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Shen X, Wang S, Chen J, Li J, Li C, Xiang R, Zhao C, Xu X. Inter-rater reliability and test-retest reliability of the foot posture index (FPI-6) for assessing static foot posture in elderly female patients with knee osteoarthritis and its association with quadriceps muscle tone and stiffness. Front Bioeng Biotechnol 2024; 12:1385986. [PMID: 38983600 PMCID: PMC11232489 DOI: 10.3389/fbioe.2024.1385986] [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: 02/14/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024] Open
Abstract
Objective 1. To assess the Inter-rater reliability and test-retest reliability of FPI-6 total score and individual scores in static foot posture evaluation among elderly female patients with knee osteoarthritis (KOA), aiming to establish the reliability of the FPI-6 scale. 2. To investigate the disparity between dominant and non-dominant quadriceps characteristics in elderly female KOA patients, as well as explore the correlation between quadriceps characteristics and abnormal foot posture, thereby offering novel insights for the prevention and treatment of KOA. Methods The study enrolled a total of 80 lower legs of 40 participants (all female) with unilateral or bilateral KOA, who were assessed by two raters at three different time points. The inter-rater and test-retest reliability of the FPI-6 was evaluated using the intra-class correlation coefficient (ICC), while the absolute reliability of FPI-6 was examined using the standard error of measurement (SEM), minimum detectable change (MDC), and Bland-Altman analysis. The internal consistency of FPI-6 was assessed using Spearman's correlation coefficient. Additionally, MyotonPRO was employed to assess quadriceps muscle tone and stiffness in all participants, and the association between quadriceps muscle tone/stiffness and the total score of FPI-6 was analyzed. Result Our study found excellent inter-rater and test-retest reliability (ICC values of 0.923 and 0.931, respectively) for the FPI-6 total score, as well as good to excellent reliability (ICC values ranging from 0.680 to 0.863 and 0.739-0.883) for individual items. The SEM and MDC values for the total score of FPI-6 among our study inter-rater were 0.78 and 2.15, respectively. and the SEM and MDC values for the test-retest total score of FPI-6 were found to be 0.76 and 2.11, respectively. Furthermore, the SEM and MDC values between inter-rater and test-retest across six individual items ranged from 0.30 to 0.56 and from 0.84 to 1.56. The Bland-Altman plots and respective 95% LOA showed no evidence of systematic bias. In terms of the mechanical properties of the quadriceps on both sides, the muscle tone and stiffness of rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were significantly higher in the non-dominant leg compared to the dominant leg. Additionally, in the non-dominant leg, there was a significant positive correlation between the muscle tone and stiffness of VM, VL, RF and the total score of FPI-6. However, in the dominant leg, only VM's muscle tone and stiffness showed a significant positive correlation with the total score of FPI-6. Conclusion The reliability of the FPI-6 total score and its six individual items was good to excellent. Our findings offer a straightforward and dependable approach for researchers to assess foot posture in elderly female patients with KOA. Furthermore, we observed significantly greater quadriceps tension and stiffness in the non-dominant leg compared to the dominant leg. The FPI-6 total score exhibited a significant correlation with changes in quadriceps muscle performance among KOA patients. These observations regarding the relationship between changes in quadriceps muscle performance and foot posture in elderly female KOA patients may provide novel insights for disease prevention, treatment, and rehabilitation.
