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Boissonnault È, Jeon A, Munin MC, Filippetti M, Picelli A, Haldane C, Reebye R. Assessing muscle architecture with ultrasound: implications for spasticity. Eur J Transl Myol 2024; 34:12397. [PMID: 38818772 PMCID: PMC11264226 DOI: 10.4081/ejtm.2024.12397] [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: 03/04/2024] [Accepted: 04/21/2024] [Indexed: 06/01/2024] Open
Abstract
Botulinum Neurotoxin Type A (BoNT-A) injections using Ultrasound (US) guidance have led to research evaluating changes in muscle architecture. Controversy remains as to what constitutes increased Echo-Intensity (EI) in spastic muscles and whether this may affect outcomes. We aim to provide a narrative review of US muscle architecture changes following Central Nervous System (CNS) lesions and explore their relationship to spasticity. Medline, CINAHL, and Embase databases were searched with keywords: ultrasonography, hypertonia, spasticity, fibrosis, and Heckmatt. Three physicians reviewed the results of the search to select relevant papers. Reviews identified in the search were used as a resource to identify additional studies. A total of 68 papers were included. Four themes were identified, including histopathological changes in spastic muscle, effects of BoNT-A on the muscle structure, available US modalities to assess the muscle, and utility of US assessment in clinical spasticity. Histopathological studies revealed atrophic and fibro-fatty changes after CNS lesions. Several papers described BoNT-A injections contributing to those modifications. These changes translated to increased EI. The exact significance of increased muscle EI remains unclear. The Modified Heckmatt Scale (MHS) is a validated tool for grading muscle EI in spasticity. The use of the US may be an important tool to assess muscle architecture changes in spasticity and improve spasticity management. Treatment algorithms may be developed based on the degree of EI. Further research is needed to determine the incidence and impact of these EI changes in spastic muscles.
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Affiliation(s)
- Ève Boissonnault
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston.
| | - April Jeon
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh.
| | - Michael C Munin
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh.
| | - Mirko Filippetti
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical and Rehabilitation Medicine section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Alessandro Picelli
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical and Rehabilitation Medicine section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Chloe Haldane
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver.
| | - Rajiv Reebye
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver.
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Howard JJ, Joumaa V, Robinson KG, Lee SK, Akins RE, Syed F, Shrader MW, Huntley JS, Graham HK, Leonard T, Herzog W. Collagenase treatment decreases muscle stiffness in cerebral palsy: A preclinical ex vivo biomechanical analysis of hip adductor muscle fiber bundles. Dev Med Child Neurol 2023; 65:1639-1645. [PMID: 37198748 DOI: 10.1111/dmcn.15637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/19/2023]
Abstract
AIM To determine the dose-response relationship of collagenase Clostridium histolyticum (CCH) on collagen content and the change in muscle fiber bundle stiffness after ex vivo treatment of adductor longus biopsies with CCH in children with cerebral palsy (CP). METHOD Biopsy samples of adductor longus from children with CP (classified in Gross Motor Function Classification System levels IV and V) were treated with 0 U/mL, 200 U/mL, 350 U/mL, or 500 U/mL CCH; percentage collagen reduction was measured to determine the dose-response. Peak and steady-state stresses were determined at 1%, 2.5%, 5%, and 7.5% strain increments; Young's modulus was calculated. RESULTS Eleven patients were enrolled (nine males, two females, mean age at surgery 6 years 5 months; range: 2-16 years). A linear CCH dose-response relationship was determined. Peak and steady-state stress generation increased linearly at 5.9/2.3mN/mm2 , 12.4/5.3mN/mm2 , 22.2/9.7mN/mm2 , and 33.3/15.5mN/mm2 at each percentage strain increment respectively. After CCH treatment, peak and steady-state stress generation decreased to 3.2/1.2mN/mm2 , 6.5/2.9mN/mm2 , 12.2/5.7mN/mm2 , and 15.4/7.7mN/mm2 respectively (p < 0.004). Young's modulus decreased from 205 kPa to 100 kPa after CCH (p = 0.003). INTERPRETATION This preclinical ex vivo study provides proof of concept for the use of collagenase to decrease muscle stiffness in individuals with CP.
