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Altherr C, Sietsema KE, Fulkerson Z. When the Powerhouse Is the Problem. Ann Am Thorac Soc 2024; 21:504-511. [PMID: 38426825 DOI: 10.1513/annalsats.202308-715cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/08/2023] [Indexed: 03/02/2024] Open
Affiliation(s)
- Cody Altherr
- Clinical Research Core, Indiana Center for Musculoskeletal Health, and
| | - Kathy E Sietsema
- Division of Respiratory and Critical Care Physiology and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Zachary Fulkerson
- Division of Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, Indiana; and
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Lehto T, Zetterman T, Markkula R, Arokoski J, Tikkanen H, Kalso E, Peltonen JE. Cardiac output and arteriovenous oxygen difference contribute to lower peak oxygen uptake in patients with fibromyalgia. BMC Musculoskelet Disord 2023; 24:541. [PMID: 37393269 DOI: 10.1186/s12891-023-06589-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/30/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Patients with fibromyalgia (FM) exhibit low peak oxygen uptake ([Formula: see text]O2peak). We aimed to detect the contribution of cardiac output to ([Formula: see text]) and arteriovenous oxygen difference [Formula: see text] to [Formula: see text] from rest to peak exercise in patients with FM. METHODS Thirty-five women with FM, aged 23 to 65 years, and 23 healthy controls performed a step incremental cycle ergometer test until volitional fatigue. Alveolar gas exchange and pulmonary ventilation were measured breath-by-breath and adjusted for fat-free body mass (FFM) where appropriate. [Formula: see text] (impedance cardiography) was monitored. [Formula: see text] was calculated using Fick's equation. Linear regression slopes for oxygen cost (∆[Formula: see text]O2/∆work rate) and [Formula: see text] to [Formula: see text]O2 (∆[Formula: see text]/∆[Formula: see text]O2) were calculated. Normally distributed data were reported as mean ± SD and non-normal data as median [interquartile range]. RESULTS [Formula: see text]O2peak was lower in FM patients than in controls (22.2 ± 5.1 vs. 31.1 ± 7.9 mL∙min-1∙kg-1, P < 0.001; 35.7 ± 7.1 vs. 44.0 ± 8.6 mL∙min-1∙kg FFM-1, P < 0.001). [Formula: see text] and C(a-v)O2 were similar between groups at submaximal work rates, but peak [Formula: see text] (14.17 [13.34-16.03] vs. 16.06 [15.24-16.99] L∙min-1, P = 0.005) and C(a-v)O2 (11.6 ± 2.7 vs. 13.3 ± 3.1 mL O2∙100 mL blood-1, P = 0.031) were lower in the FM group. No significant group differences emerged in ∆[Formula: see text]O2/∆work rate (11.1 vs. 10.8 mL∙min-1∙W-1, P = 0.248) or ∆[Formula: see text]/∆[Formula: see text]O2 (6.58 vs. 5.75, P = 0.122) slopes. CONCLUSIONS Both [Formula: see text] and C(a-v)O2 contribute to lower [Formula: see text]O2peak in FM. The exercise responses were normal and not suggestive of a muscle metabolism pathology. TRIAL REGISTRATION ClinicalTrials.gov, NCT03300635. Registered 3 October 2017-Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03300635 .
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Affiliation(s)
- Taneli Lehto
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Mäkelänkatu 47, Urhea-Hall, 00550, Helsinki, Finland.