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Affiliation(s)
- XingXing Shen
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuai Wang
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahao Chen
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junyi Li
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Congcong Li
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruian Xiang
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chuanxi Zhao
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Xuemeng Xu
- The Fifth Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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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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Hosoyama T, Kawai‐Takaishi M, Iida H, Yamamoto Y, Nakamichi Y, Watanabe T, Takemura M, Kato S, Uezumi A, Matsui Y. Lack of vitamin D signalling in mesenchymal progenitors causes fatty infiltration in muscle. J Cachexia Sarcopenia Muscle 2024; 15:907-918. [PMID: 38533539 PMCID: PMC11154772 DOI: 10.1002/jcsm.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Recent studies have indicated the importance of muscle quality in addition to muscle quantity in sarcopenia pathophysiology. Intramuscular adipose tissue (IMAT), which originates from mesenchymal progenitors (MPs) in adult skeletal muscle, is a key factor affecting muscle quality in older adults, suggesting that controlling IMAT formation is a promising therapeutic strategy for sarcopenia. However, the molecular mechanism underlying IMAT formation in older adults has not been clarified. We recently found that the vitamin D receptor (VDR) is highly expressed in MPs in comparison to myotubes (P = 0.028, N = 3), indicating a potential role of vitamin D signalling in MPs. In this study, we aimed to clarify the role of vitamin D signalling in MP kinetics, with a focus on adipogenesis. METHODS MPs isolated from mouse skeletal muscles were subjected to adipogenic differentiation conditions with or without vitamin D (1α,25(OH)2D3, 100 nM) for 7 days, and adipogenicity was evaluated based on adipogenic marker expression. For in vivo analysis, tamoxifen-inducible MP-specific VDR-deficient (VdrMPcKO) mice were newly developed to investigate whether lack of vitamin D signalling in MPs is involved in IMAT formation. To induce muscle atrophy, VdrMPcKO male mice were subjected to tenotomy of the gastrocnemius muscle, and then muscle weight, myofibre cross-sectional area, adipogenic marker expression, and fatty infiltration into the muscle were evaluated at 3 weeks after operation (N = 3-4). In addition, a vitamin D-deficient diet was provided to wild-type male mice (3 and 20 months of age, N = 5) for 3 months to investigate whether vitamin D deficiency causes IMAT formation. RESULTS Vitamin D treatment nearly completely inhibited adipogenesis of MPs through Runx1-mediated transcriptional modifications of early adipogenic factors such as PPARγ (P = 0.0031) and C/EBPα (P = 0.0027), whereas VDR-deficient MPs derived from VdrMPcKO mice differentiated into adipocytes even in the presence of vitamin D (P = 0.0044, Oil-Red O+ area). In consistency with in-vitro findings, VdrMPcKO mice and mice fed a vitamin D-deficient diet exhibited fat deposition in atrophied (P = 0.0311) and aged (P = 0.0216) skeletal muscle, respectively. CONCLUSIONS Vitamin D signalling is important to prevent fate decision of MPs towards the adipogenic lineage. As vitamin D levels decline with age, our data indicate that decreased vitamin D levels may be one of the causes of IMAT formation in older adults, and vitamin D signalling may be a novel therapeutic target for sarcopenia.
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Affiliation(s)
- Tohru Hosoyama
- Department of Musculoskeletal Disease, Research InstituteNational Center for Geriatrics and GerontologyObuJapan
| | - Minako Kawai‐Takaishi
- Department of Musculoskeletal Disease, Research InstituteNational Center for Geriatrics and GerontologyObuJapan
| | - Hiroki Iida
- Department of Musculoskeletal Disease, Research InstituteNational Center for Geriatrics and GerontologyObuJapan
- Department of Orthopaedic SurgeryNagoya University Graduate School of MedicineNagoyaJapan
| | - Yoko Yamamoto
- Department of Surgical OncologyThe University of TokyoTokyoJapan
| | - Yuko Nakamichi
- Institute for Oral ScienceMatsumoto Dental UniversityNaganoJapan
| | - Tsuyoshi Watanabe
- Center for Frailty and Locomotive SyndromeNational Center for Geriatrics and GerontologyObuJapan
- Department of Orthopaedic SurgeryNational Center for Geriatrics and GerontologyObuJapan
| | - Marie Takemura
- Center for Frailty and Locomotive SyndromeNational Center for Geriatrics and GerontologyObuJapan
| | - Shigeaki Kato
- Graduate School of Life Science and EngineeringIryo Sosei UniversityFukushimaJapan
- Research Institute of Innovative MedicineTokiwa FoundationFukushimaJapan
| | - Akiyoshi Uezumi
- Medical Institute of BioregulationKyushu UniversityFukuokaJapan
| | - Yasumoto Matsui
- Center for Frailty and Locomotive SyndromeNational Center for Geriatrics and GerontologyObuJapan
