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Adams JA, Uryash A, Lopez JR. Non-Invasive Pulsatile Shear Stress Modifies Endothelial Activation; A Narrative Review. Biomedicines 2022; 10:biomedicines10123050. [PMID: 36551807 PMCID: PMC9775985 DOI: 10.3390/biomedicines10123050] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
The monolayer of cells that line both the heart and the entire vasculature is the endothelial cell (EC). These cells respond to external and internal signals, producing a wide array of primary or secondary messengers involved in coagulation, vascular tone, inflammation, and cell-to-cell signaling. Endothelial cell activation is the process by which EC changes from a quiescent cell phenotype, which maintains cellular integrity, antithrombotic, and anti-inflammatory properties, to a phenotype that is prothrombotic, pro-inflammatory, and permeable, in addition to repair and leukocyte trafficking at the site of injury or infection. Pathological activation of EC leads to increased vascular permeability, thrombosis, and an uncontrolled inflammatory response that leads to endothelial dysfunction. This pathological activation can be observed during ischemia reperfusion injury (IRI) and sepsis. Shear stress (SS) and pulsatile shear stress (PSS) are produced by mechanical frictional forces of blood flow and contraction of the heart, respectively, and are well-known mechanical signals that affect EC function, morphology, and gene expression. PSS promotes EC homeostasis and cardiovascular health. The archetype of inducing PSS is exercise (i.e., jogging, which introduces pulsations to the body as a function of the foot striking the pavement), or mechanical devices which induce external pulsations to the body (Enhanced External Pulsation (EECP), Whole-body vibration (WBV), and Whole-body periodic acceleration (WBPA aka pGz)). The purpose of this narrative review is to focus on the aforementioned noninvasive methods to increase PSS, review how each of these modify specific diseases that have been shown to induce endothelial activation and microcirculatory dysfunction (Ischemia reperfusion injury-myocardial infarction and cardiac arrest and resuscitation), sepsis, and lipopolysaccharide-induced sepsis syndrome (LPS)), and review current evidence and insight into how each may modify endothelial activation and how these may be beneficial in the acute and chronic setting of endothelial activation and microvascular dysfunction.
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Affiliation(s)
- Jose A. Adams
- Division of Neonatology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Correspondence:
| | - Arkady Uryash
- Division of Neonatology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Jose R. Lopez
- Department of Research, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
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Possible Mechanisms for the Effects of Sound Vibration on Human Health. Healthcare (Basel) 2021; 9:healthcare9050597. [PMID: 34069792 PMCID: PMC8157227 DOI: 10.3390/healthcare9050597] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 12/17/2022] Open
Abstract
This paper presents a narrative review of research literature to “map the landscape” of the mechanisms of the effect of sound vibration on humans including the physiological, neurological, and biochemical. It begins by narrowing music to sound and sound to vibration. The focus is on low frequency sound (up to 250 Hz) including infrasound (1–16 Hz). Types of application are described and include whole body vibration, vibroacoustics, and focal applications of vibration. Literature on mechanisms of response to vibration is categorized into hemodynamic, neurological, and musculoskeletal. Basic mechanisms of hemodynamic effects including stimulation of endothelial cells and vibropercussion; of neurological effects including protein kinases activation, nerve stimulation with a specific look at vibratory analgesia, and oscillatory coherence; of musculoskeletal effects including muscle stretch reflex, bone cell progenitor fate, vibration effects on bone ossification and resorption, and anabolic effects on spine and intervertebral discs. In every category research on clinical applications are described. The conclusion points to the complexity of the field of vibrational medicine and calls for specific comparative research on type of vibration delivery, amount of body or surface being stimulated, effect of specific frequencies and intensities to specific mechanisms, and to greater interdisciplinary cooperation and focus.
