bing Gao
- Department of Pharmacy, Baotou Medical College, Baotou, China
| | - Bateer Siqin
- Xilinguole Meng Mongolian General Hospital, Xilinhaote, China
| | - Qian He
- Department of Pharmacy, Baotou Medical College, Baotou, China
| | - Ru Zhang
- Department of Pharmacy, Baotou Medical College, Baotou, China
| | - Xiangxi Meng
- Department of Pharmacy, Baotou Medical College, Baotou, China
| | - Naiheng Zhang
- Department of Pharmacy, Baotou Medical College, Baotou, China
| | - Na Zhang
- Department of Pharmacy, Baotou Medical College, Baotou, China
| | - Minhui Li
- Department of Pharmacy, Baotou Medical College, Baotou, China
- Pharmaceutical Laboratory, Inner Mongolia Institute of Traditional Chinese Medicine, Hohhot, China
- Inner Mongolia Key Laboratory of Characteristic Geoherbs Resources and Utilization, Baotou Medical College, Baotou, China
- Office of Academic Research, Qiqihar Medical University, Qiqihar, China
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25
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Cucato G, Perren D, Ritti-Dias RM, Saxton JM. Effects of additional exercise therapy after a successful vascular intervention for patients with symptomatic peripheral arterial disease. Hippokratia 2021. [DOI: 10.1002/14651858.cd014736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Gabriel Cucato
- Department of Sport, Exercise, and Rehabilitation; Northumbria University; Newcastle-upon-Tyne UK
| | - Daniel Perren
- Health Education England North East; Newcastle upon Tyne UK
| | | | - John M Saxton
- Department of Sport, Exercise, and Rehabilitation; Northumbria University; Newcastle-upon-Tyne UK
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26
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Deng Y, Tu Y, Lao S, Wu M, Yin H, Wang L, Liao W. The role and mechanism of citrus flavonoids in cardiovascular diseases prevention and treatment. Crit Rev Food Sci Nutr 2021; 62:7591-7614. [PMID: 33905288 DOI: 10.1080/10408398.2021.1915745] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cardiovascular diseases (CVDs) have been ranked as the leading cause of death in the world, whose global incidence is increasing year by year. Citrus, one of the most popular fruits in the world, is rich in flavonoids. Citrus flavonoids attract special attention due to a variety of biological activities, especially in the prevention and treatment of CVDs. The research progress of citrus flavonoids on CVDs have been constantly updated, but relatively fragmented, which needed to be systematically summarized. Hence, the recent research about citrus flavonoids and CVDs were reviewed, including the types and in vivo processes of citrus flavonoids, epidemiology study and mechanism on prevention and treatment of CVDs by citrus flavonoids. This review would provide a theoretical basis for the citrus flavonoids research and a new idea in the citrus industry development and application.
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Affiliation(s)
- Yudi Deng
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Yali Tu
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Shenghui Lao
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Mengting Wu
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Hantong Yin
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Linqing Wang
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenzhen Liao
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
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27
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Bashir AZ, Dinkel DM, Bapat GM, Despiegelaere H, Hassan M, Johanning JM, Pipinos II, Myers SA. Considerations for Implementation of an Ankle-Foot Orthosis to Improve Mobility in Peripheral Artery Disease. Arch Rehabil Res Clin Transl 2021; 3:100092. [PMID: 33778468 PMCID: PMC7984982 DOI: 10.1016/j.arrct.2020.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore the perceptions of wearing an ankle-foot orthosis (AFO) in patients with peripheral artery disease (PAD) who did and did not adopt the AFO intervention. This follows a clinical trial of the effectiveness of an AFO in improving walking distances for patients with PAD-related claudication. DESIGN A randomized crossover trial of standard of care and an AFO for 3 months. Semistructured interviews were conducted 1.5 months into the AFO intervention to understand acceptability, demand, implementation, and practicality. Data were analyzed using a summative content analysis approach. SETTING Vascular surgery clinic and biomechanics research laboratory. PARTICIPANTS Patients (N=15; male, 100%; age, 71.9±.6.7y; body mass index [calculated as weight in kilograms divided by height in meters squared], 29.0±.5.5; ankle brachial index: AFO intervention withdrawal, 0.543; AFO intervention completion, 0.740) with claudication completed the study, and 6 withdrew prior to intervention completion. INTERVENTIONS A certified orthotist fit participants with an AFO that was worn for 3 months. MAIN OUTCOME MEASURES Qualitative analysis of the semistructured interviews. RESULTS Key differences were reported between AFO intervention completion and AFO intervention withdrawal. Six of 14 of AFO intervention completion participants described their initial reactions to the AFO as negative vs 3 of 6 AFO intervention withdrawal participants. Only 5 of 15 AFO intervention completion participants reported minimal use of the AFO compared with 5 of 6 AFO intervention withdrawal participants. The AFO intervention withdrawal group reported higher levels of physical discomfort with the use of the AFO (4/6 vs 7/15) and preexisting health issues becoming a barrier to the use of the AFO (3/6 vs 5/15). Positive aspects reported included ease in standing and walking for AFO intervention withdrawal (4/6) and AFO intervention completion groups (13/15) as well as walking straighter and longer with less pain for AFO intervention withdrawal (3/6) and AFO intervention completion groups (9/15). CONCLUSIONS Patients withdrawing prior to completion of AFO intervention tended to have more negative perceptions, more comorbidities, and more physical discomfort than those completing the intervention. Both groups reported positive aspects of the AFO. Implementation studies are needed to address barriers to AFO adoption.
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Affiliation(s)
- Ayisha Z. Bashir
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska
| | - Danae M. Dinkel
- Department of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
| | - Ganesh M. Bapat
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska
| | - Holly Despiegelaere
- Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, Nebraska
| | - Mahdi Hassan
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska
| | - Jason M. Johanning
- Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, Nebraska
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Iraklis I. Pipinos
- Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, Nebraska
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sara A. Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska
- Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, Nebraska
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Barlow J, Sfyri PP, Mitchell R, Verpoorten S, Scully D, Andreou C, Papadopoulos P, Patel K, Matsakas A. Platelet releasate normalises the compromised muscle regeneration in a mouse model of hyperlipidaemia. Exp Physiol 2021; 106:700-713. [PMID: 33450106 DOI: 10.1113/ep088937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022]
Abstract
NEW FINDINGS What is the central question of this study? What is the impact of obesity-independent hyperlipidaemia on skeletal muscle stem cell function of ApoE-deficient (ApoE-/- ) mice? What is the main finding and its importance? Compromised muscle stem cell function accounts for the impaired muscle regeneration in hyperlipidaemic ApoE-/- mice. Importantly, impaired muscle regeneration is normalised by administration of platelet releasate. ABSTRACT Muscle satellite cells are important stem cells for skeletal muscle regeneration and repair after injury. ApoE-deficient mice, an established mouse model of hyperlipidaemia and atherosclerosis, show evidence of oxidative stress-induced lesions and fat infiltration in skeletal muscle followed by impaired repair after injury. However, the mechanisms underpinning attenuated muscle regeneration remain to be fully defined. Key to addressing the latter is to understand the properties of muscle stem cells from ApoE-deficient mice and their myogenic potential. Muscle stem cells from ApoE-deficient mice were cultured both ex vivo (on single fibres) and in vitro (primary myoblasts) and their myogenic capacity was determined. Skeletal muscle regeneration was studied on days 5 and 10 after cardiotoxin injury. ApoE-deficient muscle stem cells showed delayed activation and differentiation on single muscle fibres ex vivo. Impaired proliferation and differentiation profiles were also evident on isolated primary muscle stem cells in culture. ApoE-deficient mice displayed impaired skeletal muscle regeneration after acute injury in vivo. Administration of platelet releasate in ApoE-deficient mice reversed the deficits of muscle regeneration after acute injury to wild-type levels. These findings indicate that muscle stem cell myogenic potential is perturbed in skeletal muscle of a mouse model of hyperlipidaemia. We propose that platelet releasate could be a therapeutic intervention for conditions with associated myopathy such as peripheral arterial disease.