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Taniguchi M, Fukumoto Y, Yagi M, Hirono T, Yamagata M, Asayama A, Okada S, Nakai R, Kobayashi M, Ichihashi N. A higher intramuscular fat in vastus medialis is associated with functional disabilities and symptoms in early stage of knee osteoarthritis: a case-control study. Arthritis Res Ther 2023; 25:61. [PMID: 37060080 PMCID: PMC10103393 DOI: 10.1186/s13075-023-03048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND The characteristics of muscle degeneration in individual quadriceps in early knee osteoarthritis (OA) and the association of muscle quantity and quality on knee dysfunction remain unclear. This study aimed to clarify the characteristics of muscle degeneration in individual quadriceps muscles in early knee OA and elucidate the association of muscle volume and intramuscular adipose tissue (intraMAT) with knee dysfunction, including functional disabilities, symptoms, and joint morphology. METHODS Fifty participants were categorized into early knee OA and healthy control groups. 3.0 T magnetic resonance imaging (MRI) using T1-weighted and Dixon methods and 3D SPACE in the thigh muscle and knee joint regions was performed. Quadriceps muscle volume, intraMAT, and whole-organ MRI score (WORMS) were assessed. The Knee Society Score (KSS) was used to evaluate functional disabilities and knee symptoms. Univariate analysis of variance was conducted with covariates to clarify the differences in muscle volume and intraMAT between the two groups. Multiple linear regression analyses were performed using the KSS function and symptom subcategories and WORMS as dependent variables and muscle volume, intraMAT, and the presence of early knee OA as independent variables, such as potential confounders. RESULTS The quadriceps intraMAT, especially in the vastus medialis (VM), was significantly higher in patients with early knee OA than in healthy controls. The VM intraMAT, not muscle volume, was significantly associated with KSS function [B = - 3.47; 95% confidence interval [CI], - 5.24 to - 1.71; p < 0.001] and symptom scores [B = - 0.63; 95% CI, - 1.09 to - 0.17; p = 0.008], but not with WORMS. CONCLUSION These findings suggest that higher VM intraMAT is characteristic of quadriceps muscle degeneration in early knee OA and its increase is associated with functional disabilities and symptoms.
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Affiliation(s)
- Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Yoshihiro Fukumoto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- School of Health and Sport Science, Chukyo University, Aichi, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Momoko Yamagata
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Akihiro Asayama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Rehabilitation, Japanese Red Cross Nagahama Hospital, Shiga, Japan
| | - Shogo Okada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Ryusuke Nakai
- Kyoto University Institute for the Future of Human Society, Kyoto, Japan
| | | | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
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Immunohistochemical analysis of the quadriceps femoris muscle before and after total knee arthroplasty. Knee 2023; 40:42-51. [PMID: 36403397 DOI: 10.1016/j.knee.2022.10.010] [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: 03/24/2022] [Revised: 08/07/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The number of total knee arthroplasties (TKA) has increased steadily with the aging of the population. This surgical procedure is recognized for its success in pain relief and restoration of knee function. However, decreased quadriceps femoris (QF) muscle strength after TKA is frequently observed but with unknown etiology. Evidence suggests that the location of the operative incision (i.e., surgical access) can influence QF muscle structure and function. The present study aimed to assess the fiber type composition, structure and assembly of the QF's vastus medialis (VM) and vastus lateralis (VL) muscles before and after TKA. METHODS Muscle biopsies (VM and VL muscles) were collected from patients previously submitted to TKA via the medial parapatellar route and undergoing TKA revision (main group, n = 9) and patients with osteoarthrosis (OA) who were due to undergo TKA (control group: n = 18). The biopsied muscle tissue was prepared, stored, and then sectioned in a cryostat at -25 °C. The tissue sections were evaluated using routine staining techniques in pathological anatomy and histochemistry. RESULTS The normal mosaic pattern of the medial and lateral knee muscles was observed in the main and control groups, with no evidence of peripheral nerve damage. Notably, 88.9 % of the patients exhibited mild to severe VL atrophy, while only 11.1 % of patients in the control group presented this feature (P < 0.001). CONCLUSIONS The medial parapatellar incision for TKA surgical access does not generate definitive morphological changes in the VM and VL muscle fibers but may contribute to VL atrophy.
