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Pelletier C. Exercise prescription for persons with spinal cord injury: a review of physiological considerations and evidence-based guidelines. Appl Physiol Nutr Metab 2023; 48:882-895. [PMID: 37816259 DOI: 10.1139/apnm-2023-0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Persons with spinal cord injury (SCI) experience gains in fitness, physical and mental health from regular participation in exercise and physical activity. Due to changes in physiological function of the cardiovascular, nervous, and muscular systems, general population physical activity guidelines and traditional exercise prescription methods are not appropriate for the SCI population. Exercise guidelines specific to persons with SCI recommend progressive training beginning at 20 min of moderate to vigorous intensity aerobic exercise twice per week transitioning to 30 min three times per week, with strength training of the major muscle groups two times per week. These population-specific guidelines were designed considering the substantial barriers to physical activity for persons with SCI and can be used to frame an individual exercise prescription. Rating of perceived exertion (i.e., perceptually regulated exercise) is a practical way to indicate moderate to vigorous intensity exercise in community settings. Adapted exercise modes include arm cycle ergometry, hybrid arm-leg cycling, and recumbent elliptical equipment. Body weight-supported treadmill training and other rehabilitation modalities may improve some aspects of health and fitness for people with SCI if completed at sufficient intensity. Disability-specific community programs offer beneficial opportunities for persons with SCI to experience quality exercise opportunities but are not universally available.
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Affiliation(s)
- Chelsea Pelletier
- School of Health Sciences, Faculty of Human and Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Hohl K, Smith AC, Macaluso R, Giffhorn M, Prokup S, O’Dell DR, Kleinschmidt L, Elliott JM, Jayaraman A. Muscle adaptations in acute SCI following overground exoskeleton + FES training: A pilot study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:963771. [PMID: 36311207 PMCID: PMC9608781 DOI: 10.3389/fresc.2022.963771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the combined effects of robotic exoskeleton and functional electrical stimulation (FES) training on muscle composition during over-ground gait training in persons with acute spinal cord injury (SCI). Design Randomized crossover pilot study. Setting Inpatient-rehabilitation Hospital. Participants Six individuals with acute SCI. Intervention Participants were randomized to either receive training with the Ekso® Bionics exoskeleton combined with FES in addition to standard-of-care or standard-of-care alone. Outcome measures The main outcome measures for the study were quantified using magnetic resonance imaging (MRI), specifically, lower extremity muscle volume and intramuscular adipose tissue (IMAT). Static balance and fall risk were assessed using the Berg Balance Scale. Results Significant improvements were observed in muscle volume in the exoskeleton intervention group when compared to only standard-of-care (p < 0.001). There was no significant difference between the groups in IMAT even though the intervention group saw a reduction in IMAT that trended towards statistical significance (p = 0.07). Static balance improved in both groups, with greater improvements seen in the intervention group. Conclusions Early intervention with robotic exoskeleton may contribute to improved muscle function measured using MRI in individuals with acute SCI.
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Affiliation(s)
- Kristen Hohl
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Andrew C. Smith
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Rebecca Macaluso
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Matthew Giffhorn
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Sara Prokup
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Denise R. O’Dell
- Department of Physical Therapy, University of Kentucky College of Health Sciences, Lexington, KY, United States
| | - Lina Kleinschmidt
- Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jim M. Elliott
- Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Northern Sydney Local Health District, The Kolling Institute and Faculty of Medicine and Health, The University of Sydney, St. Leonards, NSW, Australia
| | - Arun Jayaraman
- Max Näder Lab for Rehabilitation Technologies / Outcomes Lab, Shirley Ryan AbilityLab, Chicago, IL, United States,Department of Physical Therapy / Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Department of Physical Medicine / Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States,Correspondence: Arun Jayaraman
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Huang H, Xue J, Zheng J, Tian H, Fang Y, Wang W, Wang G, Hou D, Lin J. Bioinformatic analysis of the gene expression profile in muscle atrophy after spinal cord injury. Sci Rep 2021; 11:21903. [PMID: 34754020 PMCID: PMC8578571 DOI: 10.1038/s41598-021-01302-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/26/2021] [Indexed: 01/13/2023] Open
Abstract
Spinal cord injury (SCI) is often accompanied by muscle atrophy; however, its underlying mechanisms remain unclear. Here, the molecular mechanisms of muscle atrophy following SCI were investigated. The GSE45550 gene expression profile of control (before SCI) and experimental (14 days following SCI) groups, consisting of Sprague–Dawley rat soleus muscle (n = 6 per group), was downloaded from the Gene Expression Omnibus database, and then differentially expressed gene (DEG) identification and Gene Ontology, pathway, pathway network, and gene signal network analyses were performed. A total of 925 differentially expressed genes, 149 biological processes, and 55 pathways were screened. In the pathway network analysis, the 10 most important pathways were citrate cycle (TCA cycle), pyruvate metabolism, MAPK signalling pathway, fatty acid degradation, propanoate metabolism, apoptosis, focal adhesion, synthesis and degradation of ketone bodies, Wnt signalling, and cancer pathways. In the gene signal network analysis, the 10 most important genes were Acat1, Acadvl, Acaa2, Hadhb, Acss1, Oxct1, Hadha, Hadh, Acaca, and Cpt1b. Thus, we screened the key genes and pathways that may be involved in muscle atrophy after SCI and provided support for finding valuable markers for this disease.
