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Grillet PE, Badiou S, Lambert K, Sutra T, Plawecki M, Raynaud de Mauverger E, Brun JF, Mercier J, Gouzi F, Cristol JP. Biomarkers of Redox Balance Adjusted to Exercise Intensity as a Useful Tool to Identify Patients at Risk of Muscle Disease through Exercise Test. Nutrients 2022; 14:1886. [PMID: 35565853 PMCID: PMC9105000 DOI: 10.3390/nu14091886] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
The screening of skeletal muscle diseases constitutes an unresolved challenge. Currently, exercise tests or plasmatic tests alone have shown limited performance in the screening of subjects with an increased risk of muscle oxidative metabolism impairment. Intensity-adjusted energy substrate levels of lactate (La), pyruvate (Pyr), β-hydroxybutyrate (BOH) and acetoacetate (AA) during a cardiopulmonary exercise test (CPET) could constitute alternative valid biomarkers to select "at-risk" patients, requiring the gold-standard diagnosis procedure through muscle biopsy. Thus, we aimed to test: (1) the validity of the V'O2-adjusted La, Pyr, BOH and AA during a CPET for the assessment of the muscle oxidative metabolism (exercise and mitochondrial respiration parameters); and (2) the discriminative value of the V'O2-adjusted energy and redox markers, as well as five other V'O2-adjusted TCA cycle-related metabolites, between healthy subjects, subjects with muscle complaints and muscle disease patients. Two hundred and thirty subjects with muscle complaints without diagnosis, nine patients with a diagnosed muscle disease and ten healthy subjects performed a CPET with blood assessments at rest, at the estimated 1st ventilatory threshold and at the maximal intensity. Twelve subjects with muscle complaints presenting a severe alteration of their profile underwent a muscle biopsy. The V'O2-adjusted plasma levels of La, Pyr, BOH and AA, and their respective ratios showed significant correlations with functional and muscle fiber mitochondrial respiration parameters. Differences in exercise V'O2-adjusted La/Pyr, BOH, AA and BOH/AA were observed between healthy subjects, subjects with muscle complaints without diagnosis and muscle disease patients. The energy substrate and redox blood profile of complaining subjects with severe exercise intolerance matched the blood profile of muscle disease patients. Adding five tricarboxylic acid cycle intermediates did not improve the discriminative value of the intensity-adjusted energy and redox markers. The V'O2-adjusted La, Pyr, BOH, AA and their respective ratios constitute valid muscle biomarkers that reveal similar blunted adaptations in muscle disease patients and in subjects with muscle complaints and severe exercise intolerance. A targeted metabolomic approach to improve the screening of "at-risk" patients is discussed.
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Affiliation(s)
- Pierre-Edouard Grillet
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (P.-E.G.); (S.B.); (K.L.); (T.S.); (M.P.); (E.R.d.M.); (J.-F.B.); (J.M.); (J.-P.C.)
- Department of Biochemistry and Hormonology, CHU Montpellier, 34295 Montpellier, France
| | - Stéphanie Badiou
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (P.-E.G.); (S.B.); (K.L.); (T.S.); (M.P.); (E.R.d.M.); (J.-F.B.); (J.M.); (J.-P.C.)
- Department of Biochemistry and Hormonology, CHU Montpellier, 34295 Montpellier, France
| | - Karen Lambert
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (P.-E.G.); (S.B.); (K.L.); (T.S.); (M.P.); (E.R.d.M.); (J.-F.B.); (J.M.); (J.-P.C.)
| | - Thibault Sutra
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (P.-E.G.); (S.B.); (K.L.); (T.S.); (M.P.); (E.R.d.M.); (J.-F.B.); (J.M.); (J.-P.C.)
- Department of Biochemistry and Hormonology, CHU Montpellier, 34295 Montpellier, France
| | - Maëlle Plawecki
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (P.-E.G.); (S.B.); (K.L.); (T.S.); (M.P.); (E.R.d.M.); (J.-F.B.); (J.M.); (J.-P.C.)
- Department of Biochemistry and Hormonology, CHU Montpellier, 34295 Montpellier, France
| | - Eric Raynaud de Mauverger
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (P.-E.G.); (S.B.); (K.L.); (T.S.); (M.P.); (E.R.d.M.); (J.-F.B.); (J.M.); (J.-P.C.)