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Affiliation(s)
- Joseph Barlow
- Molecular Physiology Laboratory, Hull York Medical School, Centre for Atherothrombosis & Metabolic Disease, University of Hull, Hull, UK
| | - Pagona Panagiota Sfyri
- Molecular Physiology Laboratory, Hull York Medical School, Centre for Atherothrombosis & Metabolic Disease, University of Hull, Hull, UK
| | - Rob Mitchell
- School of Biological Sciences, University of Reading, Reading, UK
| | - Sandrine Verpoorten
- Molecular Physiology Laboratory, Hull York Medical School, Centre for Atherothrombosis & Metabolic Disease, University of Hull, Hull, UK
| | - David Scully
- Molecular Physiology Laboratory, Hull York Medical School, Centre for Atherothrombosis & Metabolic Disease, University of Hull, Hull, UK
| | - Charalampos Andreou
- Molecular Physiology Laboratory, Hull York Medical School, Centre for Atherothrombosis & Metabolic Disease, University of Hull, Hull, UK
| | - Petros Papadopoulos
- Department of Hematology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, UK
| | - Antonios Matsakas
- Molecular Physiology Laboratory, Hull York Medical School, Centre for Atherothrombosis & Metabolic Disease, University of Hull, Hull, UK
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29
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Zhang H, Rzechorzek W, Aghajanian A, Faber JE. Hypoxia induces de novo formation of cerebral collaterals and lessens the severity of ischemic stroke. J Cereb Blood Flow Metab 2020; 40:1806-1822. [PMID: 32423327 PMCID: PMC7430105 DOI: 10.1177/0271678x20924107] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Pial collaterals provide protection in stroke. Evidence suggests their formation late during gestation (collaterogenesis) is driven by reduced oxygen levels in the cerebral watersheds. The purpose of this study was to determine if collaterogenesis can be re-activated in the adult to induce formation of additional collaterals ("neo-collateral formation", NCF). Mice were gradually acclimated to reduced inspired oxygen (FIO2) and maintained at 12, 10, 8.5 or 7% for two-to-eight weeks. Hypoxemia induced "dose"-dependent NCF and remodeling of native collaterals, and decreased infarct volume after permanent MCA occlusion. In contrast, no formation occurred of addition collateral-like intra-tree anastomoses, PComs, or branches within the MCA tree. Hypoxic NCF, remodeling and infarct protection were durable, i.e. retained for at least six weeks after return to normoxia. Hypoxia increased expression of Hif2α, Vegfa, Rabep2, Angpt2, Tie2 and Cxcr4. Neo-collateral formation was abolished in mice lacking Rabep2, a novel gene involved in VEGFA→Flk1 signaling and required for formation of collaterals during development, and inhibited by knockdown of Vegfa, Flk1 and Cxcr4. Rabep2-dependent NCF was also induced by permanent MCA occlusion. This is the first report that hypoxia induces new pial collaterals to form. Hypoxia- and occlusion-induced neo-collateral formation provide models to study collaterogenesis in the adult.
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Affiliation(s)
- Hua Zhang
- Department of Cell Biology and Physiology, McAllister Heart Institute, Curriculum in Neurobiology, University of North Carolina at Chapel Hill, NC, USA
| | - Wojciech Rzechorzek
- Department of Cell Biology and Physiology, McAllister Heart Institute, Curriculum in Neurobiology, University of North Carolina at Chapel Hill, NC, USA
| | - Amir Aghajanian
- Department of Cell Biology and Physiology, McAllister Heart Institute, Curriculum in Neurobiology, University of North Carolina at Chapel Hill, NC, USA
| | - James E Faber
- Department of Cell Biology and Physiology, McAllister Heart Institute, Curriculum in Neurobiology, University of North Carolina at Chapel Hill, NC, USA
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Cordova-Fraga T, García D, Murillo-Ortiz B, García M, Gomez C, Amador-Medina F, Guzman-Cabrera R. Digital processing of ultrasound images on dilated blood vessels from diabetic patients. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2020. [DOI: 10.3233/jifs-179914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Peripheral arterial disease (PAD) is a fairly common degenerative vascular condition in diabetic patients that leads to inadequate blood flow (BF), this disease is mainly due to atherosclerosis that causes chronic narrowing of arteries, which can precipitate acute thrombotic events. In patients with diabetes, atherosclerosis is the main reason for reducing life expectancy, as long as diabetic nephropathy and retinopathy are the largest contributors to end-stage renal disease and blindness, respectively. Objective This was an assessment of dilatation of the blood vessels on diabetic patients vs. healthy volunteers by using digital processing of imaging’s. Materials and Methods The study subject was ultrasound imaging processing of blood vessels dilation on low extremities of diabetic patients, the results were compared with ultrasound images of healthy subjects. Results The digital images processing suggests that there is a significant difference among images experimental of the diabetic group and healthy volunteers’ images, the control group. Discussion The digital imaging processing performed in the Matlab platform is an adequate procedure for blood vessels dilation analysis of the ultrasound images taken from the lower extremities in diabetic patients.
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Affiliation(s)
| | - Daniel García
- Department of Physical Engineering - DCI, University of Guanajuato León campus
| | | | - Marysol García
- Department of Physical Engineering - DCI, University of Guanajuato León campus
| | - Christian Gomez
- Department of Physical Engineering - DCI, University of Guanajuato León campus
| | | | - Rafael Guzman-Cabrera
- Department of Electrical Engineering - DICIS, University of Guanajuato campus, Irapuato Salamanca
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31
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Jansen SC, Abaraogu UO, Lauret GJ, Fakhry F, Fokkenrood HJ, Teijink JA. Modes of exercise training for intermittent claudication. Cochrane Database Syst Rev 2020; 8:CD009638. [PMID: 32829481 PMCID: PMC8092668 DOI: 10.1002/14651858.cd009638.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND According to international guidelines and literature, all patients with intermittent claudication should receive an initial treatment of cardiovascular risk modification, lifestyle coaching, and supervised exercise therapy. In the literature, supervised exercise therapy often consists of treadmill or track walking. However, alternative modes of exercise therapy have been described and yielded similar results to walking. This raises the following question: which exercise mode produces the most favourable results? This is the first update of the original review published in 2014. OBJECTIVES To assess the effects of alternative modes of supervised exercise therapy compared to traditional walking exercise in patients with intermittent claudication. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 4 March 2019. We also undertook reference checking, citation searching and contact with study authors to identify additional studies. No language restriction was applied. SELECTION CRITERIA We included parallel-group randomised controlled trials comparing alternative modes of exercise training or combinations of exercise modes with a control group of supervised walking exercise in patients with clinically determined intermittent claudication. The supervised walking programme needed to be supervised at least twice a week for a consecutive six weeks of training. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data, and assessed the risk of bias for each study. As we included studies with different treadmill test protocols and different measuring units (metres, minutes, or seconds), the standardised mean difference (SMD) approach was used for summary statistics of mean walking distance (MWD) and pain-free walking distance (PFWD). Summary estimates were obtained for all outcome measures using a random-effects model. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS For this update, five additional studies were included, making a total of 10 studies that randomised a total of 527 participants with intermittent claudication (IC). The alternative modes of exercise therapy included cycling, lower-extremity resistance training, upper-arm ergometry, Nordic walking, and combinations of exercise modes. Besides randomised controlled trials, two quasi-randomised trials were included. Overall risk of bias in included studies varied from high to low. According to GRADE criteria, the certainty of the evidence was downgraded to low, due to the relatively small sample sizes, clinical inconsistency, and inclusion of three studies with risk of bias concerns. Overall, comparing alternative exercise modes versus walking showed no clear differences for MWD at 12 weeks (standardised mean difference (SMD) -0.01, 95% confidence interval (CI) -0.29 to 0.27; P = 0.95; 6 studies; 274 participants; low-certainty evidence); or at the end of training (SMD -0.11, 95% CI -0.33 to 0.11; P = 0.32; 9 studies; 412 participants; low-certainty evidence). Similarly, no clear differences were detected in PFWD at 12 weeks (SMD -0.01, 95% CI -0.26 to 0.25; P = 0.97; 5 studies; 249 participants; low-certainty evidence); or at the end of training (SMD -0.06, 95% CI -0.30 to 0.17; P = 0.59; 8 studies, 382 participants; low-certainty evidence). Four studies reported on health-related quality of life (HR-QoL) and three studies reported on functional impairment. As the studies used different measurements, meta-analysis was only possible for the walking impairment questionnaire (WIQ) distance score, which demonstrated little or no difference between groups (MD -5.52, 95% CI -17.41 to 6.36; P = 0.36; 2 studies; 96 participants; low-certainty evidence). AUTHORS' CONCLUSIONS This review found no clear difference between alternative exercise modes and supervised walking exercise in improving the maximum and pain-free walking distance in patients with intermittent claudication. The certainty of this evidence was judged to be low, due to clinical inconsistency, small sample size and risk of bias concerns. The findings of this review indicate that alternative exercise modes may be useful when supervised walking exercise is not an option. More RCTs with adequate methodological quality and sufficient power are needed to provide solid evidence for comparisons between each alternative exercise mode and the current standard of supervised treadmill walking. Future RCTs should investigate outcome measures on walking behaviour, physical activity, cardiovascular risk, and HR-QoL, using standardised testing methods and reporting of outcomes to allow meaningful comparison across studies.
