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Flores-Opazo M, Kopinke D, Helmbacher F, Fernández-Verdejo R, Tuñón-Suárez M, Lynch GS, Contreras O. Fibro-adipogenic progenitors in physiological adipogenesis and intermuscular adipose tissue remodeling. Mol Aspects Med 2024; 97:101277. [PMID: 38788527 DOI: 10.1016/j.mam.2024.101277] [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] [Received: 02/01/2024] [Revised: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
Excessive accumulation of intermuscular adipose tissue (IMAT) is a common pathological feature in various metabolic and health conditions and can cause muscle atrophy, reduced function, inflammation, insulin resistance, cardiovascular issues, and unhealthy aging. Although IMAT results from fat accumulation in muscle, the mechanisms underlying its onset, development, cellular components, and functions remain unclear. IMAT levels are influenced by several factors, such as changes in the tissue environment, muscle type and origin, extent and duration of trauma, and persistent activation of fibro-adipogenic progenitors (FAPs). FAPs are a diverse and transcriptionally heterogeneous population of stromal cells essential for tissue maintenance, neuromuscular stability, and tissue regeneration. However, in cases of chronic inflammation and pathological conditions, FAPs expand and differentiate into adipocytes, resulting in the development of abnormal and ectopic IMAT. This review discusses the role of FAPs in adipogenesis and how they remodel IMAT. It highlights evidence supporting FAPs and FAP-derived adipocytes as constituents of IMAT, emphasizing their significance in adipose tissue maintenance and development, as well as their involvement in metabolic disorders, chronic pathologies and diseases. We also investigated the intricate molecular pathways and cell interactions governing FAP behavior, adipogenesis, and IMAT accumulation in chronic diseases and muscle deconditioning. Finally, we hypothesize that impaired cellular metabolic flexibility in dysfunctional muscles impacts FAPs, leading to IMAT. A deeper understanding of the biology of IMAT accumulation and the mechanisms regulating FAP behavior and fate are essential for the development of new therapeutic strategies for several debilitating conditions.
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Affiliation(s)
| | - Daniel Kopinke
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, 32610, FL, USA; Myology Institute, University of Florida College of Medicine, Gainesville, FL, USA.
| | | | - Rodrigo Fernández-Verdejo
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA; Laboratorio de Fisiología Del Ejercicio y Metabolismo (LABFEM), Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Chile.
| | - Mauro Tuñón-Suárez
- Laboratorio de Fisiología Del Ejercicio y Metabolismo (LABFEM), Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Chile.
| | - Gordon S Lynch
- Centre for Muscle Research, Department of Anatomy and Physiology, The University of Melbourne, Melbourne, Victoria, Parkville 3010, Australia.
| | - Osvaldo Contreras
- Developmental and Regenerative Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, NSW, 2010, Australia; School of Clinical Medicine, UNSW Sydney, Kensington, NSW 2052, Australia.
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Okura K, Iwakura M, Kawagoshi A, Sugawara K, Takahashi H, Shioya T. Objective physical activity level is associated with rectus femoris muscle echo‐intensity in patients with chronic obstructive pulmonary disease. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:572-580. [PMID: 35869592 PMCID: PMC9376137 DOI: 10.1111/crj.13528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 12/22/2022]
Abstract
Introduction Skeletal muscle dysfunction is one of the major extrapulmonary complications of chronic obstructive pulmonary disease (COPD). Some studies have reported a relationship between physical activity (PA) level and skeletal muscle quality assessed by echo‐intensity (EI) in healthy individuals but not in patients with COPD. Objectives The aim of this study is to investigate the relationships between PA level and both skeletal muscle EI and skeletal muscle mass in patients with COPD. Methods We employed a cross‐sectional design. Forty male outpatients with stable COPD were enrolled. Using B‐mode ultrasonography, we measured the rectus femoris muscle cross‐sectional area (RF‐CSA) and EI (RF‐EI). The RF‐CSA and RF‐EI were measured on frozen images using an electronic caliper and 8‐bit gray‐scale analysis, respectively. The objective PA level was determined by monitoring daily step counts and moderate‐to‐vigorous physical activity time (MVPA) with an activity monitor. A general regression model was used to assess the relationships between PA level and both RF‐CSA and RF‐EI. Age and body mass index (BMI) were adopted as confounding variables. Results Twenty‐five outpatients with stable COPD (age, 70 ± 7 years old; forced expiratory volume in 1 s, 55.0 ± 24.9% of predicted values) were finally enrolled in the present study. Even after adjusting for age and BMI, the daily step counts and MVPA were significantly associated with RF‐EI, and knee extensor force was associated with RF‐CSA. Conclusion The present study showed that PA level was associated with RF‐EI in patients with COPD. In addition, RF‐CSA was associated with knee extensor force. When assessing skeletal muscle using ultrasonography in patients with COPD, we should also assess EI.