- Department of Physiology, University of Montpellier, CHU Montpellier, 34295 Montpellier, France
| | - Jean-Frédéric Brun
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (P.-E.G.); (S.B.); (K.L.); (T.S.); (M.P.); (E.R.d.M.); (J.-F.B.); (J.M.); (J.-P.C.)
- Department of Physiology, University of Montpellier, CHU Montpellier, 34295 Montpellier, France
| | - Jacques Mercier
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (P.-E.G.); (S.B.); (K.L.); (T.S.); (M.P.); (E.R.d.M.); (J.-F.B.); (J.M.); (J.-P.C.)
- Department of Physiology, University of Montpellier, CHU Montpellier, 34295 Montpellier, France
| | - Fares Gouzi
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (P.-E.G.); (S.B.); (K.L.); (T.S.); (M.P.); (E.R.d.M.); (J.-F.B.); (J.M.); (J.-P.C.)
- Department of Physiology, University of Montpellier, CHU Montpellier, 34295 Montpellier, France
| | - Jean-Paul Cristol
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, CHU Montpellier, 34295 Montpellier, France; (P.-E.G.); (S.B.); (K.L.); (T.S.); (M.P.); (E.R.d.M.); (J.-F.B.); (J.M.); (J.-P.C.)
- Department of Biochemistry and Hormonology, CHU Montpellier, 34295 Montpellier, France
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Barroso de Queiroz Davoli G, Bartels B, Mattiello-Sverzut AC, Takken T. Cardiopulmonary exercise testing in neuromuscular disease: a systematic review. Expert Rev Cardiovasc Ther 2021; 19:975-991. [PMID: 34826261 DOI: 10.1080/14779072.2021.2009802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cardiopulmonary exercise testing (CPET) is increasingly used to determine aerobic fitness in health and disability conditions. Patients with neuromuscular diseases (NMDs) often present with symptoms of cardiac and/or skeletal muscle dysfunction and fatigue that might impede the ability to deliver maximal cardiopulmonary effort. Although an increasing number of studies report on NMDs' physical fitness, the applicability of CPET remains largely unknown. AREAS COVERED This systematic review synthesized evidence about the quality and feasibility of CPET in NMDs and patient's aerobic fitness. The review followed the PRISMA guidelines (PROSPERO number CRD42020211068). Between September and October 2020 one independent reviewer searched the PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science databases. Excluding reviews and protocol description articles without baseline data, all study designs using CPET to assess adult or pediatric patients with NMDs were included. The methodological quality was assessed according to the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) recommendations. EXPERT OPINION CPET is feasible for ambulatory patients with NMDs when their functional level and the exercise modality are taken into account. However, there is still a vast potential for standardizing and designing disease-specific CPET protocols for patients with NMDs. Moreover, future studies are urged to follow the ATS/ACCP recommendations.
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Affiliation(s)
| | - Bart Bartels
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Bhatia R, Cohen BH, L McNinch N. A novel exercise testing algorithm to diagnose mitochondrial myopathy. Muscle Nerve 2021; 63:715-723. [PMID: 33533527 DOI: 10.1002/mus.27191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Oxygen uptake efficiency slope (OUES) is a noninvasive cardiopulmonary exercise testing (CPET) measurement based on oxygen uptake (V˙O2 ) and minute ventilation (V˙E) and is a marker of the efficiency of oxygen utilization by the body. However, it has not been studied in mitochondrial disorders. We explored noninvasive CPET parameters, including OUES, as a way to reliably diagnose mitochondrial myopathy. METHODS We performed cycle ergometer maximal exercise testing on definite and suspected mitochondrial myopathy subjects (MM-D and MM-S) and their age- and sex-matched controls. OUES was corrected for body surface area (OUES/BSA) to eliminate the effect of body size. RESULTS A total of 40 participants, including 20 MM-D (n = 13; 6 males; aged 14-64 years) and 7 MM-S (5 males, aged 11-30 years) subjects and 20 controls, completed the study. MM-D subjects showed lower aerobic fitness than controls. OUES/BSA was lower in MM-D subjects, suggesting inefficient oxygen utilization. Area under the curve (AUC) and 95% confidence interval (CI) for OUES/BSA (AUC, 0.91; 95% CI, 0.80-1.00), peak V˙O2 percent predicted (AUC, 0.95; 95% CI, 0.86-1.00), and V˙O2 /work slope (AUC, 0.94; 95% CI, 0.85-1.00) showed excellent ability to diagnose mitochondrial myopathy in MM-D subjects. We applied a diagnostic approach based on the parameters just noted to MM-S subjects and their controls and were able to support or disprove the diagnosis of mitochondrial myopathy. DISCUSSION We proposed and applied an approach based on the aformentioned three CPET parameters to diagnose mitochondrial myopathy reliably and found it to be clinically useful.