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Affiliation(s)
- Jason J Howard
- Department of Orthopedic Surgery, Nemours Children's Hospital, Delaware, Wilmington, DE, USA
| | - Venus Joumaa
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Karyn G Robinson
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
| | - Stephanie K Lee
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
| | - Robert E Akins
- Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE, USA
| | - Faizan Syed
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - M Wade Shrader
- Department of Orthopedic Surgery, Nemours Children's Hospital, Delaware, Wilmington, DE, USA
| | - James S Huntley
- Division of Orthopedic Surgery, Department of Surgery, Sidra Medicine, Doha, Qatar
| | - H Kerr Graham
- Department of Orthopaedic Surgery, University of Melbourne, Hugh Williamson Gait Laboratory, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Timothy Leonard
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Wohlgemuth RP, Brashear SE, Smith LR. Alignment, cross linking, and beyond: a collagen architect's guide to the skeletal muscle extracellular matrix. Am J Physiol Cell Physiol 2023; 325:C1017-C1030. [PMID: 37661921 PMCID: PMC10635663 DOI: 10.1152/ajpcell.00287.2023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
The muscle extracellular matrix (ECM) forms a complex network of collagens, proteoglycans, and other proteins that produce a favorable environment for muscle regeneration, protect the sarcolemma from contraction-induced damage, and provide a pathway for the lateral transmission of contractile force. In each of these functions, the structure and organization of the muscle ECM play an important role. Many aspects of collagen architecture, including collagen alignment, cross linking, and packing density affect the regenerative capacity, passive mechanical properties, and contractile force transmission pathways of skeletal muscle. The balance between fortifying the muscle ECM and maintaining ECM turnover and compliance is highly dependent on the integrated organization, or architecture, of the muscle matrix, especially related to collagen. While muscle ECM remodeling patterns in response to exercise and disease are similar, in that collagen synthesis can increase in both cases, one outcome leads to a stronger muscle and the other leads to fibrosis. In this review, we provide a comprehensive analysis of the architectural features of each layer of muscle ECM: epimysium, perimysium, and endomysium. Further, we detail the importance of muscle ECM architecture to biomechanical function in the context of exercise or fibrosis, including disease, injury, and aging. We describe how collagen architecture is linked to active and passive muscle biomechanics and which architectural features are acutely dynamic and adapt over time. Future studies should investigate the significance of collagen architecture in muscle stiffness, ECM turnover, and lateral force transmission in the context of health and fibrosis.
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Affiliation(s)
- Ross P Wohlgemuth
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, California, United States
| | - Sarah E Brashear
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, California, United States
| | - Lucas R Smith
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, California, United States
- Department of Physical Medicine and Rehabilitation, University of California, Davis, California, United States
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Loomis T, Smith LR. Thrown for a loop: fibro-adipogenic progenitors in skeletal muscle fibrosis. Am J Physiol Cell Physiol 2023; 325:C895-C906. [PMID: 37602412 DOI: 10.1152/ajpcell.00245.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023]
Abstract
Fibro-adipogenic progenitors (FAPs) are key regulators of skeletal muscle regeneration and homeostasis. However, dysregulation of these cells leads to fibro-fatty infiltration across various muscle diseases. FAPs are the key source of extracellular matrix (ECM) deposition in muscle, and disruption to this process leads to a pathological accumulation of ECM, known as fibrosis. The replacement of contractile tissue with fibrotic ECM functionally impairs the muscle and increases muscle stiffness. FAPs and fibrotic muscle form a progressively degenerative feedback loop where, as a muscle becomes fibrotic, it induces a fibrotic FAP phenotype leading to further development of fibrosis. In this review, we summarize FAPs' role in fibrosis in terms of their activation, heterogeneity, contributions to fibrotic degeneration, and role across musculoskeletal diseases. We also discuss current research on potential therapeutic avenues to attenuate fibrosis by targeting FAPs.