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Taniguchi M, Fukumoto Y, Yagi M, Motomura Y, Okada S, Okada S, Kobayashi M, Ichihashi N. Enhanced echo intensity in vastus medialis is associated with worsening of functional disabilities and symptoms in patients with knee osteoarthritis: a 3 years longitudinal study. Rheumatol Int 2022; 43:953-960. [PMID: 36394599 PMCID: PMC9672570 DOI: 10.1007/s00296-022-05246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
Patients with knee osteoarthritis (OA) experience muscle quality loss, and is characterized by the enhanced echo intensity (EI) of the vastus medialis (VM) muscles and a high extracellular water-to-intracellular water (ECW/ICW) ratio of the thigh. This study aimed to elucidate the association between muscle degeneration and the worsening of functional disabilities and symptoms in patients with KOA over 3 years duration. Thirty-three patients with KOA who completed follow-up over 3 years were included in the analysis. The knee scoring system (KSS) was used to evaluate the functional abilities and symptoms. Based on the 3 years change in KSS scores, patients were classified into progressive or non-progressive groups. Muscle thickness (MT) and EI of the VM were determined using ultrasonography. The ECW/ICW ratio was measured using segmental-bioelectrical impedance spectroscopy. Multivariable logistic regression analyses were conducted with the groups as the dependent variables and VM-MT, VM-EI, and ECW/ICW ratio at baseline as independent variables, including potential confounders. Thirteen (39.4%) patients showed progressive features. VM-EI at baseline was significantly associated with the progression of functional disabilities (adjusted odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03 − 1.50) and symptoms (adjusted OR 1.13; 95% CI 1.01 − 1.25). Enhanced VM-EI was associated with the worsening of functional disabilities and symptoms in patients with KOA over a period of 3 years. Therefore, the assessment of VM-EI using ultrasonography is a useful indicator for predicting the future worsening of KOA.
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Affiliation(s)
- Masashi Taniguchi
- Graduate School of Medicine, Human Health Sciences, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
| | - Yoshihiro Fukumoto
- Graduate School of Medicine, Human Health Sciences, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Masahide Yagi
- Graduate School of Medicine, Human Health Sciences, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
| | - Yoshiki Motomura
- Graduate School of Medicine, Human Health Sciences, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
- Department of Orthopaedic Surgery, Kobayashi Hospital, Kyoto, Japan
| | - Sayaka Okada
- Graduate School of Medicine, Human Health Sciences, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
| | - Shogo Okada
- Graduate School of Medicine, Human Health Sciences, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
| | | | - Noriaki Ichihashi
- Graduate School of Medicine, Human Health Sciences, Kyoto University, 53-Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507 Japan
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Teoli A, Martel-Pelletier J, Abram F, Pelletier JP, Robbins SM. Vastus medialis intramuscular fat is associated with reduced quadriceps strength, but not knee osteoarthritis severity. Clin Biomech (Bristol, Avon) 2022; 96:105669. [PMID: 35636307 DOI: 10.1016/j.clinbiomech.2022.105669] [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: 09/16/2021] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vastus medialis intramuscular fat has been proposed to be a modifiable determinant of knee cartilage loss in patients with knee osteoarthritis. The objective was to determine whether vastus medialis intramuscular fat relates to osteoarthritis severity and quadriceps muscle strength in patients with non-traumatic and post-traumatic knee osteoarthritis. METHODS For this cross-sectional study, participants with knee osteoarthritis were classified into two groups: non-traumatic (n = 22; mean age = 60 years) and post-traumatic (n = 19; mean age = 56 years). Healthy adults were included (n = 22; mean age = 59 years). A 3-Tesla magnetic resonance imaging was used to measure vastus medialis cross-sectional area and intramuscular fat. Isometric knee extensor muscle torque was assessed using an isokinetic dynamometer and normalized to body mass (Nm/kg). Knee osteoarthritis severity was assessed using standing antero-posterior radiographs (Kellgren-Lawrence scores). Regression analyses examined relationships between 1) vastus medialis intramuscular fat with knee osteoarthritis severity and osteoarthritis group, after accounting for sex and body mass index, and 2) knee extensor muscle torque with vastus medialis intramuscular fat, after accounting for sex and vastus medialis cross-sectional area. FINDINGS Vastus medialis intramuscular fat was positively associated with body mass index (B = 0.321, P < 0.001), but not with osteoarthritis severity or group (P > 0.05). Higher vastus medialis intramuscular fat was associated with reduced knee extensor muscle torque (B = -0.040, P = 0.018). INTERPRETATION Greater vastus medialis intramuscular fat was associated with lower quadriceps muscle strength in patients with knee OA. It is unclear whether this is due to the accumulation of vastus medialis intramuscular fat or other potential factors, such as diet and physical inactivity.