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Affiliation(s)
- Rajeev Bhatia
- Department of Pediatrics, Division of Pulmonology, Akron Children's Hospital, Akron, Ohio
| | - Bruce H Cohen
- Department of Pediatrics, Neurodevelopmental Science Center-Division of Neurology, Akron Children's Hospital, Akron, Ohio.,Northeast Ohio Medical University, Rootstown, Ohio
| | - Neil L McNinch
- Rebecca D Considine Research Institute, Akron Children's Hospital, Akron, Ohio
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Fiuza-Luces C, Valenzuela PL, Laine-Menéndez S, Fernández-de la Torre M, Bermejo-Gómez V, Rufián-Vázquez L, Arenas J, Martín MA, Lucia A, Morán M. Physical Exercise and Mitochondrial Disease: Insights From a Mouse Model. Front Neurol 2019; 10:790. [PMID: 31402893 PMCID: PMC6673140 DOI: 10.3389/fneur.2019.00790] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/09/2019] [Indexed: 01/13/2023] Open
Abstract
Purpose: Mitochondrial diseases (MD) are among the most prevalent neuromuscular disorders. Unfortunately, no curative treatment is yet available. This study analyzed the effects of exercise training in an animal model of respiratory chain complex I deficiency, the Harlequin (Hq) mouse, which replicates the clinical features of this condition. Methods: Male heterozygous Harlequin (Hq/Y) mice were assigned to an “exercise” (n = 10) or a “sedentary” control group (n = 11), with the former being submitted to an 8 week combined exercise training intervention (aerobic + resistance training performed five times/week). Aerobic fitness, grip strength, and balance were assessed at the beginning and at the end of the intervention period in all the Hq mice. Muscle biochemical analyses (with results expressed as percentage of reference data from age/sex-matched sedentary wild-type mice [n = 12]) were performed at the end of the aforementioned period for the assessment of major molecular signaling pathways involved in muscle anabolism (mTOR activation) and mitochondrial biogenesis (proliferator activated receptor gamma co-activator 1α [PGC-1α] levels), and enzyme activity and levels of respiratory chain complexes, and antioxidant enzyme levels. Results: Exercise training resulted in significant improvements in aerobic fitness (−33 ± 13 m and 83 ± 43 m for the difference post- vs. pre-intervention in total distance covered in the treadmill tests in control and exercise group, respectively, p = 0.014) and muscle strength (2 ± 4 g vs. 17 ± 6 g for the difference post vs. pre-intervention, p = 0.037) compared to the control group. Higher levels of ribosomal protein S6 kinase beta-1 phosphorylated at threonine 389 (156 ± 30% vs. 249 ± 30%, p = 0.028) and PGC-1α (82 ± 7% vs. 126 ± 19% p = 0.032) were observed in the exercise-trained mice compared with the control group. A higher activity of respiratory chain complexes I (75 ± 4% vs. 95 ± 6%, p = 0.019), III (79 ± 5% vs. 97 ± 4%, p = 0.031), and V (77 ± 9% vs. 105 ± 9%, p = 0.024) was also found with exercise training. Exercised mice presented with lower catalase levels (204 ± 22% vs. 141 ± 23%, p = 0.036). Conclusion: In a mouse model of MD, a training intervention combining aerobic and resistance exercise increased aerobic fitness and muscle strength, and mild improvements were found for activated signaling pathways involved in muscle mitochondrial biogenesis and anabolism, OXPHOS complex activity, and redox status in muscle tissue.