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Adams JA, Lopez JR, Uryash A, Sackner MA. Whole body periodic acceleration (pGz) improves endotoxin induced cardiomyocyte contractile dysfunction and attenuates the inflammatory response in mice. Heliyon 2021; 7:e06444. [PMID: 33748496 PMCID: PMC7970274 DOI: 10.1016/j.heliyon.2021.e06444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/10/2020] [Accepted: 03/04/2021] [Indexed: 11/01/2022] Open
Abstract
Sepsis-induces myocardial contractile dysfunction. We previously showed that whole body periodic acceleration (pGz), the sinusoidal motion of the supine body head-foot ward direction significantly improves survival and decreases microvascular permeability in a lethal model of sepsis. We tested the hypothesis that pGz improves LPS induced cardiomyocyte contractile dysfunction and decreases LPS pro-inflammatory cytokine response when applied pre- or post-treatment. Isolated cardiomyocytes were obtained from mice that received LPS who had been pre-treated with pGz for three days (pGz-LPS) or control. Peak shortening (PS), maximal velocity of shortening (+dL/dt), and relengthening (-dL/dt) as well as diastolic intracellular calcium concentration ([Ca+2]d), sodium ([Na+]d), reactive oxygen species (ROS), and cardiac troponin (cTnT) production were measured. LPS decreased PS, +dL/dt, and -dL/dt, by 37%, 41% and 35% change respectively (p < 0.01), increased [Ca+2]d, [Na+]d, ROS, and cTnT by 343%, 122%, 298%, and 610% change respectively (p < 0.01) compared to control. pGz pre-treatment attenuated the parameters mentioned above. In a separate cohort, the effects of a lethal dose of LPS on protein expression of nitric oxide synthases (iNOS, eNOS, nNOS), pro- and anti-inflammatory cytokines in hearts of mice was studied in pre-treated with pGz for three days prior to LPS (pGz-LPS) and post-treated with pGz 30 min after LPS (LPS-pGz) were determined. LPS increased expression of early and late iNOS and decreased expression of eNOS, phosphorylated eNOS (p-eNOS), and nNOS. Both pre- and post-treatment with pGz markedly reduced early and late pro-inflammatory surge. Therefore, pre- and post-treatment with pGz improves LPS-induced cardiomyocyte dysfunction, decreases iNOS expression, and increases cytoprotective eNOS and nNOS, with decreased pro-inflammatory response. Such results have potential for translation to benefit outcomes in human sepsis.
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Affiliation(s)
- Jose A Adams
- Division of Neonatology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Jose R Lopez
- Department of Research, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Arkady Uryash
- Division of Neonatology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Marvin A Sackner
- Department of Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
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Adams JA, Uryash A, Nadkarni V, Berg RA, Lopez JR. Whole body periodic acceleration (pGz) preserves heart rate variability after cardiac arrest. Resuscitation 2015; 99:20-5. [PMID: 26690649 DOI: 10.1016/j.resuscitation.2015.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/03/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
AIMS Heart rate variability (HRV) is a measure of the balance between the sympathetic and parasympathetic autonomic nervous system and lack thereof an ominous sign in many cardiac and neurological conditions including post-cardiac arrest syndrome. Whole body periodic acceleration (pGz) has been shown to be cardio protective when applied prior to during and after cardiac arrest (CA). Here, we investigate whether or not pGz pre or post treatment after CA preserves HRV. METHODS Eight min of unsupported ventricular fibrillation followed by CPR and defibrillation was carried out in 32 anesthetized and paralyzed male swine who were randomized to pretreatment (1h pGz prior to CA, pre-pGz [n=8]) or post-treatment (pGz beginning at 30min after return of spontaneous circulation ([ROSC], post-pGz [n=8]) or none (CONT [n=8]). pGz was applied together with conventional mechanical ventilation. In a separate group (n=8), infusion of TRIM (nNOS inhibitor) was used to determine the effects of nNOS inhibition on HRV. RESULTS Time and frequency domain measures of HRV were determined along with measurements of blood gases and hemodynamics, obtained at baseline and at 30, 60, 120 and 180min after ROSC. All animals had ROSC and there were no significant differences for arterial blood gases, mean blood pressure and coronary perfusion pressure after ROSC among the groups. HRV was significantly depressed after cardiac arrest and remained depressed in CONT group. In contrast, both pre and post pGz treated groups had significantly higher and preserved time domain measures of HRV (RMSSD and SDNN) from 60 to 180min after ROSC, and nNOS inhibition markedly reduced HRV. The frequency domain of HRV did not show changes. CONCLUSIONS In a pig model of CA, pre or post treatment with pGz preserves HRV. Inhibition of nNOS markedly reduced HRV. Post-treatment with pGz is a novel therapeutic strategy that might serve as an adjunct to current pharmacological or hypothermia modalities to potentially improve outcomes from post-cardiac arrest syndrome.