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Affiliation(s)
- Sandra Cp Jansen
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ukachukwu Okoroafor Abaraogu
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Medical Rehabilitation, University of Nigeria, Nsukka, Nigeria
| | - Gert Jan Lauret
- Department of Vascular Surgery, Slingeland Hospital, Doetinchem, Netherlands
| | - Farzin Fakhry
- Department of Cardiology, Haga Teaching Hospital, The Hague, Netherlands
| | - Hugo Jp Fokkenrood
- Department of Vascular Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Joep Aw Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands
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Yao W, Wang L, Chen Q, Wang F, Feng N. Effects of Valsartan on Restenosis in Patients with Arteriosclerosis Obliterans of the Lower Extremities Undergoing Interventional Therapy: A Prospective, Randomized, Single-Blind Trial. Med Sci Monit 2020; 26:e919977. [PMID: 32541643 PMCID: PMC7318833 DOI: 10.12659/msm.919977] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/06/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to further clarify the effects of valsartan on restenosis in patients with arteriosclerosis obliterans of the lower extremities. MATERIAL AND METHODS Patients with arteriosclerosis obliterans of the lower extremities undergoing continuous stent implantation in the superficial femoral artery were enrolled and randomly divided into an ARB group and a control group. Patients in the ARB group received valsartan orally in a single-blind manner and were followed up for 6 months. An evaluation was performed based on the criteria for clinical efficacies designed by the Committee of Vascular Disease, Chinese Association of Integrative Medicine. The total clinical effective rate was calculated, and ankle brachial index (ABI) of the patients was assessed. The concentrations of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) were measured using enzyme-linked immunosorbent assay. The in-stent restenosis of patients was examined by angiography. RESULTS One patient in the control group died due to acute cerebral hemorrhage 4 months after enrollment, and 1 patient was lost to follow-up due to acute myocardial infarction during follow-up 5 months after enrollment. Age, sex, Fontaine stage, and underlying diseases were comparable between the 2 groups. Hs-CRP (3.93±1.43) and IL-6 (11.26±2.29) levels were significant different in the ARB group compared with the control group. The postoperative follow-up showed that ABI was 0.98±0.20 in the ARB group and 0.62±0.48 in the control group. CONCLUSIONS Valsartan inhibited the increase in hs-CRP and IL-6 levels, improved clinical efficacies, increased ABI, and decreased the restenosis rate after the interventional therapy in patients with arteriosclerosis obliterans of the lower extremities.
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Affiliation(s)
- Wei Yao
- Department of Cardiology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, Hebei, P.R.China
| | - Lixin Wang
- Department of Interventional Vascular Surgery, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, Hebei, P.R.China
| | - Qing Chen
- Department of Cardiology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, Hebei, P.R.China
| | - Fang Wang
- Department of Cardiology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, Hebei, P.R.China
| | - Nana Feng
- Department of Cardiology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, Hebei, P.R.China
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Rezvani F, Heider D, Härter M, König HH, Bienert F, Brinkmann J, Herbarth L, Kramer E, Steinisch P, Freudenstein F, Terhalle R, Grosse Y, Bock S, Posselt J, Beutel C, Reif F, Kirchhoff F, Neuschwander C, Löffler F, Brunner L, Dickmeis P, Heidenthal T, Schmitz L, Chase DP, Seelenmeyer C, Alscher MD, Tegtbur U, Dirmaier J. Telephone health coaching with exercise monitoring using wearable activity trackers (TeGeCoach) for improving walking impairment in peripheral artery disease: study protocol for a randomised controlled trial and economic evaluation. BMJ Open 2020; 10:e032146. [PMID: 32503866 PMCID: PMC7279623 DOI: 10.1136/bmjopen-2019-032146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Peripheral artery disease (PAD) is the third most prevalent cardiovascular disease worldwide, with smoking and diabetes being the strongest risk factors. The most prominent symptom is leg pain while walking, known as intermittent claudication. To improve mobility, first-line treatment for intermittent claudication is supervised exercise programmes, but these remain largely unavailable and economically impractical, which has led to the development of structured home-based exercise programmes. This trial aims to determine the effectiveness and cost advantage of TeGeCoach, a 12-month long home-based exercise programme, compared with usual care of PAD. It is hypothesised that TeGeCoach improves walking impairment and lowers the need of health care resources that are spent on patients with PAD. METHODS AND ANALYSIS The investigators conduct a prospective, pragmatic randomised controlled clinical trial in a health insurance setting. 1760 patients diagnosed with PAD at Fontaine stage II are randomly assigned to either TeGeCoach or care-as-usual. TeGeCoach consists of telemonitored intermittent walking exercise with medical supervision by a physician and telephone health coaching. Participants allocated to the usual care group receive information leaflets and can access supervised exercise programmes, physical therapy and a variety of programmes for promoting a healthy lifestyle. The primary outcome is patient reported walking ability based on the Walking Impairment Questionnaire. Secondary outcome measures include quality of life, health literacy and health behaviour. Claims data are used to collect total health care costs, healthcare resource use and (severe) adverse events. Outcomes are measured at baseline, 12 and 24 months. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Medical Association Hamburg. Findings are disseminated through peer-reviewed journals, reports to the funding body, conference presentations and media press releases. Data from this trial are made available to the public and researchers upon reasonable request.NCT03496948 (www.clinicaltrials.gov), Pre-results.
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Affiliation(s)
- Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Frank Bienert
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Julia Brinkmann
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Lutz Herbarth
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Edith Kramer
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | | | - René Terhalle
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Yvonne Grosse
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Susanne Bock
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | - Corinna Beutel
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Franziska Reif
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | | | | | | | | | | | | | | | - Claudia Seelenmeyer
- Dr Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart, Baden-Württemberg, Germany
| | - Mark Dominik Alscher
- Dr Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart, Baden-Württemberg, Germany
| | - Uwe Tegtbur
- Department of Sports Medicine, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
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Fuglestad M, Hernandez H, Gao Y, Ybay H, Schieber M, Brunette KE, Myers S, Casale G, Pipinos I. Reply. J Vasc Surg 2020; 71:1072-1073. [PMID: 32089205 DOI: 10.1016/j.jvs.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Matthew Fuglestad
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Hernan Hernandez
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Yue Gao
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Henamari Ybay
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb
| | - Molly Schieber
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb
| | | | - Sara Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb
| | - George Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Iraklis Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb; Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb; Department of Surgery, Veterans Affairs Medical Center, Omaha, Neb
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Park SY, Wong A, Son WM, Pekas EJ. Effects of heated water-based versus land-based exercise training on vascular function in individuals with peripheral artery disease. J Appl Physiol (1985) 2020; 128:565-575. [PMID: 32027542 DOI: 10.1152/japplphysiol.00744.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with poor vascular function, walking impairment, and reduced quality of life. Land-based exercise therapy (LBET) is frequently recommended to improve walking and reduce symptoms. Recently, evidence has suggested that heated-water exercise therapy (HWET) is an effective intervention for PAD. However, the efficacy of LBET versus HWET in PAD patients had not been elucidated. Therefore, we sought to compare effects of LBET with HWET on cardiovascular function, exercise tolerance, physical function, and body composition in PAD patients. PAD patients (n = 53) were recruited and randomly assigned to a LBET group (n = 25) or HWET group (n = 28). The LBET group performed treadmill walking, whereas the HWET group performed walking in heated water for 12 wk. Leg (legPWV) and brachial-to-ankle arterial stiffness (baPWV), blood pressure (BP), ankle-brachial index (ABI), 6-min walking distance (6MWD), claudication onset time (COT), physical function, and body composition were assessed before and after 12 wk. There were significant group-by-time interactions (P < 0.05) for legPWV, BP, 6MWD, COT, body composition, and resting metabolic rate (RMR). Both groups significantly reduced (P < 0.05) legPWV, BP, and body fat percentage, and HWET measures were significantly lower than LBET measures. Both groups significantly increased 6MWD, COT, and RMR, and HWET group measures were significantly greater than LBET measures. A time effect was noted for baPWV reduction in both groups (P < 0.05). These results suggest that both LBET and HWET improve cardiovascular function, exercise tolerance, and body composition, and HWET showed considerably greater improvements compared with LBET in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that although land-based exercise therapy is effective for reducing arterial stiffness and blood pressure in patients with peripheral artery disease (PAD), heated-water exercise therapy demonstrates greater benefits on vascular function. The greater improvements in muscular strength, time to onset of claudication, and exercise tolerance after heated-water exercise therapy may have clinical implications for improving quality of life in patients with PAD. The heated-water exercise therapy intervention demonstrated relatively higher exercise training adherence (∼88%) compared with the land-based exercise intervention (∼81%).