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Affiliation(s)
- Hui Huang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Jinju Xue
- Department of Geriatrics, Affiliated Haikou Hospital, Central South University Xiangya School of Medicine, Haikou, 570208, Hainan, China
| | - Jiaxuan Zheng
- Department of Pathology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Haiquan Tian
- Department of Orthopaedic Surgery, The Second People's Hospital of Changzhi, Changzhi, 046000, Shanxi, China
| | - Yehan Fang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Wei Wang
- Department of Emergency, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Guangji Wang
- Department of Sports Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China
| | - Dan Hou
- Department of Neurology, Affiliated Haikou Hospital, Central South University Xiangya School of Medicine, Haikou, 570208, Hainan, China.
| | - Jianping Lin
- Department of Joint Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, Hainan, China.
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Changes in Tissue Composition and Load Response After Transtibial Amputation Indicate Biomechanical Adaptation. Ann Biomed Eng 2021; 49:3176-3188. [PMID: 34580782 PMCID: PMC8671271 DOI: 10.1007/s10439-021-02858-0] [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: 04/20/2021] [Accepted: 08/20/2021] [Indexed: 12/03/2022]
Abstract
Despite the potential for biomechanical conditioning with prosthetic use, the soft tissues of residual limbs following lower-limb amputation are vulnerable to damage. Imaging studies revealing morphological changes in these soft tissues have not distinguished between superficial and intramuscular adipose distribution, despite the recognition that intramuscular fat levels indicate reduced tolerance to mechanical loading. Furthermore, it is unclear how these changes may alter tissue tone and stiffness, which are key features in prosthetic socket design. This study was designed to compare the morphology and biomechanical response of limb tissues to mechanical loading in individuals with and without transtibial amputation, using magnetic resonance imaging in combination with tissue structural stiffness. The results revealed higher adipose infiltrating muscle in residual limbs than in intact limbs (residual: median 2.5% (range 0.2–8.9%); contralateral: 1.7% (0.1–5.1%); control: 0.9% (0.4–1.3%)), indicating muscle atrophy and adaptation post-amputation. The intramuscular adipose content correlated negatively with daily socket use, although there was no association with time post-amputation. Residual limbs were significantly stiffer than intact limbs at the patellar tendon site, which plays a key role in load transfer across the limb-prosthesis interface. The tissue changes following amputation have relevance in the clinical understanding of prosthetic socket design variables and soft tissue damage risk in this vulnerable group.
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El-Kotob R, Craven BC, Thabane L, Papaioannou A, Adachi JD, Giangregorio LM. Exploring changes in bone mass in individuals with a chronic spinal cord injury. Osteoporos Int 2021; 32:759-767. [PMID: 33089353 DOI: 10.1007/s00198-020-05705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022]
Abstract
UNLABELLED People experience rapid bone loss shortly after a spinal cord injury (SCI), but the long-term bone changes are yet to be confirmed. This study showed that trabecular bone may have reached a steady state, whereas cortical bone continued to decline in people with a chronic SCI (mean time post injury: 15.5 ± 10 years). INTRODUCTION (1) To explore changes in bone [primary measure: trabecular volumetric bone mineral density (vBMD); secondary measures: cortical vBMD, cortical thickness, cortical cross-sectional area (CSA), and polar moment of inertia] over 2 years in individuals with a chronic spinal cord injury (SCI). (2) To explore whether muscle density changes were potential correlates of the observed bone changes. METHODS This study is a secondary data analysis of a prospective, observational study involving 70 people with a chronic SCI (≥ 2 years post injury). The study included 4 strata of participants with diverse impairments: (1) Paraplegia (T1-T12) motor complete American Spinal Injury Association Impairment Scale (AIS) A/B (n = 23), (2) Paraplegia motor incomplete AIS C/D (n = 11), (3) Tetraplegia (C2-C8) AIS A/B (n = 22), and (4) Tetraplegia AIS C/D (n = 14). Peripheral quantitative computed tomography scans were taken at the 4% (distal tibia), 38% (diaphyseal tibia), and 66% (muscle cross-sectional area) tibia sites by measuring from the distal to proximal tibia starting at the inferior border of the medial malleolus. The tibia sites were assessed annually over a span of 2 years. Comparisons were made using a paired-samples t test and simple linear regression was used to adjust for sex, time post injury, and bisphosphonate use. RESULTS We observed no changes in trabecular vBMD at the 4% tibia site, but there was a statistically significant decline in cortical vBMD, cortical thickness, and CSA at the 38% tibia site. Changes in muscle density were not associated with the decreases observed in cortical bone. CONCLUSION Our findings suggest that individuals with chronic SCI (mean duration of injury: 15.5 ± 10 years) may have reached a plateau in bone loss with respect to trabecular bone, but cortical bone loss can continue well into the chronic stages.
