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Li J, Fong DYT, Lok KYW, Wong JYH, Man Ho M, Choi EPH, Pandian V, Davidson PM, Duan W, Tarrant M, Lee JJ, Lin CC, Akingbade O, Alabdulwahhab KM, Ahmad MS, Alboraie M, Alzahrani MA, Bilimale AS, Boonpatcharanon S, Byiringiro S, Hasan MKC, Schettini LC, Corzo W, De Leon JM, De Leon AS, Deek H, Efficace F, El Nayal MA, El-Raey F, Ensaldo-Carrasco E, Escotorin P, Fadodun OA, Fawole IO, Goh YSS, Irawan D, Khan NE, Koirala B, Krishna A, Kwok C, Le TT, Leal DG, Lezana-Fernández MÁ, Manirambona E, Mantoani LC, Meneses-González F, Mohamed IE, Mukeshimana M, Nguyen CTM, Nguyen HTT, Nguyen KT, Nguyen ST, Nurumal MS, Nzabonimana A, Omer NAMA, Ogungbe O, Poon ACY, Reséndiz-Rodriguez A, Puang-Ngern B, Sagun CG, Shaik RA, Shankar NG, Sommer K, Toro E, Tran HTH, Urgel EL, Uwiringiyimana E, Vanichbuncha T, Youssef N. Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study. J Glob Health 2024; 14:04068. [PMID: 38606605 PMCID: PMC11010581 DOI: 10.7189/jogh-14-04068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Background Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.
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Affiliation(s)
- Jiaying Li
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Janet Yuen Ha Wong
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, China
| | - Mandy Man Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Vinciya Pandian
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patricia M Davidson
- Vice-Chancellor and Principal, University of Wollongong, Wollongong, Australia
| | - Wenjie Duan
- Department of Social Work, East China University of Science and Technology, Shanghai, China
| | - Marie Tarrant
- School of Nursing, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Oluwadamilare Akingbade
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Nursing Research, Osogbo, Osun State, Nigeria
| | | | - Mohammad Shakil Ahmad
- Department of Family & Community Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Meshari A Alzahrani
- Department of Urology, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Anil S Bilimale
- School of Public Health, JSS Medical College, JSS AHER, Mysuru, India
| | | | - Samuel Byiringiro
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | | | | | - Hiba Deek
- Nursing Department, Faculty of Health Science, Beirut Arab University, Beirut, Lebanon
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | | | - Fathiya El-Raey
- Department of hepatogastroenterology and infectious diseases, Damietta faculty of medicine, Al-Azhar University, Cairo, Egypt
| | | | - Pilar Escotorin
- Laboratory of Applied Prosocial Research, Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Yong-Shian Shawn Goh
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Devi Irawan
- School of Nursing, Wijaya Husada Health Institute, Bogor, Indonesia
| | | | - Binu Koirala
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Cannas Kwok
- School of Nursing, Paramedicine and Health Care Science, Charles Sturt University, New South Wales, Australia
| | | | | | | | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leandro Cruz Mantoani
- Department of Physiotherapy, Faculty of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, Brazil
| | | | - Iman Elmahdi Mohamed
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Benghazi University, Benghazi, Libya
| | - Madeleine Mukeshimana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | | | | | - Mohd Said Nurumal
- Kulliyyah of Nursing, International Islamic University, Kuantan, Malaysia
| | - Aimable Nzabonimana
- Center for Language Enhancement, College of Arts and Social Sciences, University of Rwanda, Huye, Rwanda
| | | | | | | | | | | | - Ceryl G Sagun
- School of Nursing, Centro Escolar University, Manila, Philippines
| | - Riyaz Ahmed Shaik
- Department of Family & Community Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Nikhil Gauri Shankar
- Mental Health and Learning division, Wrexham Maelor Hospital, Wrexham, Wales, UK
| | - Kathrin Sommer
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Edgardo Toro
- Pontificia Universidad Católica de Valparaíso, School of Social Work, Valparaíso, Chile
| | | | - Elvira L Urgel
- School of Nursing, Centro Escolar University, Manila, Philippines
| | | | - Tita Vanichbuncha
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Naglaa Youssef
- Medical-surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
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2
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Ben Shimol J. Perimenopause in women with rheumatologic diseases: a spotlight on an under-addressed transition. Climacteric 2024; 27:115-121. [PMID: 37990992 DOI: 10.1080/13697137.2023.2276201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
Abundant research has been published describing the effects invoked during menopause across different organ systems. Changing levels of estrogen and progesterone result in bidirectional alterations of immune cell pathways. Overall, the net trend dampens immunoregulation and promotes inflammation. In paradigmatic rheumatologic diseases, the combined effect is far from predictable. While some features may abate during menopause, studies have shown a general increased frequency toward disease exacerbation. Similarly, while impossible to isolate the ramifications of menopause in women with fibromyalgia, a tendency toward enhanced symptoms is unquestionably apparent. Furthermore, the comorbidities accrued by increasing age and the consequences of long-term medication use may also confound this picture. Periodic rheumatologic visits are warranted, with clinical assessments directed toward a multi-disciplinary approach. Ultimately, while an arsenal of effective tools is available for caring for these women and their underlying conditions, more studies are needed to better clarify how the different stages surrounding perimenopause affect subpopulations with rheumatic diseases and fibromyalgia-related disorders so that clinical course can be predicted and addressed prior to the emergence of symptomatology.