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Affiliation(s)
- Song-Young Park
- School of Health and Kinesiology, University of Nebraska-Omaha, Omaha, Nebraska
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, Virginia
| | - Won-Mok Son
- School of Health and Kinesiology, University of Nebraska-Omaha, Omaha, Nebraska
| | - Elizabeth J Pekas
- School of Health and Kinesiology, University of Nebraska-Omaha, Omaha, Nebraska
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Diaz-Castro J, Moreno-Fernandez J, Chirosa I, Chirosa LJ, Guisado R, Ochoa JJ. Beneficial Effect of Ubiquinol on Hematological and Inflammatory Signaling during Exercise. Nutrients 2020; 12:nu12020424. [PMID: 32041223 PMCID: PMC7071169 DOI: 10.3390/nu12020424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 01/03/2023] Open
Abstract
Strenuous exercise (any activity that expends six metabolic equivalents per minute or more causing sensations of fatigue and exhaustion to occur, inducing deleterious effects, affecting negatively different cells), induces muscle damage and hematological changes associated with high production of pro-inflammatory mediators related to muscle damage and sports anemia. The objective of this study was to determine whether short-term oral ubiquinol supplementation can prevent accumulation of inflammatory mediators and hematological impairment associated to strenuous exercise. For this purpose, 100 healthy and well-trained firemen were classified in two groups: Ubiquinol (experimental group), and placebo group (control). The protocol was two identical strenuous exercise tests with rest period between tests of 24 h. Blood samples were collected before supplementation (basal value) (T1), after supplementation (T2), after first physical exercise test (T3), after 24 h of rest (T4), and after second physical exercise test (T5). Hematological parameters, pro- and anti-inflammatory cytokines and growth factors were measured. Red blood cells (RBC), hematocrit, hemoglobin, VEGF, NO, EGF, IL-1ra, and IL-10 increased in the ubiquinol group while IL-1, IL-8, and MCP-1 decreased. Ubiquinol supplementation during high intensity exercise could modulate inflammatory signaling, expression of pro-inflammatory, and increasing some anti-inflammatory cytokines. During exercise, RBC, hemoglobin, hematocrit, VEGF, and EGF increased in ubiquinol group, revealing a possible pro-angiogenic effect, improving oxygen supply and exerting a possible protective effect on other physiological alterations.
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Affiliation(s)
- Javier Diaz-Castro
- Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Biomedical Research Centre, Health-Sciencies Technological Park, Avenida del Conocimiento s/n, Armilla, E-18071 Granada, Spain; (J.M.-F.); (J.J.O.)
- Department of Physiology, University of Granada, E-18071 Granada, Spain
- Correspondence: ; Tel.: +34-958-24-10-00 (ext. 20303)
| | - Jorge Moreno-Fernandez
- Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Biomedical Research Centre, Health-Sciencies Technological Park, Avenida del Conocimiento s/n, Armilla, E-18071 Granada, Spain; (J.M.-F.); (J.J.O.)
- Department of Physiology, University of Granada, E-18071 Granada, Spain
| | - Ignacio Chirosa
- Departament of Physical Education, University of Granada, E-18071 Granada, Spain; (I.C.); (L.J.C.)
| | - Luis Javier Chirosa
- Departament of Physical Education, University of Granada, E-18071 Granada, Spain; (I.C.); (L.J.C.)
| | - Rafael Guisado
- Faculty of Health Sciences, University of Granada, E-18071 Granada, Spain;
| | - Julio J. Ochoa
- Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Biomedical Research Centre, Health-Sciencies Technological Park, Avenida del Conocimiento s/n, Armilla, E-18071 Granada, Spain; (J.M.-F.); (J.J.O.)
- Department of Physiology, University of Granada, E-18071 Granada, Spain
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Brindisino F, Pennella D, Giovannico G, Rossettini G, Heick JD, Maselli F. Low back pain and calf pain in a recreational runner masking peripheral artery disease: A case report. Physiother Theory Pract 2019; 37:1146-1157. [PMID: 31661344 DOI: 10.1080/09593985.2019.1683922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Running is one of the most popular sports worldwide due to its low costs and its beneficial impact on health. Recent evidence suggests 11% to 85% of recreational runners experience at least one running-related injury each year and most of these are related to musculoskeletal conditions. The aim of this case report is to describe the clinical decision-making process that guided a physiotherapist to suspect a non-musculoskeletal cause in a recreational runner presenting with low back pain and calf pain secondary to Peripheral Artery Disease.Case Presentation: This case report describes the clinical history, clinical exam, laboratory and imaging tests, and surgical procedure of a 65 y.o. amateur runner suffering low back pain and left calf pain for 3 months. The patient's clinical findings suggested that referral to another health-care provider was required to explore potential non-musculoskeletal sources of pain. An angioplasty was necessary to solve the patient's clinical situation.Discussion and Conclusion: In this patient case, clinical findings along with a comprehensive family and personal history, ruled out a musculoskeletal condition and implicated a vascular condition.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise C/da Tappino c/o Cardarelli Hospital, Campobasso, Italy.,FTM, Physiotherapy and Manual Therapy, Physiotherapy Department, Lizzanello, Italy
| | - Denis Pennella
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise C/da Tappino c/o Cardarelli Hospital, Campobasso, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise C/da Tappino c/o Cardarelli Hospital, Campobasso, Italy.,FTM, Physiotherapy and Manual Therapy, Physiotherapy Department, Lizzanello, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - John D Heick
- Northern Arizona University Flagstaff, Flagstaff, AZ, USA.,Department of Physical Therapy and Athletic Training, Flagstaff, AZ, USA
| | - Filippo Maselli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
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Schieber MN, Pipinos II, Johanning JM, Casale GP, Williams MA, DeSpiegelaere HK, Senderling B, Myers SA. Supervised walking exercise therapy improves gait biomechanics in patients with peripheral artery disease. J Vasc Surg 2019; 71:575-583. [PMID: 31443974 DOI: 10.1016/j.jvs.2019.05.044] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/08/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE In patients with peripheral artery disease (PAD), supervised exercise therapy is a first line of treatment because it increases maximum walking distances comparable with surgical revascularization therapy. Little is known regarding gait biomechanics after supervised exercise therapy. This study characterized the effects of supervised exercise therapy on gait biomechanics and walking distances in claudicating patients with PAD. METHODS Forty-seven claudicating patients with PAD underwent gait analysis before and immediately after 6 months of supervised exercise therapy. Exercise sessions consisted of a 5-minute warmup of mild walking and stretching of upper and lower leg muscles, 50 minutes of intermittent treadmill walking, and 5 minutes of cooldown (similar to warmup) three times per week. Measurements included self-perceived ambulatory limitations measured by questionnaire, the ankle-brachial index (ABI), walking distance measures, maximal plantar flexor strength measured by isometric dynamometry, and overground gait biomechanics trials performed before and after the onset of claudication pain. Paired t-tests were used to test for differences in quality of life, walking distances, ABI, and maximal strength. A two-factor repeated measures analysis of variance determined differences for intervention and condition for gait biomechanics dependent variables. RESULTS After supervised exercise therapy, quality of life, walking distances, and maximal plantar flexor strength improved, although the ABI did not significantly change. Several gait biomechanics parameters improved after the intervention, including torque and power generation at the ankle and hip. Similar to previous studies, the onset of claudication pain led to a worsening gait or a gait that was less like healthy individuals with a pain-free gait. CONCLUSIONS Six months of supervised exercise therapy produced increases in walking distances and quality of life that are consistent with concurrent improvements in muscle strength and gait biomechanics. These improvements occurred even though the ABI did not improve. Future work should examine the benefits of supervised exercise therapy used in combination with other available treatments for PAD.