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
| | - Teemu Zetterman
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Pain Clinic, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- City of Vantaa Health Centre, Vantaa, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Ritva Markkula
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Pain Clinic, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Jari Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Heikki Tikkanen
- Sports and Exercise Medicine, Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Eija Kalso
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Pain Clinic, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- SLEEPWELL Research Programme, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha E Peltonen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Mäkelänkatu 47, Urhea-Hall, 00550, Helsinki, Finland
- Foundation for Sports and Exercise Medicine, Helsinki Sports and Exercise Medicine Clinic, Helsinki, Finland
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From Single- to Multi-organ-on-a-Chip System for Studying Metabolic Diseases. BIOCHIP JOURNAL 2023. [DOI: 10.1007/s13206-023-00098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Wilkinson M, Cash K, Gutschmidt B, Otto S, Limaye V. Secondary myoadenylate deaminase deficiency is not a common feature of inflammatory myopathies: A descriptive study. Front Med (Lausanne) 2022; 9:1061722. [PMID: 36507531 PMCID: PMC9727292 DOI: 10.3389/fmed.2022.1061722] [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: 10/05/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Myoadenylate deaminase (MAD) deficiency is a form of metabolic myopathy, which generally causes only mild symptoms in the primary inherited form. Inflammatory myopathies are a group of autoimmune diseases which result in skeletal muscle weakness. In addition to inflammatory pathology, it has been speculated that non-inflammatory mechanisms, and possibly secondary MAD-deficiency, may potentially contribute to weakness in these conditions. Methods We investigated for an association between these two myopathic processes through two complementary methods. Firstly, muscle biopsy records in South Australia over a 17-year period were retrospectively reviewed for diagnosis of myositis or MAD-deficiency, as well as associated clinical features. Secondly, a prospective arm histochemically tested all incident biopsy specimens over a 12-month period for MAD-deficiency. Results In the retrospective arm, 30 MAD-deficient cases were identified (1.3% of all biopsies), with no significant difference observed in overall rates of myositis diagnosis between patients with intact and deficient MAD activity (21.3% vs 26.7%, P = 0.47). No cases of MAD-deficiency were detected in the prospective arm, despite 39 cases of myositis being identified over this period. Conclusion Secondary MAD deficiency is unlikely to be a major driver of symptoms in inflammatory myopathies.
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Affiliation(s)
- Michael Wilkinson
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia,Department of Rheumatology, Flinders Medical Centre, Adelaide, SA, Australia,Department of Rheumatology, Royal Adelaide Hospital, Adelaide, SA, Australia,*Correspondence: Michael Wilkinson,
| | - Kathy Cash
- Muscle and Nerve Laboratory, Department of Anatomical Pathology, SA Pathology, Adelaide, SA, Australia
| | - Bernice Gutschmidt
- Muscle and Nerve Laboratory, Department of Anatomical Pathology, SA Pathology, Adelaide, SA, Australia
| | - Sophia Otto
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia,Muscle and Nerve Laboratory, Department of Anatomical Pathology, SA Pathology, Adelaide, SA, Australia
| | - Vidya Limaye
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia,Department of Rheumatology, Royal Adelaide Hospital, Adelaide, SA, Australia
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Blumberg Y, Edelstein M, Abu Jabal K, Golan R, Tuvia N, Perets Y, Saad M, Levinas T, Saleem D, Israeli Z, Alaa AR, Elbaz Greener G, Amital A, Halabi M. Protective Effects of BNT162b2 Vaccination on Aerobic Capacity Following Mild to Moderate SARS-CoV-2 Infection: A Cross-Sectional Study Israel. J Clin Med 2022; 11:jcm11154420. [PMID: 35956037 PMCID: PMC9369692 DOI: 10.3390/jcm11154420] [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: 06/22/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 02/06/2023] Open
Abstract
Patients previously infected with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may experience post-acute adverse health outcomes, known as long COVID. The most reported symptoms are fatigue, headache and attention/concentration issues, dyspnea and myalgia. In addition, reduced aerobic capacity has been demonstrated in both mild and moderate COVID-19 patients. It is unknown whether COVID-19 vaccination mitigates against reduced aerobic capacity. Our aim was to compare the aerobic capacity of vaccinated and unvaccinated individuals previously infected with SARS-CoV-2. Methods: Individuals aged 18 to 65 years with laboratory-confirmed mild to moderate COVID-19 disease were invited to Ziv Medical Centre, Israel, three months after SARS-CoV-2 infection. We compared individuals unvaccinated at the time of infection to those vaccinated in terms of aerobic capacity, measured using symptom-limited cardiopulmonary exercise test (CPET). Results: We recruited 28 unvaccinated and 22 vaccinated patients. There were no differences in baseline demographic and pulmonary function testing (PFT) parameters. Compared with unvaccinated individuals, those vaccinated had higher V’O2/kg at peak exercise and at the anaerobic threshold. The V’O2/kg peak in the unvaccinated group was 83% of predicted vs. 100% in the vaccinated (p < 0.002). At the anaerobic threshold (AT), vaccinated individuals had a higher V’O2/kg than those unvaccinated. Conclusions: Vaccinated individuals had significantly better exercise performance. Compared with vaccinated individuals, a higher proportion of those unvaccinated performed substantially worse than expected on CPET. These results suggest that vaccination at the time of infection is associated with better aerobic capacity following SARS-CoV-2 infection.
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Affiliation(s)
- Yair Blumberg
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel; (Y.P.); (G.E.G.)