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Affiliation(s)
- Taryn Loomis
- Biomedical Engineering Graduate Group, University of California, Davis, California, United States
| | - Lucas R Smith
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, California, United States
- Department of Physical Medicine and Rehabilitation, University of California, Davis, California, United States
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Wohlgemuth RP, Feitzinger RM, Henricson KE, Dinh DT, Brashear SE, Smith LR. The extracellular matrix of dystrophic mouse diaphragm accounts for the majority of its passive stiffness and is resistant to collagenase digestion. Matrix Biol Plus 2023; 18:100131. [PMID: 36970609 PMCID: PMC10036937 DOI: 10.1016/j.mbplus.2023.100131] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/16/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
The healthy skeletal muscle extracellular matrix (ECM) has several functions including providing structural integrity to myofibers, enabling lateral force transmission, and contributing to overall passive mechanical properties. In diseases such as Duchenne Muscular dystrophy, there is accumulation of ECM materials, primarily collagen, which results in fibrosis. Previous studies have shown that fibrotic muscle is often stiffer than healthy muscle, in part due to the increased number and altered architecture of collagen fibers within the ECM. This would imply that the fibrotic matrix is stiffer than the healthy matrix. However, while previous studies have attempted to quantify the extracellular contribution to passive stiffness in muscle, the outcomes are dependent on the type of method used. Thus, the goals of this study were to compare the stiffness of healthy and fibrotic muscle ECM and to demonstrate the efficacy of two methods for quantifying extracellular-based stiffness in muscle, namely decellularization and collagenase digestion. These methods have been demonstrated to remove the muscle fibers or ablate collagen fiber integrity, respectively, while maintaining the contents of the extracellular matrix. Using these methods in conjunction with mechanical testing on wildtype and D2.mdx mice, we found that a majority of passive stiffness in the diaphragm is dependent on the ECM, and the D2.mdx diaphragm ECM is resistant to digestion by bacterial collagenase. We propose that this resistance is due to the increased collagen cross-links and collagen packing density in the ECM of the D2.mdx diaphragm. Taken altogether, while we did not find increased stiffness of the fibrotic ECM, we did observe that the D2.mdx diaphragm conveyed resistance against collagenase digestion. These findings demonstrate how different methods for measuring ECM-based stiffness each have their own limitations and can produce different results.
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Affiliation(s)
- Ross P. Wohlgemuth
- Department of Neurobiology, Physiology, and Behavior, University of California Davis, USA
| | - Ryan M. Feitzinger
- Department of Neurobiology, Physiology, and Behavior, University of California Davis, USA
| | - Kyle E. Henricson
- Department of Neurobiology, Physiology, and Behavior, University of California Davis, USA
- Department of Chemistry and Biochemistry, University of California Santa Cruz, USA
| | - Daryl T. Dinh
- Department of Neurobiology, Physiology, and Behavior, University of California Davis, USA
| | - Sarah E. Brashear
- Department of Neurobiology, Physiology, and Behavior, University of California Davis, USA
| | - Lucas R. Smith
- Department of Neurobiology, Physiology, and Behavior, University of California Davis, USA
- Department of Physical Medicine and Rehabilitation, University of California Davis, USA
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Kalkman BM, Bar-On L, O'Brien TD, Maganaris CN. Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome? Front Physiol 2020; 11:131. [PMID: 32153428 PMCID: PMC7047287 DOI: 10.3389/fphys.2020.00131] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/06/2020] [Indexed: 12/27/2022] Open
Abstract
Hyper-resistance at the joint is one of the most common symptoms in children with cerebral palsy (CP). Alterations to the structure and mechanical properties of the musculoskeletal system, such as a decreased muscle length and an increased joint stiffness are typically managed conservatively, by means of physiotherapy involving stretching exercises. However, the effectiveness of stretching-based interventions for improving function is poor. This may be due to the behavior of a spastic muscle during stretch, which is poorly understood. The main aim of this paper is to provide a mechanistic explanation as to why the effectiveness of stretching is limited in children with CP and consider clinically relevant means by which this shortcoming can be tackled. To do this, we review the current literature regarding muscle and tendon plasticity in response to stretching in children with CP. First, we discuss how muscle and tendon interact based on their morphology and mechanical properties to provide a certain range of motion at the joint. We then consider the effect of traditional stretching exercises on these muscle and tendon properties. Finally, we examine possible strategies to increase the effectiveness of stretching therapies and we highlight areas of further research that have the potential to improve the outcome of non-invasive interventions in children with cerebral palsy.