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Affiliation(s)
- Anthony Teoli
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada.
| | | | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada.
| | - Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-Mackay Rehabilitation Centre, and School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
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Kumar D, Link TM, Jafarzadeh SR, LaValley MP, Majumdar S, Souza RB. Association of Quadriceps Adiposity With an Increase in Knee Cartilage, Meniscus, or Bone Marrow Lesions Over Three Years. Arthritis Care Res (Hoboken) 2021; 73:1134-1139. [PMID: 32339414 PMCID: PMC7606313 DOI: 10.1002/acr.24232] [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: 08/20/2019] [Accepted: 04/21/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the association of fatty infiltration of the quadriceps and vastus medialis (VM) with an increase in knee cartilage, meniscus, or bone marrow lesions, using magnetic resonance imaging (MRI) in knee osteoarthritis (OA) over 3 years. METHODS Participants (n = 69) with and without radiographic knee OA underwent MRI at baseline and 3 years later. Chemical shift-based water/fat MRI was used to quantify the intramuscular fat fraction and the lean anatomical cross-sectional area (ACSA) for the VM and entire quadriceps muscles. MRI images of the knee were analyzed using the semiquantitative modified whole-organ MRI score (mWORMS) grading to assess change in lesions in the articular cartilage, meniscus, and bone marrow. Logistic regression was used to assess whether baseline quadriceps and VM fat fraction and lean ACSA were associated with an increase in mWORMS scores. Odds ratios (ORs) were adjusted for age, sex, and body mass index. RESULTS Overall, of the 69 subjects, 43 (62%) had an increase in cartilage lesions (26 of 43), meniscus lesions (19 of 43), or bone marrow lesions (22 of 43) scores. The quadriceps (OR 2.13 [95% confidence interval (95% CI) 1.09-4.15]) and VM (OR 2.05 [95% CI 1.25-3.36]) fat fraction were both associated with an increase in cartilage, meniscus, or bone marrow lesion scores over 3 years. The association of quadriceps or VM lean ACSA with the outcomes was not significant. CONCLUSION These longitudinal findings using quantitative MRI methods for assessment of muscle adiposity highlight the role of quadriceps adiposity, specifically in the VM, in knee OA progression. However, studies in larger cohorts are needed to confirm these findings.