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Affiliation(s)
- Molly N Schieber
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb
| | - Iraklis I Pipinos
- Department of Surgery, Veterans' Affairs Medical Center of Nebraska and Western Iowa, Omaha, Neb; Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Jason M Johanning
- Department of Surgery, Veterans' Affairs Medical Center of Nebraska and Western Iowa, Omaha, Neb; Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - George P Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Mark A Williams
- Department of Medicine, Creighton Univeristy, School of Medicine, Omaha, Neb
| | - Holly K DeSpiegelaere
- Department of Surgery, Veterans' Affairs Medical Center of Nebraska and Western Iowa, Omaha, Neb
| | | | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb; Department of Surgery, Veterans' Affairs Medical Center of Nebraska and Western Iowa, Omaha, Neb.
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39
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Development of an Exercise Training Protocol to Investigate Arteriogenesis in a Murine Model of Peripheral Artery Disease. Int J Mol Sci 2019; 20:ijms20163956. [PMID: 31416228 PMCID: PMC6720754 DOI: 10.3390/ijms20163956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 01/19/2023] Open
Abstract
Exercise is a treatment option in peripheral artery disease (PAD) patients to improve their clinical trajectory, at least in part induced by collateral growth. The ligation of the femoral artery (FAL) in mice is an established model to induce arteriogenesis. We intended to develop an animal model to stimulate collateral growth in mice through exercise. The training intensity assessment consisted of comparing two different training regimens in C57BL/6 mice, a treadmill implementing forced exercise and a free-to-access voluntary running wheel. The mice in the latter group covered a much greater distance than the former pre- and postoperatively. C57BL/6 mice and hypercholesterolemic ApoE-deficient (ApoE−/−) mice were subjected to FAL and had either access to a running wheel or were kept in motion-restricting cages (control) and hind limb perfusion was measured pre- and postoperatively at various times. Perfusion recovery in C57BL/6 mice was similar between the groups. In contrast, ApoE−/− mice showed significant differences between training and control 7 d postoperatively with a significant increase in pericollateral macrophages while the collateral diameter did not differ between training and control groups 21 d after surgery. ApoE−/− mice with running wheel training is a suitable model to simulate exercise induced collateral growth in PAD. This experimental set-up may provide a model for investigating molecular training effects.
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Silva AT, Rouf F, Semola OA, Payton ME, Lovern PC. Placental growth factor levels in quadriceps muscle are reduced by a Western diet in association with advanced glycation end products. Am J Physiol Heart Circ Physiol 2019; 317:H851-H866. [PMID: 31397166 DOI: 10.1152/ajpheart.00511.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In peripheral artery disease (PAD), atherosclerotic occlusion chronically impairs limb blood flow. Arteriogenesis (collateral artery remodeling) is a vital adaptive response to PAD that protects tissue from ischemia. People with type II diabetes have a high risk of developing PAD and would benefit from arteriogenesis. However, arteriogenesis is suppressed in people with diabetes by a multifaceted mechanism which remains incompletely defined. Upregulation of placental growth factor (PLGF) is a key early step in arteriogenesis. Therefore, we hypothesized that metabolic dysfunction would impair PLGF expression in skeletal muscle. We tested this hypothesis in C57BL/6J and ApoE-/- mice of both sexes fed a Western diet (WD) for 24 wk. We first assessed baseline levels of PLGF, vascular endothelial growth factor (VEGF-A), and VEGF receptor 1 (VEGFR1) protein in hindlimb skeletal muscle. Only PLGF was consistently decreased by the WD. We next investigated the effect of 24 wk of the WD on the response of PLGF, VEGF-A, VEGFR1, and monocyte chemoattractant protein-1 (MCP-1) to the physiological stimulus of vascular occlusion. Hindlimb ischemia was induced in mice by gradual femoral artery occlusion using an ameroid constrictor. Growth factor levels were measured 3-28 days postsurgery. In C57BL/6J mice, the WD decreased and delayed upregulation of PLGF and abolished upregulation of VEGF-A and VEGFR1 but had no effect on MCP-1. In ApoE-/- mice fed either diet, all factors tested failed to respond to occlusion. Metabolic phenotyping of mice and in vitro studies suggest that an advanced glycation end product/TNFα-mediated mechanism could contribute to the effects observed in vivo.NEW & NOTEWORTHY In this study, we tested the effect of a Western diet on expression of the arteriogenic growth factor placental growth factor (PLGF) in mouse skeletal muscle. We provide the first demonstration that a Western diet interferes with both baseline expression and hindlimb ischemia-induced upregulation of PLGF. We further identify a potential role for advanced glycation end product/TNFα signaling as a negative regulator of PLGF. These studies provide insight into one possible mechanism by which type II diabetes may limit collateral growth.
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Affiliation(s)
- Asitha T Silva
- Department of Physiological Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Farzana Rouf
- Department of Mechanical and Aerospace Engineering, Oklahoma State University, Stillwater, Oklahoma
| | - Oluwayemisi A Semola
- Department of Physiological Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Mark E Payton
- Department of Statistics, Oklahoma State University, Stillwater, Oklahoma
| | - Pamela C Lovern
- Department of Physiological Sciences, Oklahoma State University, Stillwater, Oklahoma
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Park SY, Kwak YS, Pekas EJ. Impacts of aquatic walking on arterial stiffness, exercise tolerance, and physical function in patients with peripheral artery disease: a randomized clinical trial. J Appl Physiol (1985) 2019; 127:940-949. [PMID: 31369328 DOI: 10.1152/japplphysiol.00209.2019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with attenuated vascular function, cardiorespiratory capacity, physical function, and muscular strength. It is essential to combat these negative effects on health by incorporating lifestyle interventions to slow disease progression, such as exercise. We sought to examine the effects of aquatic walking exercise on cardiovascular function, cardiorespiratory capacity [maximal volume of oxygen consumption (V̇o2max)], exercise tolerance [6-min walking distance (6MWD)], physical function, muscular strength, and body composition in patients with PAD. Patients with PAD (n = 72) were recruited and randomly assigned to a 12-wk aquatic walking training group (AQ, n = 35) or a control group (CON, n = 37). The AQ group performed walking and leg exercises in waist-to-chest-deep water. Leg arterial stiffness [femoral-to-ankle pulse wave velocity (legPWV)], heart rate (HR), blood pressure (BP), ankle-to-brachial index (ABI), V̇o2max, 6MWD, physical function, muscular strength, body composition, resting metabolic rate (RMR), and flexibility were measured before and after 12 wk. There were significant group × time interactions (P < 0.05) after 12 wk for legPWV and HR, which significantly decreased (P < 0.05) in AQ, and V̇o2max, 6MWD, physical function, and muscular strength, which significantly increased (P < 0.05) in AQ, compared with no changes in CON. There were no significant differences (P > 0.05) for BP, ABI, RMR, or flexibility after 12 wk. Interestingly, there was relatively high adherence (84%) to the aquatic walking exercise program in this population. These results suggest that aquatic walking exercise is an effective therapy to reduce arterial stiffness and resting HR and improve cardiorespiratory capacity, exercise tolerance, physical function, and muscular strength in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that aquatic walking exercise can decrease arterial stiffness and improve exercise tolerance, cardiorespiratory capacity, and muscular strength in patients with peripheral artery disease (PAD). Aquatic walking exercise training demonstrates relatively high exercise adherence in this population. Aquatic walking exercise training may be a useful therapeutic intervention for improving physical function in patients with PAD.