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Affiliation(s)
- Barbara M Kalkman
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lynn Bar-On
- Department of Rehabilitation Medicine, VC University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Thomas D O'Brien
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Constantinos N Maganaris
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Multani I, Manji J, Tang MJ, Herzog W, Howard JJ, Graham HK. Sarcopenia, Cerebral Palsy, and Botulinum Toxin Type A. JBJS Rev 2019; 7:e4. [DOI: 10.2106/jbjs.rvw.18.00153] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Larkin-Kaiser KA, Howard JJ, Leonard T, Joumaa V, Gauthier L, Logan K, Orlik B, El-Hawary R, Herzog W. Relationship of muscle morphology to hip displacement in cerebral palsy: a pilot study investigating changes intrinsic to the sarcomere. J Orthop Surg Res 2019; 14:187. [PMID: 31227002 PMCID: PMC6588916 DOI: 10.1186/s13018-019-1239-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/12/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common cause of childhood disability, typified by a static encephalopathy with peripheral musculoskeletal manifestations-most commonly related to spasticity-that are progressive with age. Hip displacement is one of the most common manifestations, observed to lead to painful degenerative arthritis over time. Despite the key role that spasticity-related adductor muscle contractures are thought to play in the development of hip displacement in CP, basic science research in this area to date has been limited. This study was initiated to correlate hip adductor muscle changes intrinsic to the sarcomere-specifically, titin isoforms and sarcomere length-to the severity of hip displacement in children with spastic cerebral palsy. METHODS Single gracilis muscle biopsies were obtained from children with CP (Gross Motor Function Classification System (GMFCS) III-V; n = 10) who underwent adductor muscle release surgery for the treatment of hip displacement. Gel electrophoresis was used to estimate titin molecular weight. Sarcomere lengths were measured from muscle fascicles using laser diffraction. The severity of hip displacement was determined by measuring by Reimers migration percentage (MP) from anteroposterior pelvic x-rays. Correlation analyses between titin, sarcomere lengths, and MP were performed. RESULTS The mean molecular weight of titin was 3588 kDa. The mean sarcomere length was 3.51 μm. Increased MP was found to be associated with heavier isoforms of titin (R2 = 0.65, p < 0.05) and with increased sarcomere lengths (R2 = 0.65, p < 0.05). Heavier isoforms of titin were also associated with increased sarcomere lengths (R2 = 0.80, p < 0.05). CONCLUSIONS Our results suggest that both larger titin isoforms and sarcomere lengths are positively correlated with increased severity of hip displacement and may represent adaptations in response to concomitant increases in spasticity and muscle shortening. TRIAL REGISTRATION As this study does not report the results of a health care intervention on human participants, it has not been registered.
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Affiliation(s)
- Kelly A. Larkin-Kaiser
- Faculty of Kinesiology, University of Calgary, 376 Collegiate Blvd NW, Calgary, AB T2N 4V8 Canada
| | - Jason J. Howard
- Weill Cornell Medicine, Sidra Medicine, Al Gharrafa St, Ar Rayyan, P.O. Box 26999, Doha, Qatar
| | - Timothy Leonard
- Faculty of Kinesiology, University of Calgary, 376 Collegiate Blvd NW, Calgary, AB T2N 4V8 Canada
| | - Venus Joumaa
- Faculty of Kinesiology, University of Calgary, 376 Collegiate Blvd NW, Calgary, AB T2N 4V8 Canada
| | - Luke Gauthier
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
| | - Karl Logan
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
| | - Benjamin Orlik
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
| | - Ron El-Hawary
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
| | - Walter Herzog
- Faculty of Kinesiology, University of Calgary, 376 Collegiate Blvd NW, Calgary, AB T2N 4V8 Canada
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