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Affiliation(s)
- J Ben Shimol
- Department of Rheumatology, Barzilai University Medical Center, Ashqelon, Israel
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3
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Gokcen N. PELVIC FLOOR MUSCLE EXERCISE AND PHYSICAL THERAPY MAY IMPROVE SYSTEMIC SCLEROSIS-ASSOCIATED FECAL INCONTINENCE. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2021. [DOI: 10.47316/cajmhe.2021.2.2.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Gastrointestinal involvement in systemic sclerosis (SSc) is observed in up to 90% of patients. Resolution of some of these gastrointestinal complications is challenging without the support of physical therapy and rehabilitation. One of these complications, SSc-associated fecal incontinence, which can be devastating for those affected, is seen in up to 39%. Studies focusing on fecal incontinence and its treatment are scarce. The hypothesis presented herein suggests that pelvic floor muscle exercise, biofeedback therapy, and neuromodulation methods might be effective and safe treatment strategies for patients affected by this debilitating complication.
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Cardial Tobias G, Lucas Penteado Gomes J, Paula Renó Soci U, Fernandes T, Menezes de Oliveira E. A Landscape of Epigenetic Regulation by MicroRNAs to the Hallmarks of Cancer and Cachexia: Implications of Physical Activity to Tumor Regression. Epigenetics 2019. [DOI: 10.5772/intechopen.84847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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5
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Zielinski MR, Systrom DM, Rose NR. Fatigue, Sleep, and Autoimmune and Related Disorders. Front Immunol 2019; 10:1827. [PMID: 31447842 PMCID: PMC6691096 DOI: 10.3389/fimmu.2019.01827] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022] Open
Abstract
Profound and debilitating fatigue is the most common complaint reported among individuals with autoimmune disease, such as systemic lupus erythematosus, multiple sclerosis, type 1 diabetes, celiac disease, chronic fatigue syndrome, and rheumatoid arthritis. Fatigue is multi-faceted and broadly defined, which makes understanding the cause of its manifestations especially difficult in conditions with diverse pathology including autoimmune diseases. In general, fatigue is defined by debilitating periods of exhaustion that interfere with normal activities. The severity and duration of fatigue episodes vary, but fatigue can cause difficulty for even simple tasks like climbing stairs or crossing the room. The exact mechanisms of fatigue are not well-understood, perhaps due to its broad definition. Nevertheless, physiological processes known to play a role in fatigue include oxygen/nutrient supply, metabolism, mood, motivation, and sleepiness-all which are affected by inflammation. Additionally, an important contributing element to fatigue is the central nervous system-a region impacted either directly or indirectly in numerous autoimmune and related disorders. This review describes how inflammation and the central nervous system contribute to fatigue and suggests potential mechanisms involved in fatigue that are likely exhibited in autoimmune and related diseases.