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Affiliation(s)
- Carmen Fiuza-Luces
- Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Pedro L Valenzuela
- Physiology Unit, Systems Biology Department, University of Alcalá, Madrid, Spain
| | - Sara Laine-Menéndez
- Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Miguel Fernández-de la Torre
- Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Verónica Bermejo-Gómez
- Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Laura Rufián-Vázquez
- Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Joaquín Arenas
- Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain.,Spanish Network for Biomedical Research in Rare Diseases (CIBERER), Madrid, Spain
| | - Miguel A Martín
- Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain.,Spanish Network for Biomedical Research in Rare Diseases (CIBERER), Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sports Sciences, European University of Madrid, Madrid, Spain.,Spanish Network for Biomedical Research in Fragility and Healthy Aging (CIBERFES), Madrid, Spain
| | - María Morán
- Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain.,Spanish Network for Biomedical Research in Rare Diseases (CIBERER), Madrid, Spain
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Domínguez-González C, Hernández-Laín A, Rivas E, Hernández-Voth A, Sayas Catalán J, Fernández-Torrón R, Fuiza-Luces C, García García J, Morís G, Olivé M, Miralles F, Díaz-Manera J, Caballero C, Méndez-Ferrer B, Martí R, García Arumi E, Badosa MC, Esteban J, Jimenez-Mallebrera C, Encinar AB, Arenas J, Hirano M, Martin MÁ, Paradas C. Late-onset thymidine kinase 2 deficiency: a review of 18 cases. Orphanet J Rare Dis 2019; 14:100. [PMID: 31060578 PMCID: PMC6501326 DOI: 10.1186/s13023-019-1071-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/17/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND TK2 gene encodes for mitochondrial thymidine kinase, which phosphorylates the pyrimidine nucleosides thymidine and deoxycytidine. Recessive mutations in the TK2 gene are responsible for the 'myopathic form' of the mitochondrial depletion/multiple deletions syndrome, with a wide spectrum of severity. METHODS We describe 18 patients with mitochondrial myopathy due to mutations in the TK2 gene with absence of clinical symptoms until the age of 12. RESULTS The mean age of onset was 31 years. The first symptom was muscle limb weakness in 10/18, eyelid ptosis in 6/18, and respiratory insufficiency in 2/18. All patients developed variable muscle weakness during the evolution of the disease. Half of patients presented difficulty in swallowing. All patients showed evidence of respiratory muscle weakness, with need for non-invasive Mechanical Ventilation in 12/18. Four patients had deceased, all of them due to respiratory insufficiency. We identified common radiological features in muscle magnetic resonance, where the most severely affected muscles were the gluteus maximus, semitendinosus and sartorius. On muscle biopsies typical signs of mitochondrial dysfunction were associated with dystrophic changes. All mutations identified were previously reported, being the most frequent the in-frame deletion p.Lys202del. All cases showed multiple mtDNA deletions but mtDNA depletion was present only in two patients. CONCLUSIONS The late-onset is the less frequent form of presentation of the TK2 deficiency and its natural history is not well known. Patients with late onset TK2 deficiency have a consistent and recognizable clinical phenotype and a poor prognosis, due to the high risk of early and progressive respiratory insufficiency.
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Affiliation(s)
- Cristina Domínguez-González
- Neurology department, Neuromuscular disorders Unit, 12 de Octubre Hospital, Madrid, Spain.,Research Institute i+12, 12 de Octubre Hospital, Madrid, Spain.,Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Aurelio Hernández-Laín
- Neuropathology, Pathology Department, Neuromuscular disorders Unit, 12 de Octubre Hospital, Madrid, Spain
| | - Eloy Rivas
- Pathological Anatomic Department, Neuromuscular Disorders Unit, Instituto de Biomedicina de Sevilla, Hospital U. Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Ana Hernández-Voth
- Neumology department, Neuromuscular disorders Unit, 12 de Octubre Hospital, Madrid, Spain
| | - Javier Sayas Catalán
- Neumology department, Neuromuscular disorders Unit, 12 de Octubre Hospital, Madrid, Spain
| | | | - Carmen Fuiza-Luces
- Research Institute i+12, 12 de Octubre Hospital, Madrid, Spain.,Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital '12 de Octubre' ('i+12'), Madrid, Spain
| | | | - Germán Morís
- Neurology Department, Neuromuscular disorders Unit, Hospital Central de Asturias, Oviedo, Spain
| | - Montse Olivé
- Pathological Anatomy Department, Neuromuscular disorders unit, IDIBELL-Hospital de Bellvitge, Barcelona, Spain
| | - Frances Miralles
- Neurology department, Neuromuscular disorders unit, Hospital Universitari Son Espases, Palma, Spain
| | - Jordi Díaz-Manera
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Neurology department, Neuromuscular disorders unit, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Candela Caballero
- Respiratory Department, Instituto de Biomedicina de Sevilla, Hospital U. Virgen del Rocío, CSIC, CIBERES, Universidad de Sevilla, Sevilla, Spain
| | | | - Ramon Martí