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Affiliation(s)
- R El-Kotob
- Deparment of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M4G 3V9, Canada.
| | - B C Craven
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M4G 3V9, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - L Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - A Papaioannou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - L M Giangregorio
- Deparment of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada
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Rabey KN, Satkunam L, Webber CA, Hocking JC. Isolated fatty infiltration of the gastrocnemius medial head, a cadaveric case study. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Legg Ditterline BE, Wade S, Ugiliweneza B, Singam NS, Harkema SJ, Stoddard MF, Hirsch GA. Beneficial Cardiac Structural and Functional Adaptations After Lumbosacral Spinal Cord Epidural Stimulation and Task-Specific Interventions: A Pilot Study. Front Neurosci 2020; 14:554018. [PMID: 33192245 PMCID: PMC7643015 DOI: 10.3389/fnins.2020.554018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022] Open
Abstract
Cardiac myocyte atrophy and the resulting decreases to the left ventricular mass and dimensions are well documented in spinal cord injury. Therapeutic interventions that increase preload can increase the chamber size and improve the diastolic filling ratios; however, there are no data describing cardiac adaptation to chronic afterload increases. Research from our center has demonstrated that spinal cord epidural stimulation (scES) can normalize arterial blood pressure, so we decided to investigate the effects of scES on cardiac function using echocardiography. Four individuals with chronic, motor-complete cervical spinal cord injury were implanted with a stimulator over the lumbosacral enlargement. We assessed the cardiac structure and function at the following time points: (a) prior to implantation; (b) after scES targeted to increase systolic blood pressure; (c) after the addition of scES targeted to facilitate voluntary (i.e., with intent) movement of the trunk and lower extremities; and (d) after the addition of scES targeted to facilitate independent, overground standing. We found significant improvements to the cardiac structure (left ventricular mass = 10 ± 2 g, p < 0.001; internal dimension during diastole = 0.1 ± 0.04 cm, p < 0.05; internal dimension during systole = 0.06 ± 0.03 cm, p < 0.05; interventricular septum dimension = 0.04 ± 0.02 cm, p < 0.05), systolic function (ejection fraction = 1 ± 0.4%, p < 0.05; velocity time integral = 2 ± 0.4 cm, p < 0.001; stroke volume = 4.4 ± 1.5 ml, p < 0.01), and diastolic function (mitral valve deceleration time = -32 ± 11 ms, p < 0.05; mitral valve deceleration slope = 50 ± 25 cm s-1, p < 0.05; isovolumic relaxation time = -6 ± 1.9 ms, p < 0.05) with each subsequent scES intervention. Despite the pilot nature of this study, statistically significant improvements to the cardiac structure, systolic function, and diastolic function demonstrate that scES combined with task-specific interventions led to beneficial cardiac remodeling, which can reverse atrophic changes that result from spinal cord injury. Long-term improvements to cardiac function have implications for increased quality of life and improved cardiovascular health in individuals with spinal cord injury, decreasing the risk of cardiovascular morbidity and mortality.