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Affiliation(s)
- Mark R Zielinski
- Veterans Affairs Boston Healthcare System, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - David M Systrom
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Noel R Rose
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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6
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Zöller M, Zhao K, Kutlu N, Bauer N, Provaznik J, Hackert T, Schnölzer M. Immunoregulatory Effects of Myeloid-Derived Suppressor Cell Exosomes in Mouse Model of Autoimmune Alopecia Areata. Front Immunol 2018; 9:1279. [PMID: 29951053 PMCID: PMC6008552 DOI: 10.3389/fimmu.2018.01279] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/22/2018] [Indexed: 01/28/2023] Open
Abstract
The treatment of autoimmune diseases still poses a major challenge, frequently relying on non-specific immunosuppressive drugs. Current efforts aim at reestablishing self tolerance using immune cells with suppressive activity like the regulatory T cells (Treg) or the myeloid-derived suppressor cells (MDSC). We have demonstrated therapeutic efficacy of MDSC in mouse Alopecia Areata (AA). In the same AA model, we now asked whether MDSC exosomes (MDSC-Exo) can replace MDSC. MDSC-Exo from bone marrow cells (BMC) cultures of healthy donors could substantially facilitate treatment. With knowledge on MDSC-Exo being limited, their suitability needs to be verified in advance. Protein marker profiles suggest comparability of BMC- to ex vivo collected inflammatory MDSC/MDSC-Exo in mice with a chronic contact dermatitis, which is a therapeutic option in AA. Proteome analyses substantiated a large overlap of function-relevant molecules in MDSC and MDSC-Exo. Furthermore, MDSC-Exo are taken up by T cells, macrophages, NK, and most avidly by Treg and MDSC-Exo uptake exceeds binding of MDSC themselves. In AA mice, MDSC-Exo preferentially target skin-draining lymph nodes and cells in the vicinity of remnant hair follicles. MDSC-Exo uptake is accompanied by a strong increase in Treg, reduced T helper proliferation, mitigated cytotoxic activity, and a slight increase in lymphocyte apoptosis. Repeated MDSC-Exo application in florid AA prevented progression and sufficed for partial hair regrowth. Deep sequencing of lymphocyte mRNA from these mice revealed a significant increase in immunoregulatory mRNA, including FoxP3 and arginase 1. Downregulated mRNA was preferentially engaged in prohibiting T cell hyperreactivity. Taken together, proteome analysis provided important insights into potential MDSC-Exo activities, these Exo preferentially homing into AA-affected organs. Most importantly, changes in leukocyte mRNA seen after treatment of AA mice with MDSC-Exo sustainably supports the strong impact on the adaptive and the non-adaptive immune system, with Treg expansion being a dominant feature. Thus, MDSC-Exo could potentially serve as therapeutic agents in treating AA and other autoimmune diseases.
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Affiliation(s)
- Margot Zöller
- Tumor Cell Biology, Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Kun Zhao
- Tumor Cell Biology, Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Natalia Kutlu
- Tumor Cell Biology, Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Nathalie Bauer
- Tumor Cell Biology, Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Jan Provaznik
- Gene Core Unit, EMBL Heidelberg, Heidelberg, Germany
| | - Thilo Hackert
- Pancreas Section, Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Martina Schnölzer
- Functional Proteome Analysis, German Cancer Research Center, Heidelberg, Germany
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7
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Zöller M. Janus-Faced Myeloid-Derived Suppressor Cell Exosomes for the Good and the Bad in Cancer and Autoimmune Disease. Front Immunol 2018; 9:137. [PMID: 29456536 PMCID: PMC5801414 DOI: 10.3389/fimmu.2018.00137] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/16/2018] [Indexed: 12/22/2022] Open
Abstract
Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of immature myeloid cells originally described to hamper immune responses in chronic infections. Meanwhile, they are known to be a major obstacle in cancer immunotherapy. On the other hand, MDSC can interfere with allogeneic transplant rejection and may dampen autoreactive T cell activity. Whether MDSC-Exosomes (Exo) can cope with the dangerous and potentially therapeutic activities of MDSC is not yet fully explored. After introducing MDSC and Exo, it will be discussed, whether a blockade of MDSC-Exo could foster the efficacy of immunotherapy in cancer and mitigate tumor progression supporting activities of MDSC. It also will be outlined, whether application of native or tailored MDSC-Exo might prohibit autoimmune disease progression. These considerations are based on the steadily increasing knowledge on Exo composition, their capacity to distribute throughout the organism combined with selectivity of targeting, and the ease to tailor Exo and includes open questions that answers will facilitate optimizing protocols for a MDSC-Exo blockade in cancer as well as for strengthening their therapeutic efficacy in autoimmune disease.