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Affiliation(s)
- Kazuki Okura
- Division of Rehabilitation Akita University Hospital Akita City Japan
| | - Masahiro Iwakura
- Department of Rehabilitation Akita City Hospital Akita City Japan
| | | | - Keiyu Sugawara
- Department of Rehabilitation Akita City Hospital Akita City Japan
| | - Hitomi Takahashi
- Department of Physical Therapy, School of Health Sciences Fukushima Medical University Fukushima City Japan
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Persson HL, Sioutas A, Kentson M, Jacobson P, Lundberg P, Dahlqvist Leinhard O, Forsgren MF. Skeletal Myosteatosis is Associated with Systemic Inflammation and a Loss of Muscle Bioenergetics in Stable COPD. J Inflamm Res 2022; 15:4367-4384. [PMID: 35937916 PMCID: PMC9355337 DOI: 10.2147/jir.s366204] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Common features among patients with more advanced chronic obstructive pulmonary disease (COPD) are systemic inflammation and a loss of both muscle mass and normal muscle composition. In the present study, we investigated COPD subjects to better understand how thigh muscle fat infiltration (MFI) and energy metabolism relate to each other and to clinical features of COPD with emphasis on systemic inflammation. Methods Thirty-two Caucasians with stable COPD were investigated using questionnaires, lung function tests, blood analysis and magnetic resonance imaging (MRI) for analysis of body- and thigh muscle composition. Bioenergetics in the resting thigh muscle, expressed as the PCr/Pi ratio, were analysed using 31phosphorus magnetic resonance spectroscopy (31P-MRS). Results Based on the combination of the MFI adjusted for sex (MFIa) and the thigh fat-tissue free muscle volume, expressed as the deviation from the expected muscle volume of a matched virtual control group (FFMVvcg), all COPD subjects displayed abnormally composed thigh muscles. Clinical features of increased COPD severity, including a decrease of blood oxygenation (r = −0.44, p < 0.05) and FEV1/FVC ratio, reflecting airway obstruction (r = −0.53, p < 0.01) and an increase of COPD symptoms (r = 0.37, p < 0.05) and breathing frequency at rest (r = 0.41, p < 0.05), were all associated with a raise of the PCr/Pi ratio in the thigh muscle. Increased MFIa of the thigh muscle correlated positively with markers of systemic inflammation (white blood cell count, r = 0.41, p < 0.05; fibrinogen, r = 0.44, p < 0.05), and negatively with weekly physical activity (r = −0.40, p < 0.05) and the PCr/Pi ratio in the resting thigh muscle (r = −0.41, p < 0.05). Conclusion The present study implies a link between systemic inflammation, excessive MFI and a loss of bioenergetics in subjects with stable COPD.
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Affiliation(s)
- Hans Lennart Persson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Respiratory Medicine in Linköping, Linköping University, Linköping, Sweden
- Correspondence: Hans Lennart Persson; Apostolos Sioutas, Department of Respiratory Medicine in Linköping, Linköping University, Linköping, SE-581 85, Sweden, Tel +46 0 13 1033621, Email ;
| | - Apostolos Sioutas
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Respiratory Medicine in Linköping, Linköping University, Linköping, Sweden
| | - Magnus Kentson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Pulmonology, Ryhov County Hospital, Jönköping, Sweden
| | - Petra Jacobson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Respiratory Medicine in Linköping, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Radiation Physics in Linköping, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- AMRA Medical AB, Linköping, Sweden
| | - Mikael Fredrik Forsgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
- AMRA Medical AB, Linköping, Sweden
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Qiao X, Hou G, Kang J, Wang QY, Yin Y. CT Attenuation and Cross-Sectional Area of the Pectoralis Are Associated With Clinical Characteristics in Chronic Obstructive Pulmonary Disease Patients. Front Physiol 2022; 13:833796. [PMID: 35721549 PMCID: PMC9205603 DOI: 10.3389/fphys.2022.833796] [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: 12/14/2021] [Accepted: 04/20/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose: Muscle wasting is associated with prognosis in patients with chronic obstructive pulmonary disease (COPD). Computed tomography (CT) could serve as a method for muscle assessment due to its ability to measure both muscle quantity (e.g., cross-sectional muscle area) and muscle quality (e.g., muscle attenuation). Our study aimed to compare the differences in CT-derived pectoralis muscle cross-sectional area (PMA) and pectoralis muscle attenuation (PMT) between COPD patients and healthy controls and explore the association between PMA and PMT measurements and clinical characteristics in patients with COPD. Methods: A total of 252 participants included in our analysis consisted of 80 healthy controls and 172 patients with COPD. PMA and PMT were measured from a single axial slice of the CT scan above the aortic arch. Linear regression analysis was used to determine the correlation between PMA and PMT measurements and clinical characteristics in patients with COPD. Associations were adjusted for age, sex, BMI, FEV1%pred, smoking pack-years, current smoking status, emphysema percentage, and total airway count (TAC) of the right upper lobe apical bronchus (RB1). Results: PMA and PMT were lower in COPD patients, especially those with acute exacerbation, than in healthy controls. PMA and PMT were significantly associated with the severity of emphysema and the TAC of RB1 (p < 0.05). Patients with stable COPD, who had lower PMA and lower PMT, had significantly worse pulmonary function, poorer exercise tolerance, decreased quality of life, and worse dyspnea scores. In addition, patients with acute COPD exacerbation, who had lower PMA and lower PMT, had a higher risk of respiratory failure on admission. Conclusion: CT-derived measurements of the pectoralis muscle may be helpful in detecting declines in muscle quantity and quality and predicting disease severity in patients with COPD.