- Correspondence: (Y.B.); (M.H.)
| | - Michael Edelstein
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel; (Y.P.); (G.E.G.)
| | - Kamal Abu Jabal
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel; (Y.P.); (G.E.G.)
| | - Ron Golan
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
| | - Neta Tuvia
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
| | - Yuval Perets
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel; (Y.P.); (G.E.G.)
| | - Musa Saad
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
| | - Tatyana Levinas
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel; (Y.P.); (G.E.G.)
| | - Dabbah Saleem
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
| | - Zeev Israeli
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel; (Y.P.); (G.E.G.)
| | - Abu Raya Alaa
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
| | - Gabby Elbaz Greener
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel; (Y.P.); (G.E.G.)
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Anat Amital
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
| | - Majdi Halabi
- Rivka Ziv Medical Center, Safed, Israel; (M.E.); (K.A.J.); (R.G.); (N.T.); (M.S.); (T.L.); (D.S.); (Z.I.); (A.R.A.); (A.A.)
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel; (Y.P.); (G.E.G.)
- Correspondence: (Y.B.); (M.H.)
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He J, Fu J, Zhao W, Ren C, Liu P, Chen L, Li D, Zhou L, Tang L, Liu X, Ye S, Liu X, Ma Y, Zhang Y, Ma X, Zhang L, Zhang G, Li N, Fan D. Exercise Physiology Impairments of Patients With Amyotrophic Lateral Sclerosis: Cardiopulmonary Exercise Testing Findings. Front Physiol 2022; 13:792660. [PMID: 35370778 PMCID: PMC8967153 DOI: 10.3389/fphys.2022.792660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Objective In amyotrophic lateral sclerosis (ALS), progressive weakness significantly limits the ability to exercise. However, measurements of the impaired exercise function and their practical value to assess disease progression in ALS are scarce. Cardiopulmonary exercise testing (CPET) is a non-invasive accurate method used to comprehensively quantify exercise physiology in a variety of diseases. This study aimed to evaluate the clinical value of CPET and to explore its association with disease severity and prognosis prediction in ALS. Methods A total of 319 participants were enrolled in this 3-year prospective study. After strict quality control, 109 patients with ALS and 150 age- and sex-matched healthy controls were included with comprehensive clinical assessment and follow-ups. The incremental ramp protocol for symptom-limited CPET was applied in both groups. The exercise physiology during peak effort exercise was systematically measured, including the overall aerobic capacity of exercise (VO2 peak) and the respective capacity of the exercise-involved organs [cardiac response (heart rate peak—HR peak), ventilatory efficiency (VE/VCO2 slope), breathing economy (VE/VO2 peak), and other relevant parameters]. Disease severity and progression were evaluated using recognized scales. Survival was monitored with regular follow-ups every 6 months. Results Decreased exercise capacity (VO2 peak < 16 ml/kg/min) occurred more frequently in patients with ALS than in controls (44.95% vs. 9.33%, p < 0.01). In patients with ALS, the average VO2 peak (16.16 ± 5.43 ml/kg/min) and HR peak [135 (112–153) bpm] were significantly lower (p < 0.01) than in controls [22.26 ± 7.09 ml/kg/min; 148 (135–164) bpm], but the VE/VCO2 slope was significantly higher [28.05 (25.03–32.16) vs. 26.72 (24.37–29.58); p = 0.03]. In patients with ALS, the VO2 peak and HR peak were significantly correlated with disease severity and progression scores (p < 0.05). Survival analyses revealed the VO2 peak and HR peak as protective indicators while the VE/VO2 peak as a detrimental indicator for the prognostic prediction in ALS (HR = 0.839, p = 0.001; HR = 0.967, p < 0.001; HR = 1.137, p = 0.028, respectively). Conclusion Our prospective study quantified the significantly decreased exercise capacity in ALS through non-invasive CPET. The impaired VO2 peak and HR peak closely correlated with disease severity and independently predicted a worse prognosis. Our findings identified the clinical value of CPET as an objective indicator of disease progression in ALS.
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Affiliation(s)
- Ji He
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Jiayu Fu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Wei Zhao
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Chuan Ren
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Ping Liu
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Dan Li
- Department of Cardiology, Peking University Third Hospital, Beijing, China
- Physical Examination Center, Peking University Third Hospital, Beijing, China
| | - Lequn Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Lu Tang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiangyi Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Shan Ye
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiaolu Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yan Ma
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yixuan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xinran Ma
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Linjing Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Gaoqi Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Nan Li
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
- Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
- *Correspondence: Dongsheng Fan,
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