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Affiliation(s)
- Jose A Adams
- Mt Sinai Medical Center, Division of Neonatology, Miami Beach, FL, USA.
| | - Arkady Uryash
- Mt Sinai Medical Center, Division of Neonatology, Miami Beach, FL, USA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jose R Lopez
- Department of Molecular Biosciences, University of California Davis, Davis, CA, USA
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Adams JA, Uryash A, Wu H, Bassuk JA, Nadkarni V, Berg R, Jorapur V, Kurlansky P. Microcirculatory and therapeutic effects of whole body periodic acceleration (pGz) applied after cardiac arrest in pigs. Resuscitation 2011; 82:767-75. [PMID: 21392877 DOI: 10.1016/j.resuscitation.2011.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 01/25/2011] [Accepted: 02/08/2011] [Indexed: 01/25/2023]
Abstract
AIMS Cardiac arrest (CA) and resuscitation are models of whole body ischemia reperfusion injury. Interventions performed prior to (pre-treatment) or after (post-treatment) can result in cardioprotection. Myocardial stunning, characterized by microcirculatory and contractile dysfunction after CA, is an important component of the post-cardiac arrest syndrome. Periodic acceleration (pGz), produced by the cyclical motion of the supine body headward to footward, increases microcirculatory blood flow to vital organs and elicits production of endothelial derived cytoprotective factors in normal animals. We tested the hypothesis that application of pGz 30 min after return of circulation from CA, as a delayed post-treatment strategy, would improve regional microcirculatory blood flow to vital organs and functional indices of myocardial stunning in pigs. METHODS 8 min of unsupported VF followed by cardiopulmonary resuscitation and defibrillation was carried out in twenty anesthetized and paralyzed male swine who were randomized to delayed post-treatment with pGz (dPost) or none (CONT). pGz was begun 30 min after return of circulation along with conventional mechanical ventilation. Hemodynamics, echocardiogram, and regional blood flows were measured as well as biochemical index of cardiac tissue injury. RESULTS All animals had spontaneous return of circulation after cardiopulmonary resuscitation (CPR) and defibrillation. dPost animals had less myocardial stunning and greater regional blood flows to the heart, brain, kidneys, ileum and stomach than CONT. Post-treatment with pGz blunted the increase in Troponin I produced by CA and resuscitation, and, induced a greater rise in endothelial derived nitric oxide synthase (eNOS) and its phosphorylation (p-eNOS). CONCLUSIONS Delayed post-treatment with pGz as a therapeutic strategy, protects against early myocardial stunning in VF cardiac arrest by improving microcirculatory blood flow to the heart and also protects other vital organs by this mechanism.
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Affiliation(s)
- Jose A Adams
- Division of Neonatology, Mt Sinai Medical Center, Miami Beach, FL 33140, United States.