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Affiliation(s)
- Xin Qiao
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jian Kang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qiu-Yue Wang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Qiu-Yue Wang, ; Yan Yin,
| | - Yan Yin
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Qiu-Yue Wang, ; Yan Yin,
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Decker ST, Kwon OS, Zhao J, Hoidal JR, Heuckstadt T, Richardson RS, Sanders KA, Layec G. Skeletal muscle mitochondrial adaptations induced by long-term cigarette smoke exposure. Am J Physiol Endocrinol Metab 2021; 321:E80-E89. [PMID: 34121449 PMCID: PMC8321829 DOI: 10.1152/ajpendo.00544.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/18/2022]
Abstract
Because patients with chronic obstructive pulmonary disease (COPD) are often physically inactive, it is still unclear whether the lower respiratory capacity in the locomotor muscles of these patients is due to cigarette smoking per se or is secondary to physical deconditioning. Accordingly, the purpose of this study was to examine mitochondrial alterations in the quadriceps muscle of 10 mice exposed to 8 mo of cigarette smoke, a sedentary mouse model of emphysema, and 9 control mice, using immunoblotting, spectrophotometry, and high-resolution respirometry in permeabilized muscle fibers. Mice exposed to smoke displayed a twofold increase in the oxidative stress marker, 4-HNE, (P < 0.05) compared with control mice. This was accompanied by significant decrease in protein expression of UCP3 (65%), ANT (58%), and mitochondrial complexes II-V (∼60%-75%). In contrast, maximal ADP-stimulated respiration with complex I and II substrates (CON: 23.6 ± 6.6 and SMO: 19.2 ± 8.2 ρM·mg-1·s-1) or octanoylcarnitine (CON: 21.8 ± 9.0 and SMO: 16.5 ± 6.6 ρM·mg-1·s-1) measured in permeabilized muscle fibers, as well as citrate synthase activity, were not significantly different between groups. Collectively, our findings revealed that sedentary mice exposed to cigarette smoke for 8 mo, which is typically associated with pulmonary inflammation and emphysema, exhibited a preserved mitochondrial respiratory capacity for various substrates, including fatty acid, in the skeletal muscle. However, the mitochondrial adaptations induced by cigarette smoke favored the development of chronic oxidative stress, which can indirectly contribute to augment the susceptibility to muscle fatigue and exercise intolerance.NEW & NOTEWORTHY It is unclear whether the exercise intolerance and skeletal muscle mitochondrial dysfunction observed in patients with COPD is due to cigarette smoke exposure, per se, or if they are secondary consequences to inactivity. Herein, while long-term exposure to cigarette smoke induces oxidative stress and an altered skeletal muscle phenotype, cigarette smoke does not directly contribute to mitochondrial dysfunction. With this evidence, we demonstrate the critical role of physical inactivity in cigarette smoke-related skeletal muscle dysfunction.
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Affiliation(s)
- Stephen T Decker
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Oh-Sung Kwon
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut
- UConn Center on Aging and Department of Orthopaedic Surgery, University of Connecticut, School of Medicine, Farmington, Connecticut
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
| | - Jia Zhao
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
| | - John R Hoidal
- Department of Internal Medicine, Pulmonary Division, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Thomas Heuckstadt
- Department of Internal Medicine, Pulmonary Division, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Karl A Sanders
- Department of Internal Medicine, Pulmonary Division, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah
| | - Gwenael Layec
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
- Institute of Applied Life Science, University of Massachusetts Amherst, Amherst, Massachusetts
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, Utah
- Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
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Sadaka AS, Faisal A, Khalil YM, Mourad SM, Zidan MH, Polkey MI, Hopkinson NS. Reduced skeletal muscle endurance and ventilatory efficiency during exercise in adult smokers without airflow obstruction. J Appl Physiol (1985) 2021; 130:976-986. [DOI: 10.1152/japplphysiol.00762.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In adult smokers without airflow obstruction, the contributions of pulmonary and skeletal muscle functions to reduced exercise capacity are unclear. We found that non-COPD smokers had decreased exercise capacity and muscle endurance although strength was preserved compared with never-smoking controls. Exercise endurance was associated with quadriceps endurance and CO transfer factor. Despite similar physical activity levels, smokers developed leg fatigue, breathlessness, and displayed increased ventilation with reduced ventilatory efficiency at lower workloads, without exhibiting ventilatory constraint.
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Affiliation(s)
- Ahmed S. Sadaka
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Azmy Faisal
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
- Faculty of Physical Education for Men, Alexandria University, Alexandria, Egypt
| | - Yehia M. Khalil
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sahar M. Mourad
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed H. Zidan
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Michael I. Polkey
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Respiratory Medicine Department, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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Vegter RJK, van den Brink S, Mouton LJ, Sibeijn-Kuiper A, van der Woude LHV, Jeneson JAL. Magnetic Resonance-Compatible Arm-Crank Ergometry: A New Platform Linking Whole-Body Calorimetry to Upper-Extremity Biomechanics and Arm Muscle Metabolism. Front Physiol 2021; 12:599514. [PMID: 33679429 PMCID: PMC7933461 DOI: 10.3389/fphys.2021.599514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Evaluation of the effect of human upper-body training regimens may benefit from knowledge of local energy expenditure in arm muscles. To that end, we developed a novel arm-crank ergometry platform for use in a clinical magnetic resonance (MR) scanner with 31P spectroscopy capability to study arm muscle energetics. Complementary datasets on heart-rate, whole-body oxygen consumption, proximal arm-muscle electrical activity and power output, were obtained in a mock-up scanner. The utility of the platform was tested by a preliminary study over 4 weeks of skill practice on the efficiency of execution of a dynamic arm-cranking task in healthy subjects. RESULTS The new platform successfully recorded the first ever in vivo 31P MR spectra from the human biceps brachii (BB) muscle during dynamic exercise in five healthy subjects. Changes in BB energy- and pH balance varied considerably between individuals. Surface electromyography and mechanical force recordings revealed that individuals employed different arm muscle recruitment strategies, using either predominantly elbow flexor muscles (pull strategy; two subjects), elbow extensor muscles (push strategy; one subject) or a combination of both (two subjects). The magnitude of observed changes in BB energy- and pH balance during ACT execution correlated closely with each strategy. Skill practice improved muscle coordination but did not alter individual strategies. Mechanical efficiency on group level seemed to increase as a result of practice, but the outcomes generated by the new platform showed the additional caution necessary for the interpretation that total energy cost was actually reduced at the same workload. CONCLUSION The presented platform integrates dynamic in vivo 31P MRS recordings from proximal arm muscles with whole-body calorimetry, surface electromyography and biomechanical measurements. This new methodology enables evaluation of cyclic motor performance and outcomes of upper-body training regimens in healthy novices. It may be equally useful for investigations of exercise physiology in lower-limb impaired athletes and wheelchair users as well as frail patients including patients with debilitating muscle disease and the elderly.
