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Gupta A, Nicholas R, McGing JJ, Nixon AV, Mallinson JE, McKeever TM, Bradley CR, Piasecki M, Cox EF, Bonnington J, Lord JM, Brightling CE, Evans RA, Hall IP, Francis ST, Greenhaff PL, Botlon CE. DYNamic assessment of multi-organ level dysfunction in patients recovering from COVID-19: DYNAMO COVID-19. Exp Physiol 2024. [PMID: 38923603 DOI: 10.1113/ep091590] [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: 12/30/2023] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
We evaluated the impacts of COVID-19 on multi-organ and metabolic function in patients following severe hospitalised infection compared to controls. Patients (n = 21) without previous diabetes, cardiovascular or cerebrovascular disease were recruited 5-7 months post-discharge alongside controls (n = 10) with similar age, sex and body mass. Perceived fatigue was estimated (Fatigue Severity Scale) and the following were conducted: oral glucose tolerance (OGTT) alongside whole-body fuel oxidation, validated magnetic resonance imaging and spectroscopy during resting and supine controlled exercise, dual-energy X-ray absorptiometry, short physical performance battery (SPPB), intra-muscular electromyography, quadriceps strength and fatigability, and daily step-count. There was a greater insulin response (incremental area under the curve, median (inter-quartile range)) during the OGTT in patients [18,289 (12,497-27,448) mIU/min/L] versus controls [8655 (7948-11,040) mIU/min/L], P < 0.001. Blood glucose response and fasting and post-prandial fuel oxidation rates were not different. This greater insulin resistance was not explained by differences in systemic inflammation or whole-body/regional adiposity, but step-count (P = 0.07) and SPPB scores (P = 0.004) were lower in patients. Liver volume was 28% greater in patients than controls, and fat fraction adjusted liver T1, a measure of inflammation, was raised in patients. Patients displayed greater perceived fatigue scores, though leg muscle volume, strength, force-loss, motor unit properties and post-exercise muscle phosphocreatine resynthesis were comparable. Further, cardiac and cerebral architecture and function (at rest and on exercise) were not different. In this cross-sectional study, individuals without known previous morbidity who survived severe COVID-19 exhibited greater insulin resistance, pointing to a need for physical function intervention in recovery.
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Affiliation(s)
- Ayushman Gupta
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rosemary Nicholas
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham, UK
| | - Jordan J McGing
- David Greenfield Human Physiology Unit, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Aline V Nixon
- David Greenfield Human Physiology Unit, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Joanne E Mallinson
- David Greenfield Human Physiology Unit, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christopher R Bradley
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham, UK
| | - Mathew Piasecki
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Nottingham, UK
| | - Eleanor F Cox
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham, UK
| | | | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | | | - Rachael A Evans
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ian P Hall
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Susan T Francis
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham, UK
| | - Paul L Greenhaff
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- David Greenfield Human Physiology Unit, School of Life Sciences, University of Nottingham, Nottingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Nottingham, UK
| | - Charlotte E Botlon