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Affiliation(s)
- Margot Zöller
- Tumor Cell Biology, University Hospital of Surgery, University of Heidelberg, Heidelberg, Germany
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8
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Henze T, Feneberg W, Flachenecker P, Seidel D, Albrecht H, Starck M, Meuth SG. Neues zur symptomatischen MS-Therapie: Teil 5 – Fatigue. DER NERVENARZT 2017; 89:446-452. [DOI: 10.1007/s00115-017-0442-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Affiliation(s)
- Yong-Seok Jee
- Research Institute of Sports and Industry Science, Hanseo University, 46 Hanseo 1-ro, Haemi-myeon, Seosan 31962, Korea, E-mail:
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10
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Dasari H, Wootla B, Warrington AE, Rodriguez M. Concomitant Use of Neuroprotective Drugs in Neuro Rehabilitation of Multiple Sclerosis. ACTA ACUST UNITED AC 2016; 4. [PMID: 27595123 PMCID: PMC5006625 DOI: 10.4172/2329-9096.1000348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We provide an overview of rehabilitation in neurological diseases. A large amount of literature available on neurorehabilitation is based from the rehabilitative work on stroke and spinal cord injuries. After a brief description of rehabilitation, the potential application of neurorehabilitation in neurodegenerative diseases specifically multiple sclerosis (MS) is summarized. Since MS causes a wide variety of symptoms, the rehabilitation in MS patients may benefit from an interdisciplinary approach that encloses physiotherapy, cognitive rehabilitation, psychological therapy, occupational therapy, and other methods to improve fatigue. Neurorehabilitation helps patients to reach and maintain their optimal physical, psychological and intellectual, levels but it does not reverse long-term disabilities that arise from neurological disorders. This calls for the need of better neuroregenerative and neuroprotective treatment strategies in addition to neurorehabilitation. We discuss neuroprotective drugs aimed at preventing axonal, neuronal, myelin and oligodendrocyte damage and cell death that are approved and others that are currently in clinical trials, with an emphasis on human derived natural antibodies with remyleination potential. Our investigative group developed recombinant natural human IgM antibodies against oligodendrocytes and neurons with a potential for CNS repair and remyleination. One such recombinant antibody, rHIgM22 completed a phase 1 clinical trial with no toxicity and with an objective of promoting remyleination in multiple sclerosis. Inclusion of these drugs as a multifaceted approach may further enhance the efficacy of neurorehabilitation in neuroinflammatory and neurodegenerative disorders.
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Affiliation(s)
- Harika Dasari
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Bharath Wootla
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Arthur E Warrington
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Moses Rodriguez
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Immunology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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11
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Juvenile idiopathic arthritis and physical activity: possible inflammatory and immune modulation and tracks for interventions in young populations. Autoimmun Rev 2015; 14:726-34. [PMID: 25936296 DOI: 10.1016/j.autrev.2015.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/12/2015] [Indexed: 12/26/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease characterized by persistent joint inflammation that manifests as joint pain and swelling and limited range of joint motion. In healthy subjects, the literature reports that physical activity has an anti-inflammatory effect. In JIA patients, exercise could be used as a therapeutic tool to counteract disease-related inflammation and thereby improve clinical symptoms, although transient flare of pain could be the price to pay. Indeed, in patients with a chronic inflammatory disease, physical activity is prone to exacerbate underlying inflammatory stress. Physical activity improves quality of life and symptoms in JIA patients, but the mechanisms of action remain unclear. This review focuses on the mechanisms underlying exercise-induced immune and hormonal changes. Data on the impact of acute and chronic physical activities on the secretion of hormones and other molecules such as miRNA or peptides involved in the inflammatory process in JIA was compiled and summarized, and the key role of the biological effect of muscle-derived interleukin 6 in the exercise-induced modulation of pro/anti-inflammatory balance is addressed. We also go on to review the effect of training and type of exercise on cytokine response. This review highlights the beneficial effect of physical exercise in children with JIA and potential effect of exercise on the balance between pro- and anti-inflammatory response.