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Affiliation(s)
- Riemer J. K. Vegter
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sebastiaan van den Brink
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Leonora J. Mouton
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Anita Sibeijn-Kuiper
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University Medical Center Groningen, Groningen, Netherlands
| | - Lucas H. V. van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Center for Rehabilitation, University Medical Center Groningen, Groningen, Netherlands
| | - Jeroen A. L. Jeneson
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University Medical Center Groningen, Groningen, Netherlands
- Center for Child Development and Exercise, Wilhelmina’s Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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Polkey MI, Praestgaard J, Berwick A, Franssen FME, Singh D, Steiner MC, Casaburi R, Tillmann HC, Lach-Trifilieff E, Roubenoff R, Rooks DS. Activin Type II Receptor Blockade for Treatment of Muscle Depletion in Chronic Obstructive Pulmonary Disease. A Randomized Trial. Am J Respir Crit Care Med 2019; 199:313-320. [PMID: 30095981 DOI: 10.1164/rccm.201802-0286oc] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Bimagrumab is a fully human monoclonal antibody that blocks the activin type II receptors, preventing the activity of myostatin and other negative skeletal muscle regulators. OBJECTIVES To assess the effects of bimagrumab on skeletal muscle mass and function in patients with chronic obstructive pulmonary disease (COPD) and reduced skeletal muscle mass. METHODS Sixty-seven patients with COPD (mean FEV1, 1.05 L [41.6% predicted]; aged 40-80 yr; body mass index < 20 kg/m2 or appendicular skeletal muscle mass index ≤ 7.25 [men] and ≤ 5.67 [women] kg/m2), received two doses of either bimagrumab 30 mg/kg intravenously (n = 33) or placebo (n = 34) (Weeks 0 and 8) over 24 weeks. MEASUREMENTS AND MAIN RESULTS We assessed changes in thigh muscle volume (cubic centimeters) as the primary endpoint along with 6-minute-walk distance (meters), safety, and tolerability. Fifty-five (82.1%) patients completed the study. Thigh muscle volume increased by Week 4 and remained increased at Week 24 in bimagrumab-treated patients, whereas no changes were observed with placebo (Week 4: +5.9% [SD, 3.4%] vs. 0.0% [3.3%], P < 0.001; Week 8: +7.0% [3.7%] vs. -0.7% [2.8%], P < 0.001; Week 16: +7.8% [5.1%] vs. -0.9% [4.5%], P < 0.001; Week 24: +5.0% [4.9%] vs. -1.3% [4.3%], P < 0.001). Over 24 weeks, 6-minute-walk distance did not increase significantly in either group. Adverse events in the bimagrumab group included muscle-related symptoms, diarrhea, and acne, most of which were mild in severity. CONCLUSIONS Blocking the action of negative muscle regulators through the activin type II receptors with bimagrumab treatment safely increased skeletal muscle mass but did not improve functional capacity in patients with COPD and low muscle mass. Clinical trial registered with www.clinicaltrials.gov (NCT01669174).
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Affiliation(s)
- Michael I Polkey
- 1 National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College London, London, United Kingdom
| | - Jens Praestgaard
- 2 Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Amy Berwick
- 3 Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Frits M E Franssen
- 4 Department of Research and Education, CIRO, Center of Expertise for Chronic Organ Failure, Horn, the Netherlands
| | - Dave Singh
- 5 Centre for Respiratory Medicine and Allergy, University of Manchester and the Medicines Evaluation Unit, University Hospital of South Manchester National Health Service Foundation Trust, Manchester, United Kingdom
| | - Michael C Steiner
- 6 Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre, Respiratory, Glenfield Hospital, Leicester, United Kingdom
| | - Richard Casaburi
- 7 Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute, Harbor-University of California Los Angeles Medical Center, Torrance, California; and
| | | | | | - Ronenn Roubenoff
- 8 Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Daniel S Rooks
- 3 Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
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Abdulai RM, Jensen TJ, Patel NR, Polkey MI, Jansson P, Celli BR, Rennard SI. Deterioration of Limb Muscle Function during Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 197:433-449. [PMID: 29064260 DOI: 10.1164/rccm.201703-0615ci] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Important features of both stable and acute exacerbation of chronic obstructive pulmonary disease (COPD) are skeletal muscle weakness and wasting. Limb muscle dysfunction during an exacerbation has been linked to various adverse outcomes, including prolonged hospitalization, readmission, and mortality. The contributing factors leading to muscle dysfunction are similar to those seen in stable COPD: disuse, nutrition/energy balance, hypercapnia, hypoxemia, electrolyte derangements, inflammation, and drugs (i.e., glucocorticoids). These factors may be the trigger for a downstream cascade of local inflammatory changes, pathway process alterations, and structural degradation. Ultimately, the clinical effects can be wide ranging and include reduced limb muscle strength. Current therapies, such as pulmonary/physical rehabilitation, have limited impact because of low participation rates. Recently, novel drugs have been developed in similar disorders, and learnings from these studies can be used as a foundation to facilitate discovery in patients hospitalized with a COPD exacerbation. Nevertheless, investigators should approach this patient population with knowledge of the limitations of each intervention. In this Concise Clinical Review, we provide an overview of acute muscle dysfunction in patients hospitalized with acute exacerbation of COPD and a strategic approach to drug development in this setting.