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Affiliation(s)
- Song-Young Park
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska.,Department of Physical Education, Dong-Eui University, Busan, South Korea
| | - Yi-Sub Kwak
- Department of Physical Education, Dong-Eui University, Busan, South Korea
| | - Elizabeth J Pekas
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
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Russell KS, Yates DP, Kramer CM, Feller A, Mahling P, Colin L, Clough T, Wang T, LaPerna L, Patel A, Lawall H, Shennak MM, Fulmer J, Nikol S, Smith WB, Müller OJ, Ratchford EV, Basson CT. A randomized, placebo-controlled trial of canakinumab in patients with peripheral artery disease. Vasc Med 2019; 24:414-421. [PMID: 31277561 DOI: 10.1177/1358863x19859072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Extensive atherosclerotic plaque burden in the lower extremities often leads to symptomatic peripheral artery disease (PAD) including impaired walking performance and claudication. Interleukin-1β (IL-1β) may play an important pro-inflammatory role in the pathogenesis of this disease. Interruption of IL-1β signaling was hypothesized to decrease plaque progression in the leg macrovasculature and improve the mobility of patients with PAD with intermittent claudication. Thirty-eight patients (mean age 65 years; 71% male) with symptomatic PAD (confirmed by ankle-brachial index) were randomized 1:1 to receive canakinumab (150 mg subcutaneously) or placebo monthly for up to 12 months. The mean vessel wall area (by 3.0 T black-blood magnetic resonance imaging (MRI)) of the superficial femoral artery (SFA) was used to measure plaque volume. Mobility was assessed using the 6-minute walk test. Canakinumab was safe and well tolerated. Markers of systemic inflammation (interleukin-6 and high-sensitivity C-reactive protein) fell as early as 1 month after treatment. MRI (32 patients at 3 months; 21 patients at 12 months) showed no evidence of plaque progression in the SFA in either placebo-treated or canakinumab-treated patients. Although an exploratory endpoint, placebo-adjusted maximum and pain-free walking distance (58 m) improved as early as 3 months after treatment with canakinumab when compared with placebo. Although canakinumab did not alter plaque progression in the SFA, there is an early signal that it may improve maximum and pain-free walking distance in patients with symptomatic PAD. Larger studies aimed at this endpoint will be required to definitively demonstrate this. ClinicalTrials.gov Identifier: NCT01731990.
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Affiliation(s)
- Kerry S Russell
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Denise P Yates
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | | | - Andrea Feller
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Ping Mahling
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Laurence Colin
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Timothy Clough
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Tianke Wang
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Lucy LaPerna
- Remington-Davis Clinical Research, Columbus, OH, USA
| | - Alpa Patel
- Jacksonville Center for Clinical Research, Jacksonville, FL, USA
| | - Holger Lawall
- Praxis für Herzkreislauferkrankungen, Max Grundig Klinik Bühlerhöhe, Bühl, Germany
| | | | | | | | | | - Oliver J Müller
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Craig T Basson
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
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Otsuka K, Nakanishi K, Shimada K, Nakamura H, Inanami H, Nishioka H, Fujimoto K, Kasayuki N, Yoshiyama M. Ankle-brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end-stage kidney disease. Clin Cardiol 2019; 42:656-662. [PMID: 31020665 PMCID: PMC6605000 DOI: 10.1002/clc.23188] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Although ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are significant predictors of major adverse cardiovascular event (MACE), their prognostic value in association with biomarkers has not been fully evaluated in patients with end-stage kidney disease (ESKD). HYPOTHESIS We hypothesized that ABI/baPWV would provide better prognostic value independent of biomarkers in ESKD patients. METHODS This study included 104 ESKD patients treated with maintenance hemodialysis who underwent ABI and baPWV examinations and laboratory tests, including brain-natriuretic peptide, high-sensitive cardiac troponin T (hs-cTnT), and high-sensitive C-reactive protein (hs-CRP). MACE was defined as a composite event of all-cause death, acute coronary syndrome, and stroke. RESULTS During a mean follow-up of 3.6 ± 1.7 years, a total of 51 MACE were observed. The independent factors associated with MACE were age >75 years (adjusted hazard ratio [HR], 2.15; P < .05), abnormal ABI (adjusted HR, 2.01; P < .05), left ventricular ejection fraction (LVEF) <50% (adjusted HR, 3.33; P < .001), the upper tertile of hs-cTnT (adjusted HR, 2.77; P < .05), and hs-CRP (HR, 1.96; P < .05). However, baPWV did not remain as an independent predictor of MACE in the entire cohort and also in patients without abnormal ABI. The combination of predictors improves the predictive value of MACE, providing increased HR with 4.00 for abnormal ABI + hs-CRP, 4.42 for abnormal ABI + hs-cTnT, and 7.04 for abnormal ABI + LVEF <50% (all P < .001). CONCLUSION Abnormal ABI is a robust predictor of MACE independent of biomarkers and their combination provides better risk stratification compared with a single predictor in ESKD patients.
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Affiliation(s)
- Kenichiro Otsuka
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
| | - Kenei Shimada
- Department of Cardiovascular Medicine, Kashiba-seiki Hospital, Kashiba, Japan
| | - Haruo Nakamura
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, Japan
| | - Hitoshi Inanami
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, Japan
| | - Hiroki Nishioka
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, Japan
| | - Kohei Fujimoto
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, Japan
| | - Noriaki Kasayuki
- Department of Cardiovascular Medicine, Ishikiri-seiki Hospital, Higashi-osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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44
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Substance P accelerates wound repair by promoting neovascularization and preventing inflammation in an ischemia mouse model. Life Sci 2019; 225:98-106. [PMID: 30959026 DOI: 10.1016/j.lfs.2019.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 01/26/2023]
Abstract
AIMS Arterial insufficiency ulcers are frequent complications of peripheral artery disease and infection or long-term neglect of the ulcer can eventually lead to amputation of the affected body part. An ischemic environment, caused by interrupted blood flow, affects the supply of nutrients and elongates the inflammation period, inducing tissue degeneration. Thus, the modulation of neovascularization and inflammation could be an ideal therapeutic strategy for ischemic wound healing. This study aimed to elucidate whether systemically administered substance P (SP) could promote ischemic wound repair in mice by restoring blood perfusion and suppressing inflammation. MAIN METHODS The effects of SP were assessed by analyzing wound size, blood flow, epidermal and dermal layer regeneration, vessel formation, and the inflammatory cytokine profiles in a hind-limb ischemia non-clinical mouse model. KEY FINDINGS SP-treated mice exhibited dramatically rapid wound healing and restoration of blood flow within the ischemic zone, compared with saline-treated mice. Notably, SP-treated mice showed enhanced pericyte-covered vasculature compared to saline-treated mice. Moreover, anti-inflammatory effects were detected in mice in the SP-treated group, including suppression of inflammation-mediated spleen enlargement, reduction of tumor necrosis factor-alpha, and promotion of circulatory interleukin-10 levels. SIGNIFICANCE These results suggest that SP could be a possible therapeutic candidate for patients with peripheral artery disease, including those with ischemic ulcers.
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Gorski T, De Bock K. Metabolic regulation of exercise-induced angiogenesis. VASCULAR BIOLOGY 2019; 1:H1-H8. [PMID: 32923947 PMCID: PMC7439921 DOI: 10.1530/vb-19-0008] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/11/2019] [Indexed: 12/19/2022]
Abstract
Skeletal muscle relies on an ingenious network of blood vessels, which ensures optimal oxygen and nutrient supply. An increase in muscle vascularization is an early adaptive event to exercise training, but the cellular and molecular mechanisms underlying exercise-induced blood vessel formation are not completely clear. In this review, we provide a concise overview on how exercise-induced alterations in muscle metabolism can evoke metabolic changes in endothelial cells (ECs) that drive muscle angiogenesis. In skeletal muscle, angiogenesis can occur via sprouting and splitting angiogenesis and is dependent on vascular endothelial growth factor (VEGF) signaling. In the resting muscle, VEGF levels are controlled by the estrogen-related receptor γ (ERRγ). Upon exercise, the transcriptional coactivator peroxisome-proliferator-activated receptor-γ coactivator-1α (PGC1α) orchestrates several adaptations to endurance exercise within muscle fibers and simultaneously promotes transcriptional activation of Vegf expression and increased muscle capillary density. While ECs are highly glycolytic and change their metabolism during sprouting angiogenesis in development and disease, a similar role for EC metabolism in exercise-induced angiogenesis in skeletal muscle remains to be elucidated. Nonetheless, recent studies have illustrated the importance of endothelial hydrogen sulfide and sirtuin 1 (SIRT1) activity for exercise-induced angiogenesis, suggesting that EC metabolic reprogramming may be fundamental in this process. We hypothesize that the exercise-induced angiogenic response can also be modulated by metabolic crosstalk between muscle and the endothelium. Defining the underlying molecular mechanisms responsible for skeletal muscle angiogenesis in response to exercise will yield valuable insight into metabolic regulation as well as the determinants of exercise performance.