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Wahidi R, Zhang Y, Li R, Xu J, Zayed MA, Hastings MK, Zheng J. Quantitative Assessment of Peripheral Oxidative Metabolism With a New Dynamic 1H MRI Technique: A Pilot Study in People With and Without Diabetes Mellitus. J Magn Reson Imaging 2024; 59:2091-2100. [PMID: 37695103 PMCID: PMC10925551 DOI: 10.1002/jmri.28996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is linked to impaired mitochondrial function. Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) is a gadolinium-contrast-free 1H method to assess mitochondrial function by measuring low-concentration metabolites. A CEST MRI-based technique may serve as a non-invasive proxy for assessing mitochondrial health. HYPOTHESIS A 1H CEST MRI technique may detect significant differences in in vivo skeletal muscle phosphocreatine (SMPCr) kinetics between healthy volunteers and T2DM patients undergoing standardized isometric exercise. STUDY TYPE Cross-sectional study. SUBJECTS Seven subjects without T2DM (T2DM-) and seven age, sex, and BMI-matched subjects with T2DM (T2DM+). FIELD STRENGTH/SEQUENCE Single-shot rapid acquisition with refocusing echoes (RARE) and single-shot gradient-echo sequences, 3 T. ASSESSMENT Subjects underwent a rest-exercise-recovery imaging protocol to dynamically acquire SMPCr maps in calf musculature. Medial gastrocnemius (MG) and soleus SMPCr concentrations were plotted over time, and SMPCr recovery time, τ , was determined. Mitochondrial function index was calculated as the ratio of resting SMPCr to τ . Participants underwent a second exercise protocol for imaging of skeletal muscle blood flow (SMBF), and its association with SMPCr was assessed. STATISTICAL TESTS Unpaired t-tests and Pearson correlation coefficient. A P value <0.05 was considered statistically significant. RESULTS SMPCr concentrations in MG and soleus displayed expected declines during exercise and returns to baseline during recovery. τ was significantly longer in the T2DM+ cohort (MG 83.5 ± 25.8 vs. 54.0 ± 21.1, soleus 90.5 ± 18.9 vs. 51.2 ± 14.5). The mitochondrial function index in the soleus was significantly lower in the T2DM+ cohort (0.33 ± 0.08 vs. 0.66 ± 0.19). SMBF was moderately correlated with the SMPCr in T2DM-; this correlation was not significant in T2DM+ (r = -0.23, P = 0.269). CONCLUSION The CEST MRI method is feasible for quantifying SMPCr in peripheral muscle tissue. T2DM+ individuals had significantly lower oxidative capacities than T2DM- individuals. In T2DM, skeletal muscle metabolism appeared to be decoupled from perfusion. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Ryan Wahidi
- Washington University School of Medicine, Missouri, Saint Louis, USA
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ran Li
- Washington University School of Medicine, Missouri, Saint Louis, USA
| | - Jiadi Xu
- John Hopkins University, Baltimore, MD, USA
| | - Mohamed A. Zayed
- Washington University School of Medicine, Missouri, Saint Louis, USA
| | - Mary K. Hastings
- Washington University School of Medicine, Missouri, Saint Louis, USA
| | - Jie Zheng
- Washington University School of Medicine, Missouri, Saint Louis, USA
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Kawakami R, Matsui H, Matsui M, Iso T, Yokoyama T, Ishii H, Kurabayashi M. Empagliflozin induces the transcriptional program for nutrient homeostasis in skeletal muscle in normal mice. Sci Rep 2023; 13:18025. [PMID: 37865720 PMCID: PMC10590450 DOI: 10.1038/s41598-023-45390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/19/2023] [Indexed: 10/23/2023] Open
Abstract
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve heart failure (HF) outcomes across a range of patient characteristics. A hypothesis that SGLT2i induce metabolic change similar to fasting has recently been proposed to explain their profound clinical benefits. However, it remains unclear whether SGLT2i primarily induce this change in physiological settings. Here, we demonstrate that empagliflozin administration under ad libitum feeding did not cause weight loss but did increase transcripts of the key nutrient sensors, AMP-activated protein kinase and nicotinamide phosphoribosyltransferase, and the master regulator of mitochondrial gene expression, PGC-1α, in quadriceps muscle in healthy mice. Expression of these genes correlated with that of PPARα and PPARδ target genes related to mitochondrial metabolism and oxidative stress response, and also correlated with serum ketone body β-hydroxybutyrate. These results were not observed in the heart. Collectively, this study revealed that empagliflozin activates transcriptional programs critical for sensing and adaptation to nutrient availability intrinsic to skeletal muscle rather than the heart even in normocaloric condition. As activation of PGC-1α is sufficient for metabolic switch from fatigable, glycolytic metabolism toward fatigue-resistant, oxidative mechanism in skeletal muscle myofibers, our findings may partly explain the improvement of exercise tolerance in patients with HF receiving empagliflozin.