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Affiliation(s)
- Raolat M Abdulai
- 1 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,2 Respiratory, Inflammation, and Autoimmunity, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Boston, Massachusetts
| | - Tina Jellesmark Jensen
- 3 Respiratory, Inflammation, and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Naimish R Patel
- 2 Respiratory, Inflammation, and Autoimmunity, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Boston, Massachusetts.,4 Beth Israel Deaconess Hospital, Boston, Massachusetts
| | - Michael I Polkey
- 5 National Institute for Health Research, Respiratory Biomedical Research Unit at the Royal Brompton Hospital and Imperial College London, London, United Kingdom
| | - Paul Jansson
- 3 Respiratory, Inflammation, and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Bartolomé R Celli
- 1 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,6 Harvard Medical School, Boston, Massachusetts
| | - Stephen I Rennard
- 7 Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska; and.,8 Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
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10
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Ye X, Wang M, Xiao H. Echo intensity of the rectus femoris in stable COPD patients. Int J Chron Obstruct Pulmon Dis 2017; 12:3007-3015. [PMID: 29075109 PMCID: PMC5648322 DOI: 10.2147/copd.s143645] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective The aim of this study was to investigate whether echo intensity of the rectus femoris when measured using ultrasound can distinguish muscles affected by COPD compared with healthy non-COPD affected muscles and whether the severity of ultrasonic abnormalities was associated with health-related quality of life (HRQoL). Methods Echo intensity, areas of the rectus femoris, and the thickness of quadriceps muscles were measured using ultrasound in 50 COPD outpatients and 21 age-matched non-COPD controls. The results of the 8-Item Short-Form Health Survey and the functional assessment of chronic illness therapy fatigue scales were used to evaluate HRQoL. Results There was a significantly higher echo intensity of the rectus femoris in all stages of COPD patients than in age-matched non-COPD subjects; the quadriceps muscle thickness and cross-sectional area of the rectus femoris significantly decreased in COPD GOLD III–IV only. Furthermore, in our stable COPD patients, echo intensity of the rectus femoris was associated with HRQoL independently. Conclusion Quantitative ultrasound distinguishes healthy muscles from those affected by COPD grade I–IV, and quality and quantity of muscles are associated with HRQoL and forced expiratory volume in 1 second. Ultrasonic echo intensity of the rectus femoris may be a useful instrument for assessing disease severity and monitoring the changes of skeletal muscle resulting from disease progression or clinical intervention in patients with COPD.
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Affiliation(s)
- Xiong Ye
- College of Clinical Medicine, Shanghai University of Medicine & Health Sciences
| | - Mingjie Wang
- Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hui Xiao
- Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
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11
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Rozenberg D, Martelli V, Vieira L, Orchanian-Cheff A, Keshwani N, Singer LG, Mathur S. Utilization of non-invasive imaging tools for assessment of peripheral skeletal muscle size and composition in chronic lung disease: A systematic review. Respir Med 2017; 131:125-134. [DOI: 10.1016/j.rmed.2017.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022]
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12
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Willingham TB, McCully KK. In Vivo Assessment of Mitochondrial Dysfunction in Clinical Populations Using Near-Infrared Spectroscopy. Front Physiol 2017; 8:689. [PMID: 28959210 PMCID: PMC5603672 DOI: 10.3389/fphys.2017.00689] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/28/2017] [Indexed: 12/13/2022] Open
Abstract
The ability to sustain submaximal exercise is largely dependent on the oxidative capacity of mitochondria within skeletal muscle, and impairments in oxidative metabolism have been implicated in many neurologic and cardiovascular pathologies. Here we review studies which have demonstrated the utility of Near-infrared spectroscopy (NIRS) as a method of evaluating of skeletal muscle mitochondrial dysfunction in clinical human populations. NIRS has been previously used to noninvasively measure tissue oxygen saturation, but recent studies have demonstrated the utility of NIRS as a method of evaluating skeletal muscle oxidative capacity using post-exercise recovery kinetics of oxygen metabolism. In comparison to historical methods of measuring muscle metabolic dysfunction in vivo, NIRS provides a more versatile and economical method of evaluating mitochondrial oxidative capacity in humans. These advantages generate great potential for the clinical applicability of NIRS as a means of evaluating muscle dysfunction in clinical populations.