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Affiliation(s)
- Bonnie E. Legg Ditterline
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of NeuroSurgery, University of Louisville, Louisville, KY, United States
| | - Shelley Wade
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of NeuroSurgery, University of Louisville, Louisville, KY, United States
| | - Narayana Sarma Singam
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, KY, United States
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of NeuroSurgery, University of Louisville, Louisville, KY, United States
| | - Marcus F. Stoddard
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, KY, United States
| | - Glenn A. Hirsch
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, KY, United States
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, United States
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Systolic and diastolic function in chronic spinal cord injury. PLoS One 2020; 15:e0236490. [PMID: 32716921 PMCID: PMC7384657 DOI: 10.1371/journal.pone.0236490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/07/2020] [Indexed: 12/24/2022] Open
Abstract
Individuals with spinal cord injury develop cardiovascular disease more than age-matched, non-injured cohorts. However, progression of systolic and diastolic dysfunction into cardiovascular disease after spinal cord injury is not well described. We sought to investigate the relationship between systolic and diastolic function in chronic spinal cord injury to describe how biological sex, level, severity, and duration of injury correlate with structural changes in the left ventricle. Individuals with chronic spinal cord injury participated in this study (n = 70). Registered diagnostic cardiac sonographers used cardiac ultrasound to measure dimensions, mass, and systolic and diastolic function of the left ventricle. We found no significant relationship to severity or duration of injury with left ventricle measurements, systolic function outcome, or diastolic function outcome. Moreover, nearly all outcomes measured were within the American Society of Echocardiography-defined healthy range. Similar to non-injured individuals, when indexed by body surface area (BSA) left ventricle mass [-14 (5) g/m2, p < .01], end diastolic volume [-6 (3) mL/m2, p < .05], and end systolic volume [-4 (1) mL/m2, p < .01] were significantly decreased in women compared with men. Likewise, diastolic function outcomes significantly worsened with age: E-wave velocity [-5 (2), p < .01], E/A ratio [-0.23 (0.08), p < .01], and e’ velocity [lateral: -1.5 (0.3) cm/s, p < .001; septal: -0.9 (0.2), p < .001] decreased with age while A-wave velocity [5 (1) cm/s, p < .001] and isovolumic relaxation time [6 (3) ms, p < .05] increased with age. Women demonstrated significantly decreased cardiac size and volumes compared with men, but there was no biological relationship to dysfunction. Moreover, individuals were within the range of ASE-defined healthy values with no evidence of systolic or diastolic function and no meaningful relationship to level, severity, or duration of injury. Decreases to left ventricular dimensions and mass seen in spinal cord injury may result from adaptation rather than maladaptive myocardial remodeling, and increased incidence of cardiovascular disease may be related to modifiable risk factors.
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Kim HN, Langley MR, Simon WL, Yoon H, Kleppe L, Lanza IR, LeBrasseur NK, Matveyenko A, Scarisbrick IA. A Western diet impairs CNS energy homeostasis and recovery after spinal cord injury: Link to astrocyte metabolism. Neurobiol Dis 2020; 141:104934. [PMID: 32376475 PMCID: PMC7982964 DOI: 10.1016/j.nbd.2020.104934] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/28/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022] Open
Abstract
A diet high in fat and sucrose (HFHS), the so-called Western diet promotes metabolic syndrome, a significant co-morbidity for individuals with spinal cord injury (SCI). Here we demonstrate that the spinal cord of mice consuming HFHS expresses reduced insulin-like growth factor 1 (IGF-1) and its receptor and shows impaired tricarboxylic acid cycle function, reductions in PLP and increases in astrogliosis, all prior to SCI. After SCI, Western diet impaired sensorimotor and bladder recovery, increased microgliosis, exacerbated oligodendrocyte loss and reduced axon sprouting. Direct and indirect neural injury mechanisms are suggested since HFHS culture conditions drove parallel injury responses directly and indirectly after culture with conditioned media from HFHS-treated astrocytes. In each case, injury mechanisms included reductions in IGF-1R, SIRT1 and PGC-1α and were prevented by metformin. Results highlight the potential for a Western diet to evoke signs of neural insulin resistance and injury and metformin as a strategy to improve mechanisms of neural neuroprotection and repair.
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Affiliation(s)
- Ha Neui Kim
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America; Rehabilitation Medicine Research Center, Department of Physiology and Biomedical Engineering, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America
| | - Monica R Langley
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America; Rehabilitation Medicine Research Center, Department of Physiology and Biomedical Engineering, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America
| | - Whitney L Simon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America
| | - Hyesook Yoon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America; Rehabilitation Medicine Research Center, Department of Physiology and Biomedical Engineering, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America
| | - Laurel Kleppe
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America
| | - Ian R Lanza
- Rehabilitation Medicine Research Center, Department of Physiology and Biomedical Engineering, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America
| | - Nathan K LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America; Rehabilitation Medicine Research Center, Department of Physiology and Biomedical Engineering, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America
| | - Aleksey Matveyenko
- Rehabilitation Medicine Research Center, Department of Physiology and Biomedical Engineering, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America
| | - Isobel A Scarisbrick
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America; Rehabilitation Medicine Research Center, Department of Physiology and Biomedical Engineering, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America; Neurosciuence Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN 55905, United States of America.