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Affiliation(s)
- Tatiane Gorski
- Department of Health Sciences and Technology, Laboratory of Exercise and Health, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Katrien De Bock
- Department of Health Sciences and Technology, Laboratory of Exercise and Health, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
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46
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Feng R, Wang L, Li Z, Yang R, Liang Y, Sun Y, Yu Q, Ghartey-Kwansah G, Sun Y, Wu Y, Zhang W, Zhou X, Xu M, Bryant J, Yan G, Isaacs W, Ma J, Xu X. A systematic comparison of exercise training protocols on animal models of cardiovascular capacity. Life Sci 2018; 217:128-140. [PMID: 30517851 DOI: 10.1016/j.lfs.2018.12.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease (CVD) is a major global cause of mortality, which has prompted numerous studies seeking to reduce the risk of heart failure and sudden cardiac death. While regular physical activity is known to improve CVD associated morbidity and mortality, the optimal duration, frequency, and intensity of exercise remains unclear. To address this uncertainty, various animal models have been used to study the cardioprotective effects of exercise and related molecular mechanism such as the mice training models significantly decrease size of myocardial infarct by affecting Kir6.1, VSMC sarc-KATP channels, and pulmonary eNOS. Although these findings cement the importance of animal models in studying exercise induced cardioprotection, the vast assortment of exercise protocols makes comparison across studies difficult. To address this issue, we review and break down the existent exercise models into categories based on exercise modality, intensity, frequency, and duration. The timing of sample collection is also compared and sorted into four distinct phases: pre-exercise (Phase I), mid-exercise (Phase II), exercise recovery (Phase III), and post-exercise (Phase IV). Finally, because the life-span of animals so are limited, small changes in animal exercise duration can corresponded to untenable amounts of human exercise. To address this limitation, we introduce the Life-Span Relative Exercise Time (RETlife span) as a method of accurately defining short-term, medium-term and long-term exercise relative to the animal's life expectancy. Systematic organization of existent protocols and this new system of defining exercise duration will allow for a more solid framework from which researchers can extrapolate animal model data to clinical application.
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Affiliation(s)
- Rui Feng
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China
| | - Liyang Wang
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Zhonguang Li
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China; Ohio State University School of Medicine, Columbus, OH 43210, USA
| | - Rong Yang
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China
| | - Yu Liang
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China
| | - Yuting Sun
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China
| | - Qiuxia Yu
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China
| | - George Ghartey-Kwansah
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China; Department of Biomedical Sciences, College of Health and Allied Sciences, University of Cape Coast, Ghana
| | - Yanping Sun
- College of Pharmacy, Xi'an Medical University, Xi'an 710062, China
| | - Yajun Wu
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China
| | - Wei Zhang
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China
| | - Xin Zhou
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China; Ohio State University School of Medicine, Columbus, OH 43210, USA
| | - Mengmeng Xu
- Department of Pharmacology, Duke University Medical Center, Durham, NC 27708, USA
| | - Joseph Bryant
- University of Maryland School of Medicine, Baltimore, MD 21287, USA
| | - Guifang Yan
- Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - William Isaacs
- Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Jianjie Ma
- Ohio State University School of Medicine, Columbus, OH 43210, USA
| | - Xuehong Xu
- National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China/CGDB, Shaanxi Normal University College of Life Sciences, Xi'an 710119, China.
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Sfyri PP, Yuldasheva NY, Tzimou A, Giallourou N, Crispi V, Aburima A, Beltran-Alvarez P, Patel K, Mougios V, Swann JR, Kearney MT, Matsakas A. Attenuation of oxidative stress-induced lesions in skeletal muscle in a mouse model of obesity-independent hyperlipidaemia and atherosclerosis through the inhibition of Nox2 activity. Free Radic Biol Med 2018; 129:504-519. [PMID: 30342191 DOI: 10.1016/j.freeradbiomed.2018.10.422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/12/2018] [Accepted: 10/09/2018] [Indexed: 02/08/2023]
Abstract
Obesity leading to hyperlipidaemia and atherosclerosis is recognised to induce morphological and metabolic changes in many tissues. However, hyperlipidaemia can occur in the absence of obesity. The impact of the latter scenario on skeletal muscle and liver is not understood sufficiently. In this regard, we used the Apolipoprotein E-deficient (ApoE-/-) mouse model, an established model of hyperlipidaemia and atherosclerosis, that does not become obese when subjected to a high-fat diet, to determine the impact of Western-type diet (WD) and ApoE deficiency on skeletal muscle morphological, metabolic and biochemical properties. To establish the potential of therapeutic targets, we further examined the impact of Nox2 pharmacological inhibition on skeletal muscle redox biology. We found ectopic lipid accumulation in skeletal muscle and the liver, and altered skeletal muscle morphology and intramuscular triacylglycerol fatty acid composition. WD and ApoE deficiency had a detrimental impact in muscle metabolome, followed by perturbed gene expression for fatty acid uptake and oxidation. Importantly, there was enhanced oxidative stress in the skeletal muscle and development of liver steatosis, inflammation and oxidative protein modifications. Pharmacological inhibition of Nox2 decreased reactive oxygen species production and protein oxidative modifications in the muscle of ApoE-/- mice subjected to a Western-type diet. This study provides key evidence to better understand the pathophysiology of skeletal muscle in the context of hyperlipidaemia and atherosclerosis and identifies Nox2 as a potential target for attenuating oxidative stress in skeletal muscle in a mouse model of obesity-independent hyperlipidaemia.
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Affiliation(s)
- Pagona Panagiota Sfyri
- Molecular Physiology Laboratory, Centre for Atherothrombotic & Metabolic Disease, Hull York Medical School, United Kingdom
| | - Nadira Y Yuldasheva
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Anastasia Tzimou
- Laboratory of Evaluation of Human Biological Performance, School of Physical Education and Sports Science at Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Natasa Giallourou
- Department of Surgery and Cancer, Division of Computational and Systems Medicine, Imperial College London, United Kingdom
| | - Vassili Crispi
- Molecular Physiology Laboratory, Centre for Atherothrombotic & Metabolic Disease, Hull York Medical School, United Kingdom
| | - Ahmed Aburima
- Molecular Physiology Laboratory, Centre for Atherothrombotic & Metabolic Disease, Hull York Medical School, United Kingdom
| | | | - Ketan Patel
- School of Biological Sciences, University of Reading, United Kingdom
| | - Vassilis Mougios
- Laboratory of Evaluation of Human Biological Performance, School of Physical Education and Sports Science at Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Jonathan R Swann
- Department of Surgery and Cancer, Division of Computational and Systems Medicine, Imperial College London, United Kingdom
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Antonios Matsakas
- Molecular Physiology Laboratory, Centre for Atherothrombotic & Metabolic Disease, Hull York Medical School, United Kingdom.