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Affiliation(s)
| | - Kevin K McCully
- Department of Kinesiology, University of GeorgiaAthens, GA, United States
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13
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Layec G, Hart CR, Trinity JD, Kwon OS, Rossman MJ, Broxterman RM, Le Fur Y, Jeong EK, Richardson RS. Oxygen delivery and the restoration of the muscle energetic balance following exercise: implications for delayed muscle recovery in patients with COPD. Am J Physiol Endocrinol Metab 2017; 313:E94-E104. [PMID: 28292763 PMCID: PMC6109703 DOI: 10.1152/ajpendo.00462.2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/03/2017] [Accepted: 03/13/2017] [Indexed: 11/22/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) experience a delayed recovery from skeletal muscle fatigue following exhaustive exercise that likely contributes to their progressive loss of mobility. As this phenomenon is not well understood, this study sought to examine postexercise peripheral oxygen (O2) transport and muscle metabolism dynamics in patients with COPD, two important determinants of muscle recovery. Twenty-four subjects, 12 nonhypoxemic patients with COPD and 12 healthy subjects with a sedentary lifestyle, performed dynamic plantar flexion exercise at 40% of the maximal work rate (WRmax) with phosphorus magnetic resonance spectroscopy (31P-MRS), near-infrared spectroscopy (NIRS), and vascular Doppler ultrasound assessments. The mean response time of limb blood flow at the offset of exercise was significantly prolonged in patients with COPD (controls: 56 ± 27 s; COPD: 120 ± 87 s; P < 0.05). In contrast, the postexercise time constant for capillary blood flow was not significantly different between groups (controls: 49 ± 23 s; COPD: 51 ± 21 s; P > 0.05). The initial postexercise convective O2 delivery (controls: 0.15 ± 0.06 l/min; COPD: 0.15 ± 0.06 l/min) and the corresponding oxidative adenosine triphosphate (ATP) demand (controls: 14 ± 6 mM/min; COPD: 14 ± 6 mM/min) in the calf were not significantly different between controls and patients with COPD (P > 0.05). The phosphocreatine resynthesis time constant (controls: 46 ± 20 s; COPD: 49 ± 21 s), peak mitochondrial phosphorylation rate, and initial proton efflux were also not significantly different between groups (P > 0.05). Therefore, despite perturbed peripheral hemodynamics, intracellular O2 availability, proton efflux, and aerobic metabolism recovery in the skeletal muscle of nonhypoxemic patients with COPD are preserved following plantar flexion exercise and thus are unlikely to contribute to the delayed recovery from exercise in this population.
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Affiliation(s)
- Gwenael Layec
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah;
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Corey R Hart
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - Joel D Trinity
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
| | - Oh-Sung Kwon
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Matthew J Rossman
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah
| | - Ryan M Broxterman
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Yann Le Fur
- Centre de Résonance Magnétique Biologique et Médicale, Aix-Marseille Universite, Centre National de la Recherche Scientifique, Marseille, France; and
| | - Eun-Kee Jeong
- Department of Radiology and Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah
| | - Russell S Richardson
- Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah
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14
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15
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Absence of calf muscle metabolism alterations in active cystic fibrosis adults with mild to moderate lung disease. J Cyst Fibros 2017; 16:98-106. [DOI: 10.1016/j.jcf.2016.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 11/19/2022]
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16
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Robles PG, Sussman MS, Naraghi A, Brooks D, Goldstein RS, White LM, Mathur S. Intramuscular Fat Infiltration Contributes to Impaired Muscle Function in COPD. Med Sci Sports Exerc 2016; 47:1334-41. [PMID: 25373483 DOI: 10.1249/mss.0000000000000556] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
UNLABELLED Muscle weakness is a prevalent complication in chronic obstructive pulmonary disease (COPD). Atrophy does not fully explain muscle weakness in this population. The recent focus on fat infiltration and its clinical implications in age and diseased muscles are important because it may further explain the extent of declining muscle strength and mobility seen in COPD. PURPOSE The objectives of this study are to quantify fat infiltration (muscle quality) of lower-limb muscles in people with COPD and healthy older adults using magnetic resonance imaging and proton magnetic resonance spectroscopy, and to explore its relationship with muscle strength and walking capacity in COPD. METHODS T1-weighted magnetic resonance imaging and proton magnetic resonance spectroscopy were performed in people with COPD (n = 10) and control subjects (n = 10) matched for age, gender, and body mass index. Maximal cross-sectional area (muscle size), isokinetic and isometric muscle peak torques, and 6-min walk distance were also assessed. RESULTS In addition to muscle atrophy (mean between-group differences of 20% to 25%, P < 0.05), COPD group presented with fatty infiltration in thigh and calf muscles that were significantly greater than what was observed in their healthy counterparts (mean between-group differences of 74% to 89%, P = 0.001). There was a strong inverse correlation between intramuscular fat infiltration, muscle peak torque, and walking distance (r = -0.6 to -0.8, P < 0.001) in this group as opposed to fair-to-moderate correlations between muscle size and the same outcomes (r = 0.4-0.6, P < 0.01). CONCLUSION Poor muscle quality accompanies atrophy in people with COPD. Intramuscular fat infiltration not only appears to have a strong correlation with impaired function but also is more profound than muscle atrophy in this group. Monitoring both muscle size and quality may enable a more comprehensive assessment of exercise programs in COPD.