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12
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Flachenecker P. Clinical implications of neuroplasticity - the role of rehabilitation in multiple sclerosis. Front Neurol 2015; 6:36. [PMID: 25784896 PMCID: PMC4347609 DOI: 10.3389/fneur.2015.00036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/12/2015] [Indexed: 01/21/2023] Open
Affiliation(s)
- Peter Flachenecker
- Neurological Rehabilitation Center Quellenhof , Bad Wildbad, Baden-Württemberg , Germany
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13
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Aerobic exercise training as therapy for cardiac and cancer cachexia. Life Sci 2015; 125:9-14. [DOI: 10.1016/j.lfs.2014.11.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/12/2014] [Accepted: 11/25/2014] [Indexed: 01/03/2023]
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14
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A pilot study of an exercise-based patient education program in people with multiple sclerosis. Mult Scler Int 2015; 2014:306878. [PMID: 25587449 PMCID: PMC4283388 DOI: 10.1155/2014/306878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/17/2022] Open
Abstract
There is increasing evidence that physical exercise leads to numerous positive effects in PwMS. However, long-term effects of exercise may only be achievable if training is implemented in daily routine. Enabling patients to exercise regularly, we developed a patient education program focused on evidence-based information of training. PwMS were educated in neurophysiological effects of physical exercise, exercise-induced benefits for PwMS, and risk factors (e.g., weather). Fifteen PwMS were analyzed before (T 0) and after (T 1) a 12-week patient education. Afterwards, participants performed their exercises autonomously for 32 weeks and were tested in sustainability tests (T 2). Guided interviews were carried out, additionally. Significant improvements from T 0 to T 1 were found in 6MWT, gait velocity, TUG, fatigue, and quality of life. Significant results of TUG and gait velocity from T 1 to T 2 demonstrated that participants kept few effects after the 32-week training phase. Qualitative analyses showed improved self-confidence and identified training strategies and barriers. This pilot study provides evidence that PwMS are able to acquire good knowledge about physical exercise and apply this knowledge successfully in training management. One might conclude that this exercise-based patient education seems to be a feasible option to maintain or improve patients' integral constitution concerning physical and mental health.
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Wolff A, Weinstock-Zlotnick G, Gordon J. SSc management--In person appointments and remote therapy (SMART): a framework for management of chronic hand conditions. J Hand Ther 2014; 27:143-50; quiz 151. [PMID: 24524885 DOI: 10.1016/j.jht.2013.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/11/2013] [Accepted: 11/30/2013] [Indexed: 02/03/2023]
Abstract
The changing health care climate poses unique challenges to managing a chronic and progressive disease like systemic sclerosis (SSc). At our institution, we employ a new model for SSc management that combines "in person" appointments and "remote" therapy (SMART). This program fosters an understanding of the disease process with the goal of improving skills and confidence for self-management and empowering individuals by providing a means of daily self-assessment. Technology is utilized as a means to remotely monitor and assess progress. We present our approach as a framework for long term management of chronic hand conditions. Evidence from a variety of disciplines is cited to support the design and parameters of this model.
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Affiliation(s)
- Aviva Wolff
- Leon Root Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Hand Therapy Center, Department of Rehabilitation, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Gwen Weinstock-Zlotnick
- Hand Therapy Center, Department of Rehabilitation, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Jessica Gordon
- Scleroderma and Vasculitis Center, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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16
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Inflammatory cytokines and physical activity in multiple sclerosis. ISRN NEUROLOGY 2014; 2014:151572. [PMID: 24592334 PMCID: PMC3921944 DOI: 10.1155/2014/151572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/05/2013] [Indexed: 11/18/2022]
Abstract
Background. Besides the functional benefits, physical activity triggers a hormonal pattern of immunologic responses with an anti-inflammatory effect in individuals who suffer from multiple sclerosis. Purpose. To analyze the influence of physical activity on multiple sclerosis and identify the intensity threshold which triggers the anti-inflammatory physiological mechanism. Methodology. A systematic review was made on the databases Medline, PubMed, ScienceDirect, PloS, PEDro, and Web of Science. Studies from references of retrieved articles were also collected. The criteria included studies published in English and random studies referred to the inflammatory process, connected with physical activity in individuals with multiple sclerosis. The studies were methodologically analyzed by two reviewers according to PEDro scale. Results and Discussion. Five random control trial studies were identified. The results revealed that with physical activity there seems to have a modulation on anti-inflammatory cytokines which improve physical and cardiorespiratory performance. More investigation is required. Conclusions. Physical activity influences the quality of life and it seems to stimulate the presence of anti-inflammatory cytokines. With light physical activity the cellular activity is lower, while with moderate activity there seems to have more capacity to help in the resolution of an inflammatory situation.