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Bassuk JI, Wu H, Arias J, Kurlansky P, Adams JA. Whole body periodic acceleration (pGz) improves survival and allows for resuscitation in a model of severe hemorrhagic shock in pigs. J Surg Res 2010; 164:e281-9. [PMID: 20869084 DOI: 10.1016/j.jss.2010.07.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/07/2010] [Accepted: 07/18/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Whole body periodic acceleration (pGz), the repetitive, head-foot sinusoidal motion of the body, increases pulsatile shear stress on the vascular endothelium producing increased release of endothelial derived nitric oxide (eNO) into circulation. Based upon prior CPR investigations, we hypothesized that pGz instituted prior to and during hemorrhagic shock (HS) should improve survival. MATERIALS AND METHODS Sixteen anesthetized male pigs, 23 ± 5 kg, were randomized to receive 1 h pGz or no pGz (CONT) prior to and during severe controlled graded HS up to 2-1/2 h. HS was induced by removing blood at 10 mL/kg increments from the circulation at 30-min intervals up to a maximum blood loss of 50 mL/kg. Thirty minutes after maximum blood loss, shed blood and lactated Ringers solution was infused intravenously. RESULTS All animals survived up to 30 mL/kg blood loss. Survival and return to normal blood pressure to 120 min was achieved in 50% of animals receiving pGz compared with none in CONT. Cardiac output, blood pressure, and oxygen delivery decreased equally in both groups but oxygen consumption was significantly lower with pGz than CONT during all hemorrhage time points. Regional blood flow (RBF) was preserved in brain, heart, kidneys, ileum, and stomach in both groups up to 40 mL/kg of blood loss. After 40 mL/kg blood loss, RBF was much better preserved in pGz than CONT. CONCLUSIONS pGz applied 1 h prior to and during severe graded hemorrhagic shock delays onset of irreversible shock, enabling potential restoration of blood loss and survival.
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Affiliation(s)
- Jorge I Bassuk
- Division of Neonatology, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA
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Albaghdadi AS, Brooks LA, Pretorius AM, Kerber RE. Perfluorocarbon induced intra-arrest hypothermia does not improve survival in a swine model of asphyxial cardiac arrest. Resuscitation 2010; 81:353-8. [PMID: 20044200 PMCID: PMC2827481 DOI: 10.1016/j.resuscitation.2009.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 11/30/2009] [Accepted: 11/30/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pulseless electrical activity is an important cause of cardiac arrest. Our purpose was to determine if induction of hypothermia with a cold perfluorocarbon-based total liquid ventilation (TLV) system would improve resuscitation success in a swine model of asphyxial cardiac arrest/PEA. METHODS Twenty swine were randomly assigned to control (C, no ventilation, n=11) or TLV with pre-cooled PFC (n=9) groups. Asphyxia was induced by insertion of a stopper into the endotracheal tube, and continued in both groups until loss of aortic pulsations (LOAP) was reached, defined as a pulse pressure less than 2mmHg. The TLV animals underwent asphyxial arrest for an additional 2min after LOAP, followed by 3min of hypothermia, prior to starting CPR. The C animals underwent 5min of asphyxia beyond LOAP. Both groups then underwent CPR for at least 10min. The endpoint was the resumption of spontaneous circulation maintained for 10min. RESULTS Seven of 9 animals achieved resumption of spontaneous circulation (ROSC) in the TLV group vs. 5 of 11 in the C group (p=0.2). The mean pulmonary arterial temperature was lower in total liquid ventilation animals starting 4min after induction of hypothermia (TLV 36.3+/-0.2 degrees C vs. C 38.1+/-0.2 degrees C, p<0.0001). Arterial P(O)(2) was higher in total liquid ventilation animals at 2.5min of CPR (TLV 76+/-12mmHg vs. C 44+/-2mmHg; p=0.03). CONCLUSION Induction of moderate hypothermia using perfluorocarbon-based total liquid ventilation did not improve ROSC success in this model of asphyxial cardiac arrest.