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Kodani A, Kikuchi T, Tohda C. Acteoside Improves Muscle Atrophy and Motor Function by Inducing New Myokine Secretion in Chronic Spinal Cord Injury. J Neurotrauma 2019; 36:1935-1948. [PMID: 30318996 PMCID: PMC6599386 DOI: 10.1089/neu.2018.6000] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic spinal cord injury (SCI) is difficult to cure, even by several approaches effective at the acute or subacute phase. We focused on skeletal muscle atrophy as a detrimental factor in chronic SCI and explored drugs that protect against muscle atrophy and activate secretion of axonal growth factors from skeletal muscle. We found that acteoside induced the secretion of axonal growth factors from skeletal muscle cells and proliferation of these cells. Intramuscular injection of acteoside in mice with chronic SCI recovered skeletal muscle weight reduction and motor function impairment. We also identified pyruvate kinase isoform M2 (PKM2) as a secreted factor from skeletal muscle cells, stimulated by acteoside. Extracellular PKM2 enhanced proliferation of skeletal muscle cells and axonal growth in cultured neurons. Further, we showed that PKM2 might cross the blood–brain barrier. These results indicate that effects of acteoside on chronic SCI might be mediated by PKM2 secretion from skeletal muscles. This study proposes that the candidate drug acteoside and a new myokine, PKM2, could be used for the treatment of chronic SCI.
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Affiliation(s)
- Atsushi Kodani
- Division of Neuromedical Science, Institute of Natural Medicine, University of Toyama, Toyama, Japan
| | - Takahiro Kikuchi
- Division of Neuromedical Science, Institute of Natural Medicine, University of Toyama, Toyama, Japan
| | - Chihiro Tohda
- Division of Neuromedical Science, Institute of Natural Medicine, University of Toyama, Toyama, Japan
- Address correspondence to: Chihiro Tohda, PhD, Division of Neuromedical Science, Institute of Natural Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
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Silveira SL, Winter LL, Clark R, Ledoux T, Robinson-Whelen S. Baseline Dietary Intake of Individuals with Spinal Cord Injury Who Are Overweight or Obese. J Acad Nutr Diet 2018; 119:301-309. [PMID: 30393077 DOI: 10.1016/j.jand.2018.08.153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) experience significant secondary health conditions including excess adiposity. Dietary guidelines for individuals with chronic SCI do not exist. OBJECTIVE To describe baseline dietary intake and quality based on conformance with dietary recommendations in participants enrolled in GoHealthySCI, a weight loss intervention for individuals with SCI, which promotes lifestyle change. DESIGN Cross-sectional analyses were conducted on data collected from April through August 2017 in a randomized pilot study. PARTICIPANTS Thirty-seven participants enrolled in the study in Houston, TX. All participants were at least 1 year post injury with a self-reported body mass index (calculated as kg/m2) ≥23. The racially/ethnically diverse sample was predominantly male (n=23), average age was 41.8±13.5 years, and average number of years since injury was 18.1±14.9. Participants varied in terms of level of injury; 19 participants identified as having tetraplegia and 19 identified as having paraplegia. MAIN OUTCOME MEASURES The Automated Self-Administered 24-Hour Recall dietary assessment was used to obtain baseline dietary intake data. Participants reported food intake on 3 nonconsecutive days. STATISTICAL ANALYSIS Descriptive statistics were conducted for the primary research objectives. Mean macronutrient and micronutrient intake and Healthy Eating Index-2015 total and component scores are described. RESULTS Average daily energy intake was 1618±434 kcal. Daily intakes of whole fruits (0.6±0.7 cups), vegetables (1.6±0.9 cups), and whole grains (15%) of total grains were lower than recommendations from the 2015-2020 Dietary Guidelines for Americans. Average daily fiber (15.0g±6.0) met the Academy of Nutrition and Dietetics Evidence Analysis Library minimum target range for individuals with SCI. All percentages of calories from macronutrients were within the acceptable macronutrient distribution ranges: total fat (34.3%±6.2%), protein (16.7%±4.2%), and carbohydrate (49.3%±8.4%). Mean Healthy Eating Index-2015 score was 54.4. CONCLUSIONS This study provides a description of dietary intake by individuals with SCI who are overweight or obese. Although macronutrients are within the acceptable distribution range, calories from fat are at the high end and those from protein are at the low end of those ranges. In addition, on average, individuals reported inadequate intake of fruits, vegetables, whole grains, fiber, seafood and plant protein, and healthy fats and excess intake of added sugars and saturated fat. Results provide preliminary evidence of dietary inadequacies and suggest that larger studies examining dietary intake are warranted.
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