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Garcia CB, Perandini LA, Seguro LPC, Gualano B, Roschel H, Bonfa E, Borba EF, Sá-Pinto AL. Impaired aerobic exercise capacity and cardiac autonomic control in primary antiphospholipid syndrome. Lupus 2013; 22:928-31. [DOI: 10.1177/0961203313497415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary antiphospholipid syndrome (PAPS) is associated with increased risk of cardiovascular disease and mortality. Aerobic capacity and cardiac autonomic control are also associated with these risks. The aim of our study was to assess aerobic capacity and cardiac autonomic control in PAPS patients. Thirteen women with PAPS and 13 healthy controls matched for age, gender, and body mass index were enrolled for the study. Both groups were sedentary and were not under chronotropic, antidepressants and hypolipemiant drugs. All subjects performed a treadmill-graded maximal exercise. Aerobic capacity was assessed by peak oxygen uptake (VO2peak), time at anaerobic ventilatory threshold (VAT) and respiratory compensation point (RCP) and time-to-exhaustion, whereas cardiac autonomic control was assessed by chronotropic reserve (CR) and heart rate recovery at the first and second minutes after graded exercise (HRR1min and HRR2min, respectively). All aerobic capacity indexes were reduced more in PAPS patients than in healthy subjects: VO2peak (30.2 ± 4.7 vs 34.6 ± 4.3 ml.kg−1.min−1, p = 0.021), time at VAT (3.0 ± 1.5 vs 5.0 ± 2.0 min, p = 0.016), time at RCP (6.5 ± 2.0 vs 8.0 ± 2.0 min, p = 0.050), time-to-exhaustion (8.5 ± 2.0 vs 11.0 ± 2.5 min, p = 0.010). HRR1min (22 ± 9 vs 30 ± 7 bpm, p = 0.032) and HRR2min (33 ± 9 vs 46 ± 8 bpm, p = 0.002) were delayed in PAPS patients compared to healthy controls but CR was not significantly different ( p = 0.272). In conclusion, an impaired aerobic capacity and cardiac autonomic control was identified in PAPS.
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Affiliation(s)
- CB Garcia
- Rheumatology Division, School of Medicine, University of São Paulo, Brazil
| | - LA Perandini
- Rheumatology Division, School of Medicine, University of São Paulo, Brazil
| | - LPC Seguro
- Rheumatology Division, School of Medicine, University of São Paulo, Brazil
| | - B Gualano
- Rheumatology Division, School of Medicine, University of São Paulo, Brazil
- School of Physical Education and Sport, University of São Paulo, Brazil
| | - H Roschel
- Rheumatology Division, School of Medicine, University of São Paulo, Brazil
- School of Physical Education and Sport, University of São Paulo, Brazil
| | - E Bonfa
- Rheumatology Division, School of Medicine, University of São Paulo, Brazil
| | - EF Borba
- Rheumatology Division, School of Medicine, University of São Paulo, Brazil
| | - AL Sá-Pinto
- Rheumatology Division, School of Medicine, University of São Paulo, Brazil
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Dimitroulas T, Nikas SN, Trontzas P, Kitas GD. Biologic therapies and systemic bone loss in rheumatoid arthritis. Autoimmun Rev 2013; 12:958-66. [PMID: 23542506 DOI: 10.1016/j.autrev.2013.03.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 03/12/2013] [Indexed: 12/12/2022]
Abstract
Chronic inflammation affects bone metabolism leading to disequilibrium in the rates of bone resorption and repair and subsequently to local and generalized bone loss. Osteoporosis represents an important co-morbidity of rheumatoid arthritis (RA) patients, which exhibit increased fracture risk. Osteoclasts play a pivotal role in the development and progression of bone loss, while resident synovial cells such as T cells, monocytes and synovial fibroblasts have been identified as sources of osteoclast differentiation signals in RA. This process is mainly mediated through the receptor activator of nuclear-kappa B ligand (RANKL) signalling system, which is upregulated by numerous proinflammatory cytokines involved in the pathogenesis of RA. Improved knowledge of the association between cells and cytokines of the immune system and their relationship to bone remodeling has revealed several promising targets for the treatment of inflammatory bone loss in RA. In this respect, initiation of biologic therapies targeting inflammatory cytokines and/or lymphocyte activation has modified RA therapy not only by blocking local and systemic inflammatory cascades but also by providing beneficial effects against bone and joint degradation. In this article we briefly present the modern view of the mechanisms that govern inflammatory bone loss, highlighting the role of cytokine-induced molecular pathways, and discuss in detail the effects of different biologic treatment strategies on bone mass in RA patients.