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Affiliation(s)
- Deepak Kumar
- Department of Physical Therapy & Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA,Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - S. Reza Jafarzadeh
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Michael P. LaValley
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA,Department of Biostatistics, School of Public Health, Boston University
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Richard B. Souza
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
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Enhanced echo intensity and a higher extracellular water-to-intracellular water ratio are helpful clinical signs for detecting muscle degeneration in patients with knee osteoarthritis. Clin Rheumatol 2021; 40:4207-4215. [PMID: 33999290 DOI: 10.1007/s10067-021-05763-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Enhanced muscle echo intensity (EI) with ultrasound imaging and a higher extracellular water-to-intracellular water (ECW/ICW) ratio with segmental-bioelectrical impedance spectroscopy (S-BIS) represent muscle quality loss. This study aimed to clarify quadriceps muscle degeneration characteristics, focusing on muscle quality changes in patients with knee osteoarthritis (OA). METHOD Forty-one women with knee OA (mean age, 71.4±6.0 years) and 27 healthy women (mean age, 75.6±4.9 years) participated. Ultrasonography was used to evaluate the muscle thickness (MT) and the EI of each quadriceps compartment. The ECW/ICW ratio was obtained by S-BIS. MT, EI, and ECW/ICW ratio differences between the two groups were tested using univariate analysis of variance, adjusting for age and body mass index. Logistic regression analyses were performed with the group as the dependent variable, and the MT and EI of the vastus medialis (VM) and the ECW/ICW ratio as independent variables. RESULTS Patients with knee OA had a significant decrease in VM MT, enhanced VM, and vastus intermedius EIs and a higher ECW/ICW ratio compared with healthy participants. Logistic regression analysis showed that the VM EI (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.06-1.35) and the ECW/ICW ratio were independently associated with knee OA (OR, 1.19; 95% CI, 1.00-1.42). CONCLUSIONS VM EI and the ECW/ICW ratio, rather than VM MT, characterised quadriceps muscle degeneration in patients with knee OA. Therefore, enhanced EI and a higher ECW/ICW ratio are helpful clinical signs for detecting muscle degeneration in patients with knee OA. Key Points •Echo intensity (EI) of the vastus medialis and the extracellular-to-intracellular water (ECW/ICW) ratio significantly increased in patients with knee osteoarthritis OA). •Enhanced EI and a higher ECW/ICW ratio are useful clinical signs for detecting muscle degeneration in patients with knee OA.
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Theret M, Rossi FMV, Contreras O. Evolving Roles of Muscle-Resident Fibro-Adipogenic Progenitors in Health, Regeneration, Neuromuscular Disorders, and Aging. Front Physiol 2021; 12:673404. [PMID: 33959042 PMCID: PMC8093402 DOI: 10.3389/fphys.2021.673404] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
Normal skeletal muscle functions are affected following trauma, chronic diseases, inherited neuromuscular disorders, aging, and cachexia, hampering the daily activities and quality of life of the affected patients. The maladaptive accumulation of fibrous intramuscular connective tissue and fat are hallmarks of multiple pathologies where chronic damage and inflammation are not resolved, leading to progressive muscle replacement and tissue degeneration. Muscle-resident fibro-adipogenic progenitors are adaptable stromal cells with multilineage potential. They are required for muscle homeostasis, neuromuscular integrity, and tissue regeneration. Fibro-adipogenic progenitors actively regulate and shape the extracellular matrix and exert immunomodulatory functions via cross-talk with multiple other residents and non-resident muscle cells. Remarkably, cumulative evidence shows that a significant proportion of activated fibroblasts, adipocytes, and bone-cartilage cells, found after muscle trauma and disease, descend from these enigmatic interstitial progenitors. Despite the profound impact of muscle disease on human health, the fibrous, fatty, and ectopic bone tissues' origins are poorly understood. Here, we review the current knowledge of fibro-adipogenic progenitor function on muscle homeostatic integrity, regeneration, repair, and aging. We also discuss how scar-forming pathologies and disorders lead to dysregulations in their behavior and plasticity and how these stromal cells can control the onset and severity of muscle loss in disease. We finally explore the rationale of improving muscle regeneration by understanding and modulating fibro-adipogenic progenitors' fate and behavior.