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Affiliation(s)
- Priscila Games Robles
- 1Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, Ontario, CANADA; 2Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, CANADA; 3Department of Physical Therapy, University of Toronto, Toronto, Ontario, CANADA; and 4Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, CANADA
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17
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Curtis KJ, O’Brien KA, Tanner RJ, Polkey JI, Minnion M, Feelisch M, Polkey MI, Edwards LM, Hopkinson NS. Acute Dietary Nitrate Supplementation and Exercise Performance in COPD: A Double-Blind, Placebo-Controlled, Randomised Controlled Pilot Study. PLoS One 2015; 10:e0144504. [PMID: 26698120 PMCID: PMC4689520 DOI: 10.1371/journal.pone.0144504] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/18/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dietary nitrate supplementation can enhance exercise performance in healthy people, but it is not clear if it is beneficial in COPD. We investigated the hypotheses that acute nitrate dosing would improve exercise performance and reduce the oxygen cost of submaximal exercise in people with COPD. METHODS We performed a double-blind, placebo-controlled, cross-over single dose study. Subjects were randomised to consume either nitrate-rich beetroot juice (containing 12.9 mmoles nitrate) or placebo (nitrate-depleted beetroot juice) 3 hours prior to endurance cycle ergometry, performed at 70% of maximal workload assessed by a prior incremental exercise test. After a minimum washout period of 7 days the protocol was repeated with the crossover beverage. RESULTS 21 subjects successfully completed the study (age 68 ± 7 years; BMI 25.2 ± 5.5 kg/m2; FEV1 percentage predicted 50.1 ± 21.6%; peak VO2 18.0 ± 5.9 ml/min/kg). Resting diastolic blood pressure fell significantly with nitrate supplementation compared to placebo (-7 ± 8 mmHg nitrate vs. -1 ± 8 mmHg placebo; p = 0.008). Median endurance time did not differ significantly; nitrate 5.65 (3.90-10.40) minutes vs. placebo 6.40 (4.01-9.67) minutes (p = 0.50). However, isotime oxygen consumption (VO2) was lower following nitrate supplementation (16.6 ± 6.0 ml/min/kg nitrate vs. 17.2 ± 6.0 ml/min/kg placebo; p = 0.043), and consequently nitrate supplementation caused a significant lowering of the amplitude of the VO2-percentage isotime curve. CONCLUSIONS Acute administration of oral nitrate did not enhance endurance exercise performance; however the observation that beetroot juice caused reduced oxygen consumption at isotime suggests that further investigation of this treatment approach is warranted, perhaps targeting a more hypoxic phenotype. TRIAL REGISTRATION ISRCTN Registry ISRCTN66099139.
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Affiliation(s)
- Katrina J. Curtis
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Katie A. O’Brien
- Centre of Human & Aerospace Physiological Sciences, King’s College London, London, United Kingdom
| | - Rebecca J. Tanner
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Juliet I. Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Magdalena Minnion
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, and Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, United Kingdom
| | - Martin Feelisch
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton, and Southampton NIHR Respiratory Biomedical Research Unit, Southampton General Hospital, Southampton, United Kingdom
| | - Michael I. Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
| | - Lindsay M. Edwards
- Centre of Human & Aerospace Physiological Sciences, King’s College London, London, United Kingdom
| | - Nicholas S. Hopkinson
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Trust and Imperial College, London, United Kingdom
- * E-mail:
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18
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Wells CE, Polkey MI, Baker EH. Insulin resistance is associated with skeletal muscle weakness in COPD. Respirology 2015; 21:689-96. [DOI: 10.1111/resp.12716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Claire E Wells
- Institute of Infection and Immunity (mail point J1A); St George's, University of London; London UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Emma H Baker
- Institute of Infection and Immunity (mail point J1A); St George's, University of London; London UK
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19
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Gea J, Pascual S, Casadevall C, Orozco-Levi M, Barreiro E. Muscle dysfunction in chronic obstructive pulmonary disease: update on causes and biological findings. J Thorac Dis 2015; 7:E418-38. [PMID: 26623119 DOI: 10.3978/j.issn.2072-1439.2015.08.04] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Respiratory and/or limb muscle dysfunction, which are frequently observed in chronic obstructive pulmonary disease (COPD) patients, contribute to their disease prognosis irrespective of the lung function. Muscle dysfunction is caused by the interaction of local and systemic factors. The key deleterious etiologic factors are pulmonary hyperinflation for the respiratory muscles and deconditioning secondary to reduced physical activity for limb muscles. Nonetheless, cigarette smoke, systemic inflammation, nutritional abnormalities, exercise, exacerbations, anabolic insufficiency, drugs and comorbidities also seem to play a relevant role. All these factors modify the phenotype of the muscles, through the induction of several biological phenomena in patients with COPD. While respiratory muscles improve their aerobic phenotype (percentage of oxidative fibers, capillarization, mitochondrial density, enzyme activity in the aerobic pathways, etc.), limb muscles exhibit the opposite phenotype. In addition, both muscle groups show oxidative stress, signs of damage and epigenetic changes. However, fiber atrophy, increased number of inflammatory cells, altered regenerative capacity; signs of apoptosis and autophagy, and an imbalance between protein synthesis and breakdown are rather characteristic features of the limb muscles, mostly in patients with reduced body weight. Despite that significant progress has been achieved in the last decades, full elucidation of the specific roles of the target biological mechanisms involved in COPD muscle dysfunction is still required. Such an achievement will be crucial to adequately tackle with this relevant clinical problem of COPD patients in the near-future.