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Affiliation(s)
- Ali S Albaghdadi
- The Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, United States
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Adams JA, Wu H, Bassuk JA, Arias J, Uryash A, Kurlansky P. Periodic acceleration (pGz) acutely increases endothelial and neuronal nitric oxide synthase expression in endomyocardium of normal swine. Peptides 2009; 30:373-7. [PMID: 19022311 DOI: 10.1016/j.peptides.2008.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 10/21/2008] [Accepted: 10/22/2008] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Periodic acceleration (pGz) is a non-invasive method of increasing pulsatile shear stress to the endothelium. pGz is achieved by the sinusoidal head to foot motion to the supine body. pGz increases endogenous production of nitric oxide in whole animal models and isolated perfused vessel preparations, and is cardioprotective when applied prior to, during and after ischemia reperfusion. In part, the protective effects of pGz are attributable to nitric oxide (NO). The purpose of this investigation was to determine whether pGz up-regulates NOS isoforms in the endomyocardium. METHODS AND RESULTS Fifteen swine weight 15-20 kg, were anesthetized, instrumented to measure hemodynamics and randomized. Ten animals received 1h of pGz at 180 cycles/min and Gz+/-3.9 m/s(2) [pGz] in addition to conventional ventilatory support and five served as time controls. RESULTS pGz produced a 2.3+/-0.4 and a 6.6+/-0.1 fold significant increase in eNOS and phosphorylated eNOS, 3.6+/-1.1 fold increase in nNOS, and no significant change in iNOS. pGz also produced a 2.4+/-0.3 and 3.9+/-0.2 folds significant increase in both total(t-Akt) and phosphorylated (p-Akt) Akt. CONCLUSIONS pGz is associated with an increase in both total and phosphorylated eNOS and nNOS protein expression in endomyocardium, and induced significant increase in total and phosphorylated-Akt. The data indicates that pGz is a novel method to induce eNOS and nNOS production in the endomyocardium. Therefore, pGz may serve as a powerful non-invasive intervention to activate the beneficial cardiac effects of endothelial and neuronal NOS.
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Affiliation(s)
- Jose A Adams
- Mount Sinai Medical Center, Division of Neonatology 3-BLUM, 4300 Alton Road, Miami Beach, FL 33140, USA.
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Adams JA, Bassuk JA, Arias J, Wu H, Jorapur V, Lamas GA, Kurlansky P. Acute effects of "delayed postconditioning" with periodic acceleration after asphyxia induced shock in pigs. Pediatr Res 2008; 64:533-7. [PMID: 18596578 DOI: 10.1203/pdr.0b013e318183f147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Asphyxia cardiac arrest and shock are models for whole body ischemia reperfusion injury. Periodic acceleration (pGz) achieved by moving the body on a platform is a novel method for inducing pulsatile vascular shear stress and endogenous production of endothelial nitric oxide, prostaglandin E2, tissue plasminogen activator, and adrenomedullin. The aforementioned are cardioprotective during and after ischemia reperfusion injury. We investigated whether pGz, applied 15 min after return of spontaneous circulation (ROSC) would serve as an effective "delayed" post conditioning tactic to lessen acute reperfusion injury markers in a pediatric swine model of asphyxia induced shock. Asphyxia shock was induced in 20 swine weight 3.9 +/- 0.6 kg. Fifteen minutes after ROSC, the animals were randomized to receive conventional mechanical ventilation (CMV, [Control]) or CMV with pGz. All animals had ROSC and no significant differences in blood gases or hemodynamics after ROSC. pGz treated had significantly less myocardial dysfunction post resuscitation, (i.e. better % ejection fraction (EF), % fractional shortening (FS), and wall motion score index) and lower biochemical indices of reperfusion injury (lower TNF-alpha, IL-6, and Troponin I, and myeloperoxidase activity). Delayed postconditioning with pGz ameliorates acute post resuscitation reperfusion injury and improves myocardial dysfunction after asphyxia-induced shock.
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Affiliation(s)
- Jose A Adams
- Divisions of Neonatology, Mt Sinai Medical Center, Miami Beach, Florida 33140, USA.
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