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Affiliation(s)
- Marine Theret
- Biomedical Research Centre, Department of Medical Genetics, School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Fabio M. V. Rossi
- Biomedical Research Centre, Department of Medical Genetics, School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Osvaldo Contreras
- Departamento de Biología Celular y Molecular, Center for Aging and Regeneration (CARE-ChileUC), Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- St. Vincent’s Clinical School, Faculty of Medicine, UNSW Sydney, Kensington, NSW, Australia
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
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Oba H, Matsui Y, Arai H, Watanabe T, Iida H, Mizuno T, Yamashita S, Ishizuka S, Suzuki Y, Hiraiwa H, Imagama S. Evaluation of muscle quality and quantity for the assessment of sarcopenia using mid-thigh computed tomography: a cohort study. BMC Geriatr 2021; 21:239. [PMID: 33849469 PMCID: PMC8045267 DOI: 10.1186/s12877-021-02187-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 04/02/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND For the diagnosis of Sarcopenia, European Working Group on Sarcopenia in Older People (EWGSOP) revised the algorisms in 2019, where they added computed tomography (CT) as an assessment tool not only for quantity but also for quality in research purpose. However, the evidence for clinical appreciation of CT has been lacking. Therefore, we investigated the correlation between CT and various motor function tests to assess the utility of CT as a potential diagnostic tool for sarcopenia. METHODS In total, 214 patients who were examined at our center during the study period (2016-2017) were included in the study. Single-slice CT scan of the mid-thigh region was performed, from which cross-sectional area (CSA) and CT attenuation value (CTV) of quadriceps femoris were evaluated for each subject. Other assessments included skeletal muscle mass index by DXA and BIA, muscle strength and physical performance. Furthermore, subjects were classified into four groups as per the Asia Working Group of Sarcopenia (AWGS) 2019 criteria as those with: normal, poor muscle function/strength (poor function), sarcopenia and severe sarcopenia. RESULTS Knee muscle strength correlated with CSA (r = 0.60) and the correlation was significantly greater than that with DXA and BIA. For physical performance, standing-up test correlated with CSA (r = - 0.20) and CTV (r = - 0.40) and walking speed with CTV (r = 0.43), which was significantly greater than that with DXA and BIA. The CSA was significantly lower in women with sarcopenia group and in both men and women with severe sarcopenia (all p < 0.01). Furthermore, CTV was significantly lower in women with poor-function and in both men and women with severe sarcopenia group (all p < 0.01). CONCLUSIONS CSA mostly correlated with muscle strength, whereas CTV mostly correlated with physical performance. CT with measurements of CSA and CTV enables the evaluation of muscle mass and quality simultaneously. CT is believed to be useful in inferring evaluation of motor function and assessment of sarcopenia.
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Affiliation(s)
- Hiroki Oba
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showaku, Nagoya, Aichi, 466-8560, Japan. .,Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, 7-430 Moriokacho, Obu, Aichi, 474-8511, Japan.
| | - Yasumoto Matsui
- Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, 7-430 Moriokacho, Obu, Aichi, 474-8511, Japan
| | - Hidenori Arai
- Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, 7-430 Moriokacho, Obu, Aichi, 474-8511, Japan
| | - Tsuyoshi Watanabe
- Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, 7-430 Moriokacho, Obu, Aichi, 474-8511, Japan.,Department of Orthopedics, National Center for Geriatrics and Gerontology, 7-430 Moriokacho, Obu, Aichi, 474-8511, Japan
| | - Hiroki Iida
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showaku, Nagoya, Aichi, 466-8560, Japan.,Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, 7-430 Moriokacho, Obu, Aichi, 474-8511, Japan
| | - Takafumi Mizuno
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showaku, Nagoya, Aichi, 466-8560, Japan.,Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, 7-430 Moriokacho, Obu, Aichi, 474-8511, Japan
| | - Satoshi Yamashita
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showaku, Nagoya, Aichi, 466-8560, Japan
| | - Shinya Ishizuka
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showaku, Nagoya, Aichi, 466-8560, Japan
| | - Yasuo Suzuki
- Center for Frailty and Locomotive Syndrome, National Center for Geriatrics and Gerontology, 7-430 Moriokacho, Obu, Aichi, 474-8511, Japan.,Department of Human Care Engineering, Faculty of Health Sciences, Nihon Fukushi University, Okuda, Mihamacho, Chita, Aichi, 470-3295, Japan
| | - Hideki Hiraiwa
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showaku, Nagoya, Aichi, 466-8560, Japan