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Affiliation(s)
- Joaquim Gea
- Servei de Pneumologia, Muscle & Respiratory System Research Unit (URMAR), Hospital del Mar-I.M.I.M., Experimental Sciences and Health Department (CEXS), Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Catalonia, Spain
| | - Sergi Pascual
- Servei de Pneumologia, Muscle & Respiratory System Research Unit (URMAR), Hospital del Mar-I.M.I.M., Experimental Sciences and Health Department (CEXS), Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Catalonia, Spain
| | - Carme Casadevall
- Servei de Pneumologia, Muscle & Respiratory System Research Unit (URMAR), Hospital del Mar-I.M.I.M., Experimental Sciences and Health Department (CEXS), Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Catalonia, Spain
| | - Mauricio Orozco-Levi
- Servei de Pneumologia, Muscle & Respiratory System Research Unit (URMAR), Hospital del Mar-I.M.I.M., Experimental Sciences and Health Department (CEXS), Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Catalonia, Spain
| | - Esther Barreiro
- Servei de Pneumologia, Muscle & Respiratory System Research Unit (URMAR), Hospital del Mar-I.M.I.M., Experimental Sciences and Health Department (CEXS), Universitat Pompeu Fabra, CIBERES, ISCIII, Barcelona, Catalonia, Spain
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20
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Mendes P, Wickerson L, Helm D, Janaudis-Ferreira T, Brooks D, Singer LG, Mathur S. Skeletal muscle atrophy in advanced interstitial lung disease. Respirology 2015; 20:953-9. [PMID: 26081374 DOI: 10.1111/resp.12571] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/02/2015] [Accepted: 03/27/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVE A limited number of studies examine skeletal muscle dysfunction in individuals with interstitial lung disease (ILD). We compared upper and lower limb muscle size and strength in individuals with advanced ILD with healthy controls. Second, the relationships of muscle size to muscle strength and function were explored. METHODS Individuals with advanced ILD listed for lung transplant and healthy control subjects were studied. B-mode ultrasound was performed to assess cross-sectional area (CSA) of rectus femoris and thickness of gastrocnemius and soleus and biceps brachii. Subjects performed isometric muscle strength testing, Short Physical Performance Battery, Timed Up and Go, and Unsupported Upper Limb Exercise Test. RESULTS Twenty-six individuals with advanced ILD (61 ± 8 years; 73% males; forced vital capacity: 2 ± 0.8 L, 49 ± 13% predicted; diffusing capacity of carbon monoxide: 9.3 ± 4 mL/min/mm Hg, 51 ± 20% predicted) and 12 healthy age and gender-matched controls (56 ± 9.5 years; 50% males) were included. Compared with controls, people with ILD had a smaller CSA of rectus femoris (7.6 ± 2.1 vs 9.4 ± 2.4 cm(2) ; P = 0.03) and lower strength of knee extensors (119 ± 35 vs 147 ± 39 Nm; P = 0.02) and plantarflexors (37 ± 19 vs 50 ± 15 Nm; P = 0.02), but not of biceps. Individuals with ILD also had impaired performance on all functional tests (P < 0.02). Moderate correlations were found between rectus femoris CSA and knee extensor strength (r = 0.63; P < 0.01) and biceps thickness and elbow flexor strength (r = 0.78; P < 0.01) in the ILD group. CONCLUSIONS Individuals with advanced ILD presented with lower limb muscle atrophy and weakness. Future studies should evaluate the effectiveness of exercise training on muscle function in advanced ILD.
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Affiliation(s)
- Polyana Mendes
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Wickerson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Toronto Lung Transplant Program, Toronto, Ontario, Canada
| | - Denise Helm
- Toronto Lung Transplant Program, Toronto, Ontario, Canada
| | - Tania Janaudis-Ferreira
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Dina Brooks
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Lianne G Singer
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto Lung Transplant Program, Toronto, Ontario, Canada
| | - Sunita Mathur
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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21
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Maddocks M, Shrikrishna D, Vitoriano S, Natanek SA, Tanner RJ, Hart N, Kemp PR, Moxham J, Polkey MI, Hopkinson NS. Skeletal muscle adiposity is associated with physical activity, exercise capacity and fibre shift in COPD. Eur Respir J 2014; 44:1188-98. [PMID: 24993908 PMCID: PMC4216454 DOI: 10.1183/09031936.00066414] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Quadriceps muscle phenotype varies widely between patients with chronic obstructive pulmonary disease (COPD) and cannot be determined without muscle biopsy. We hypothesised that measures of skeletal muscle adiposity could provide noninvasive biomarkers of muscle quality in this population. In 101 patients and 10 age-matched healthy controls, mid-thigh cross-sectional area, percentage intramuscular fat and skeletal muscle attenuation were calculated using computed tomography images and standard tissue attenuation ranges: fat -190- -30 HU; skeletal muscle -29-150 HU. Mean±sd percentage intramuscular fat was higher in the patient group (6.7±3.5% versus 4.3±1.2%, p = 0.03). Both percentage intramuscular fat and skeletal muscle attenuation were associated with physical activity level, exercise capacity and type I fibre proportion, independent of age, mid-thigh cross-sectional area and quadriceps strength. Combined with transfer factor of the lung for carbon monoxide, these variables could identify >80% of patients with fibre type shift with >65% specificity (area under the curve 0.83, 95% CI 0.72-0.95). Skeletal muscle adiposity assessed by computed tomography reflects multiple aspects of COPD related muscle dysfunction and may help to identify patients for trials of interventions targeted at specific muscle phenotypes.
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Affiliation(s)
- Matthew Maddocks
- Dept of Palliative Care, Policy and Rehabilitation, King's College London, London, UK Dept of Asthma, Allergy and Lung Biology, King's College London, London, UK Both authors contributed equally
| | - Dinesh Shrikrishna
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK Both authors contributed equally
| | - Simone Vitoriano
- Dept of Palliative Care, Policy and Rehabilitation, King's College London, London, UK Dept of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Samantha A Natanek
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Rebecca J Tanner
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Nicholas Hart
- NIHR Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Paul R Kemp
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - John Moxham
- Dept of Palliative Care, Policy and Rehabilitation, King's College London, London, UK Dept of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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