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Murrow JR, Brizendine JT, Djire B, Young HJ, Rathbun S, Nilsson KR, McCully KK. Near infrared spectroscopy-guided exercise training for claudication in peripheral arterial disease. Eur J Prev Cardiol 2018; 26:471-480. [DOI: 10.1177/2047487318795192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Rationale Supervised treadmill exercise for claudication in peripheral arterial disease is effective but poorly tolerated because of ischemic leg pain. Near infrared spectroscopy allows non-invasive detection of muscle ischemia during exercise, allowing for characterization of tissue perfusion and oxygen utilization during training. Objective We evaluated walking time, muscle blood flow, and muscle mitochondrial capacity in patients with peripheral artery disease after a traditional pain-based walking program and after a muscle oxygen-guided walking program. Method and results Patients with peripheral artery disease trained thrice weekly in 40-minute-long sessions for 12 weeks, randomized to oxygen-guided training ( n = 8, age 72 ± 9.7 years, 25% female) versus traditional pain-based training ( n = 10, age 71.6 ± 8.8 years, 20% female). Oxygen-guided training intensity was determined by maintaining a 15% reduction in skeletal muscle oxygenation by near infrared spectroscopy rather than relying on symptoms of pain to determine exercise effort. Pain free and maximal walking times were measured with a 12-minute Gardner treadmill test. Gastrocnemius mitochondrial capacity and blood flow were measured using near infrared spectroscopy. Baseline pain-free walking time was similar on a Gardner treadmill test (2.5 ± 0.9 vs. 3.6 ± 1.0 min, p = 0.5). After training, oxygen-guided cohorts improved similar to pain-guided cohorts (pain-free walking time 6.7 ± 0.9 vs. 6.9 ± 1.1 min, p < 0.01 for change from baseline and p = 0.97 between cohorts). Mitochondrial capacity improved in both groups but more so in the pain-guided cohort than in the oxygen-guided cohort (38.8 ± 8.3 vs. 14.0 ± 9.3, p = 0.018). Resting muscle blood flow did not improve significantly in either group with training. Conclusions Oxygen-guided exercise training improves claudication comparable to pain-based training regimens. Adaptations in mitochondrial function rather than increases in limb perfusion may account for functional improvement. Increases in mitochondrial oxidative capacity may be proportional to the degree of tissue hypoxia during exercise.
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Affiliation(s)
| | | | | | | | | | - Kent R Nilsson
- Augusta University – University of Georgia Medical Partnership, USA
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Farndon L, Stephenson J, Binns-Hall O, Knight K, Fowler-Davis S. The PodPAD project: a podiatry-led integrated pathway for people with peripheral arterial disease in the UK - a pilot study. J Foot Ankle Res 2018; 11:26. [PMID: 29991966 PMCID: PMC5987540 DOI: 10.1186/s13047-018-0269-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral arterial disease affects the lower limb and is associated with diabetes, high cholesterol, smoking and obesity. It increases the risk of cardiovascular morbidity and mortality. It can be symptomatic causing intermittent claudication, but often there are few clinical signs. Podiatrists are able to detect the presence of peripheral arterial disease as part of their lower limb assessment and are well placed to give advice on lifestyle changes to help reduce disease progression. This is important to improve health outcomes and is offered as a prevention/public health intervention. Method We describe the clinical and patient-centred outcomes of patients attending a podiatry-led integrated care pathway in a multi-use clinic situated in a venue supported by the National Centre for Sports and Exercise Medicine in the UK. At the baseline appointment, patients were given a full assessment where symptoms of intermittent claudication using the Edinburgh Intermittent Claudication Questionnaire, foot pulses, Doppler sounds, Ankle Brachial Pressure Indices, glycated haemoglobin (HbA1c) and cholesterol levels, and smoking status were recorded. A tailored treatment plan was devised, including referral to an exercise referral service, smoking cessation programmes (if applicable) and each participant was also seen by a dietician for nutritional advice. Participants were followed up at 3 and 6 months to assess any improvement in vascular status and with each completing the EQ-5D quality of life questionnaire and a simple satisfaction questionnaire at the end of the study. As this was a complex intervention a pilot study design was adopted to evaluate if the method and outcomes were suitable and acceptable to participants the results of which will then inform the design of a larger study. Results Data was collected on 21 individuals; 15 men (71.4%) and 6 women (28.6%) across the 6-month study period. Eleven participants were referred onto the exercise referral service; 16 participants saw the dietician for nutritional advice at baseline and had one-to-one or telephone follow-up at 3 months. Five out of 14 participants had reduced scores from baseline of intermittent claudication during the study period. No evidence for substantive changes in Doppler sounds or ABPI measurements was revealed. Quality of life scores with the EQ-5D improved in 15 participants; this was statistically significant (p = 0.007) with 14 participants who completed the simple satisfaction questionnaire expressing a positive view of the programme. Of the four people who were smokers, two stopped smoking cigarettes and moved to e-cigarettes as part of smoking cessation advice. Conclusion As this was a pilot study the sample size was low, but some statistically significant improvements with some measures were observed over the 6-month study. Podiatrists are able to provide a comprehensive vascular assessment of the lower limb and accompanying tailored advice on lifestyle changes including smoking cessation and exercise. Locating clinics in National Centres for Sports and Exercise Medicine enables easy access to exercise facilities to encourage the adoption of increased activity levels, though the long term sustainability of exercise programmes still requires evaluation.This study was reviewed and approved by London Brent Ethics Committee IRAS ID 204611 and received research governance approval from the sponsor, Sheffield Teaching Hospitals NHS Foundation Trust Research and Innovation Office STH19410.
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Affiliation(s)
- Lisa Farndon
- 1Sheffield Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Stephenson
- 2School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Oliver Binns-Hall
- 1Sheffield Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kayleigh Knight
- 1Sheffield Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sally Fowler-Davis
- 3Sheffield Hallam University /Combined Community & Acute Care Group, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Hart CR, Layec G, Trinity JD, Kwon OS, Zhao J, Reese VR, Gifford JR, Richardson RS. Increased skeletal muscle mitochondrial free radical production in peripheral arterial disease despite preserved mitochondrial respiratory capacity. Exp Physiol 2018; 103:838-850. [PMID: 29604234 DOI: 10.1113/ep086905] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/23/2018] [Indexed: 12/17/2022]
Abstract
NEW FINDINGS What is the central question of this study? What is the degree to which skeletal muscle mitochondria-derived reactive oxygen species (ROS) production is linked to impaired skeletal muscle function in patients with early-stage peripheral arterial disease (PAD) and what is the impact on mitochondrial respiratory capacity? What is the main finding and its importance? This is the first study to document increased mitochondria-derived reactive oxygen species production associated with elevated intramuscular oxidative stress, despite preserved mitochondrial respiratory function, in patients with PAD. Furthermore, systemic inflammation, mitochondria-derived ROS production and skeletal muscle oxidative stress were strongly correlated to disease severity, as indicated by ankle-brachial index, in patients with PAD. ABSTRACT Skeletal muscle mitochondrial dysfunction, which is not fully explained by disease-related arterial occlusion, has been implicated in the pathophysiology of peripheral arterial disease (PAD). Therefore, this study comprehensively assessed mitochondrial respiratory function in biopsies from the gastrocnemius of 10 patients with PAD (Fontaine Stage II) and 12 healthy controls (HC). Intramuscular and systemic inflammation, mitochondria-derived reactive oxygen species (ROS) production, and oxidative stress were also assessed to better understand the mechanisms responsible for the proposed PAD-induced mitochondrial dysfunction. Interestingly, mitochondrial respiratory capacity, assessed as complex I (CI) and complex II (CII)-driven State 3 respiration, measured separately and in combination (State 3 CI+II), revealed no difference between the patients with PAD and the HC. However, mitochondria-derived ROS production was significantly elevated in PAD (HC: 1.0 ± 0.9; PAD: 4.3 ± 1.0 AU (mg tissue)-1 ). Furthermore, patients with PAD exhibited significantly greater concentrations of the pro-inflammatory markers tumour necrosis factor α in plasma (HC: 0.9 ± 0.4; PAD: 2.0 ± 0.3 pg ml-1 ) and interleukin 6 in both plasma (HC: 2.3 ± 0.4; PAD: 4.3 ± 0.5 pg ml-1 ) and muscle (∼75% greater). Intramuscular oxidative stress, assessed by protein carbonyls and 4-hydroxynonenal, was significantly greater in PAD compared to HC. Ankle brachial index was significantly correlated with intramuscular inflammation, oxidative stress and mitochondria-derived ROS production. Thus, elevated intramuscular inflammation, oxidative stress and mitochondria-derived ROS production are likely to contribute to the pathophysiology of the skeletal muscle dysfunction associated with PAD, even in the presence of preserved mitochondrial respiratory function in this population.
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Affiliation(s)
- Corey R Hart
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Exercise and Sport Science, University of Utah, Salt Lake City, UT, USA
| | - Gwenael Layec
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA
| | - Oh Sung Kwon
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA
| | - Jia Zhao
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA
| | - Van R Reese
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA
| | - Jayson R Gifford
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
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