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Affiliation(s)
- Theodoros Dimitroulas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, West Midlands, UK.
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Menezes KM, Copetti F, Wiest MJ, Trevisan CM, Silveira AF. Efeito da equoterapia na estabilidade postural de portadores de esclerose múltipla: estudo preliminar. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000100008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Este estudo se propôs a verificar se a estimulação por meio da equoterapia é capaz de desencadear alterações no controle postural de portadores de esclerose múltipla (EM). MÉTODO: Fizeram parte deste estudo 11 portadores de EM divididos em Grupo Intervenção (GI) e Grupo Controle (GC). O GI foi inserido num programa de hipoterapia durante 4 meses, sendo conduzidas 2 sessões semanais com duração de 50 minutos cada. A estabilidade postural foi avaliada utilizando uma plataforma de força (para calcular o deslocamento do centro de pressão (COP), durante 30 segundos, em postura ereta quasi-estática, com olhos abertos e fechados, antes e após o treinamento com equoterapia. O tratamento estatístico foi feito através do ANOVA e Post hoc de Tukey com p<0,05. RESULTADOS: A amplitude de oscilação anteroposterior reduziu significativamente no GI após a estimulação, enquanto o GC manteve um comportamento inalterado entre as avaliações. Em ambos os grupos, a estabilidade postural foi reduzida com a supressão da informação visual. CONCLUSÕES: A adaptação funcional proporcionada pela equoterapia foi capaz de melhorar a estabilidade postural dos portadores de EM. Os resultados corroboram a literatura que suporta o uso da equoterapia como uma intervenção em potencial nas desordens de controle postural em portadores de EM.
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Exercise as a therapeutic tool to counteract inflammation and clinical symptoms in autoimmune rheumatic diseases. Autoimmun Rev 2012; 12:218-24. [DOI: 10.1016/j.autrev.2012.06.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 06/29/2012] [Indexed: 12/20/2022]
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Iversen MD, Brawerman M, Iversen CN. Recommendations and the state of the evidence for physical activity interventions for adults with rheumatoid arthritis: 2007 to present. ACTA ACUST UNITED AC 2012; 7:489-503. [PMID: 23538738 DOI: 10.2217/ijr.12.53] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patients with rheumatoid arthritis (RA) are twice as likely as their healthy peers to suffer from cardiovascular disease. RA is also a major cause of disability and reduced quality of life. Clinical trials of exercise and physical activity interventions demonstrate positive effects on muscle strength, function, aerobic capacity, mood and disability. While RA management guidelines emphasize the role of exercise and physical activity in the management of RA, the description of physical activity and exercise is vague and patients with RA remain less physically active than their healthy counterparts. This review discusses the benefits of physical activity and current physical activity recommendations in RA, describes measurement techniques to assess physical activity, and synthesizes the data from interventions to promote physical activity and improve health outcomes in adults with RA.
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Affiliation(s)
- Maura D Iversen
- Department of Physical Therapy, School of Health Professions, Bouve College of Health Sciences, Northeastern University, 6 Robinson Hall, Room 301C, 360 Huntington Avenue, Boston, MA 02115, USA ; Baylor University, Waco, TX, USA ; Harvard Medical School, Boston, MA, USA
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