| | - Shiro Imagama
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showaku, Nagoya, Aichi, 466-8560, Japan
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Taniguchi M, Ikezoe T, Kamitani T, Tsuboyama T, Ito H, Matsuda S, Tabara Y, Matsuda F, Ichihashi N. Extracellular-to-intracellular water ratios are associated with functional disability levels in patients with knee osteoarthritis: results from the Nagahama Study. Clin Rheumatol 2021; 40:2889-2896. [PMID: 33486595 DOI: 10.1007/s10067-021-05591-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION/OBJECTIVES To test the hypothesis that greater extracellular-to-intracellular water (ECW/ICW) ratios in lower-limb muscles are associated with worsened functional abilities in patients with knee osteoarthritis (OA). METHODS We analyzed data from 787 participants (82.2% female; mean age, 69.6 ± 5.3 years) from the Nagahama Prospective Cohort who were ≥60 years old and had radiographically confirmed bilateral knee OA. The Knee Scoring System (KSS) was used to assess functional abilities. Lower-limb ECW/ICW ratios and skeletal mass index values were determined with multi-frequency bioelectrical impedance analysis (BIA). Multiple linear regression analysis was used to test for associations between ECW/ICW ratios and functional abilities. Subgroup analyses based on OA severities and symptomaticity were also conducted. RESULTS Increased ECW/ICW ratios were associated with a 4.38-point decrease in the KSS function scores (95% confidence interval [CI], 3.15-5.62 points) after adjusting for covariates. This association varied according to the degree of knee symptoms, especially in individuals with radiologically mild OA. ECW/ICW ratios in individuals with asymptomatic mild OA were associated with a 2.14-point decrease in the KSS function score (95% CI, 0.32-3.96 points), whereas those in individuals with severe symptomatic mild OA were associated with a 6.16-point decrease (95% CI, 2.13-10.19 points). CONCLUSIONS Our findings indicate that higher ECW/ICW ratios are associated with greater functional disability in patients with knee OA. Therefore, ECW/ICW ratio measurements with multi-frequency BIA can serve as valuable indicators for functional disability in patients with knee OA. Key Points • Higher extracellular-to-intracellular water (ECW/ICW) ratios are associated with greater functional disability levels in patients with knee osteoarthritis (OA). • ECW/ICW ratios are useful clinical signs as a biomarker for poor functional abilities in patients with knee OA.
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Affiliation(s)
- Masashi Taniguchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Tome Ikezoe
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadao Tsuboyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Nemoto A, Goyagi T. Tail suspension is useful as a sarcopenia model in rats. Lab Anim Res 2021; 37:7. [PMID: 33441192 PMCID: PMC7805154 DOI: 10.1186/s42826-020-00083-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022] Open
Abstract
Background Sarcopenia promotes skeletal muscle atrophy and exhibits a high mortality rate. Its elucidation is of the highest clinical importance, but an animal experimental model remains controversial. In this study, we investigated a simple method for studying sarcopenia in rats. Results Muscle atrophy was investigated in 24-week-old, male, tail-suspended (TS), Sprague Dawley and spontaneously hypertensive rats (SHR). Age-matched SD rats were used as a control group. The skeletal muscle mass weight, muscle contraction, whole body tension (WBT), cross-sectional area (CSA), and Muscle RING finger-1 (MuRF-1) were assessed. Enzyme-linked immunosorbent assay was used to evaluate the MuRF-1 levels. Two muscles, the extensor digitorum longus and soleus muscles, were selected for representing fast and slow muscles, respectively. All data, except CSA, were analyzed by a one-way analysis of variance, whereas CSA was analyzed using the Kruskal-Wallis test. Muscle mass weight, muscle contraction, WBT, and CSA were significantly lower in the SHR (n = 7) and TS (n = 7) groups than in the control group, whereas MuRF-1 expression was dominant. Conclusions TS and SHR presented sarcopenic phenotypes in terms of muscle mass, muscle contraction and CSA. TS is a useful technique for providing muscle mass atrophy and weakness in an experimental model of sarcopenia in rats.
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Affiliation(s)
- Akira Nemoto
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-0843, Japan
| | - Toru Goyagi
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-0843, Japan.
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Georgiev T, Angelov AK. Modifiable risk factors in knee osteoarthritis: treatment implications. Rheumatol Int 2019; 39:1145-1157. [DOI: 10.1007/s00296-019-04290-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/19/2019] [Indexed: 12/23/2022]
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