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Neuromuscular Unit, Neurology Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Elena García Arumi
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Research group on Neuromuscular and Mitochondrial Diseases, Valld'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Carmen Badosa
- Neuromuscular Unit, Neurology Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jesús Esteban
- Neurology department, Neuromuscular disorders Unit, 12 de Octubre Hospital, Madrid, Spain.,Research Institute i+12, 12 de Octubre Hospital, Madrid, Spain.,Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Cecilia Jimenez-Mallebrera
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Neuromuscular Unit, Neurology Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Alberto Blazquez Encinar
- Research Institute i+12, 12 de Octubre Hospital, Madrid, Spain.,Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital '12 de Octubre' ('i+12'), Madrid, Spain
| | - Joaquín Arenas
- Research Institute i+12, 12 de Octubre Hospital, Madrid, Spain.,Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital '12 de Octubre' ('i+12'), Madrid, Spain
| | - Michio Hirano
- Department of Neurology, H. Houston Merritt Center, Columbia University Medical Center, New York, New York, USA
| | - Miguel Ángel Martin
- Research Institute i+12, 12 de Octubre Hospital, Madrid, Spain.,Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital '12 de Octubre' ('i+12'), Madrid, Spain
| | - Carmen Paradas
- Neurology Department, Neuromuscular Disorders Unit, Instituto de Biomedicina de Sevilla, Hospital U. Virgen del Rocío, CSIC, Universidad de Sevilla, Avd. Manuel Siurot s/n, 41013, Sevilla, Spain. .,Biomedical Network Research Centre on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.
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Abstract
Skeletal muscle requires a large increase in its ATP production to meet the energy needs of exercise. Normally, most of this increase in ATP is supplied by the aerobic process of oxidative phosphorylation. The main defects in muscle metabolism that interfere with production of ATP are (1) disorders of glycogenolysis and glycolysis, which prevent both carbohydrate entering the tricarboxylic acid cycle and the production of lactic acid; (2) mitochondrial myopathies where the defect is usually within the electron transport chain, reducing the rate of oxidative phosphorylation; and (3) disorders of lipid metabolism. Gas exchange measurements derived from exhaled gas analysis during cardiopulmonary exercise testing can identify defects in muscle metabolism because [Formula: see text]o2 and [Formula: see text]co2 are abnormal at the level of the muscle. Cardiopulmonary exercise testing may thus suggest a likely diagnosis and guide additional investigation. Defects in glycogenolysis and glycolysis are identified by a low peak [Formula: see text]o2 and absence of excess [Formula: see text]co2 from buffering of lactic acid by bicarbonate. Defects in the electron transport chain also result in low peak [Formula: see text]o2, but because there is an overreliance on anaerobic processes, lactic acid accumulation and excess carbon dioxide from buffering occur early during exercise. Defects in lipid metabolism result in only minor abnormalities during cardiopulmonary exercise testing. In defects of glycogenolysis and glycolysis and in mitochondrial myopathies, other features may include an exaggerated cardiovascular response to exercise, a low oxygen-pulse, and excessive ammonia release.
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Cejudo P, Bautista J, Montemayor T, Villagómez R, Jiménez L, Ortega F, Campos Y, Sánchez H, Arenas J. Exercise training in mitochondrial myopathy: A randomized controlled trial. Muscle Nerve 2005; 32:342-50. [PMID: 15962332 DOI: 10.1002/mus.20368] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Patients with mitochondrial myopathies (MM) usually suffer from exercise intolerance due to their impaired oxidative capacity and physical deconditioning. We evaluated the effects of a 12-week supervised randomized rehabilitation program involving endurance training in patients with MM. Twenty MM patients were assigned to a training or control group. For three nonconsecutive days each week, patients combined cycle exercise at 70% of their peak work rate with three upper-body weight-lifting exercises performed at 50% of maximum capacity. Training increased maximal oxygen uptake (28.5%), work output (15.5%), and minute ventilation (40%), endurance performance (62%), walking distance in shuttle walking test (+95 m), and peripheral muscle strength (32%-62%), and improved Nottingham Health Profile scores (21.47%) and clinical symptoms. Control MM patients did not change from baseline. Results show that our exercise program is an adequate training strategy for patients with mitochondrial myopathy.
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Affiliation(s)
- Pilar Cejudo
- Chest Department, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain.
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8
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Cardellach F, Casademont J. [Mitochondrial diseases: still a difficult diagnosis]. Med Clin (Barc) 2000; 114:139-40. [PMID: 10734624 DOI: 10.1016/s0025-7753(00)71220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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