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Affiliation(s)
- Ryo Kawakami
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroki Matsui
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Miki Matsui
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tatsuya Iso
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tomoyuki Yokoyama
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
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Trepakova AI, Skovpin IV, Chukanov NV, Salnikov OG, Chekmenev EY, Pravdivtsev AN, Hövener JB, Koptyug IV. Subsecond Three-Dimensional Nitrogen-15 Magnetic Resonance Imaging Facilitated by Parahydrogen-Based Hyperpolarization. J Phys Chem Lett 2022; 13:10253-10260. [PMID: 36301252 PMCID: PMC9983028 DOI: 10.1021/acs.jpclett.2c02705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Magnetic resonance imaging (MRI) provides unique information about the internal structure and function of living organisms in a non-invasive way. The use of conventional proton MRI for the observation of real-time metabolism is hampered by the dominant signals of water and fat, which are abundant in living organisms. Heteronuclear MRI in conjunction with the hyperpolarization methods does not encounter this issue. In this work, we polarized 15N nuclei of [15N1]fampridine (a drug used for the treatment of multiple sclerosis) to the level of 4% in nuclear magnetic resonance (NMR) experiments and 0.7% in MRI studies using spin-lock-induced crossing combined with signal amplification by reversible exchange. Consequently, three-dimensional 15N MRI of the hyperpolarized 15N-labeled drug was acquired in 0.1 s with a signal-to-noise ratio of 70. In addition, the NMR signal enhancements for 15N-enriched fampridine and fampridine with a natural abundance of 15N nuclei were compared and an explanation for their difference was proposed.
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Affiliation(s)
- Alexandra I. Trepakova
- International Tomography Center, SB RAS, 3A Institutskaya St., Novosibirsk, 630090, Russia
- Novosibirsk State University, 2 Pirogova St., Novosibirsk, 630090, Russia
- Institute of Cytology and Genetics, SB RAS, 10 Acad. Lavrentiev Ave., Novosibirsk, 630090, Russia
| | - Ivan V. Skovpin
- International Tomography Center, SB RAS, 3A Institutskaya St., Novosibirsk, 630090, Russia
| | - Nikita V. Chukanov
- International Tomography Center, SB RAS, 3A Institutskaya St., Novosibirsk, 630090, Russia
- Novosibirsk State University, 2 Pirogova St., Novosibirsk, 630090, Russia
| | - Oleg G. Salnikov
- International Tomography Center, SB RAS, 3A Institutskaya St., Novosibirsk, 630090, Russia
| | - Eduard Y. Chekmenev
- Department of Chemistry, Integrative Biosciences (Ibio), Karmanos Cancer Institute (KCI), Wayne State University, Detroit, Michigan, 48202, USA
- Russian Academy of Sciences (RAS), 14 Leninskiy Prospekt, Moscow, 119991, Russia
| | - Andrey N. Pravdivtsev
- Department of Radiology and Neuroradiology Section Biomedical Imaging, MOIN CC, Universitätsklinikum Schleswig-Holstein, Universität Kiel, 14 Am Botanischen Garten, Kiel, 24118, Germany
| | - Jan-Bernd Hövener
- Department of Radiology and Neuroradiology Section Biomedical Imaging, MOIN CC, Universitätsklinikum Schleswig-Holstein, Universität Kiel, 14 Am Botanischen Garten, Kiel, 24118, Germany
| | - Igor V. Koptyug
- International Tomography Center, SB RAS, 3A Institutskaya St., Novosibirsk, 630090, Russia
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Voorrips SN, Saucedo-Orozco H, Sánchez-Aguilera PI, De Boer RA, Van der Meer P, Westenbrink BD. Could SGLT2 Inhibitors Improve Exercise Intolerance in Chronic Heart Failure? Int J Mol Sci 2022; 23:ijms23158631. [PMID: 35955784 PMCID: PMC9369142 DOI: 10.3390/ijms23158631] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
Despite the constant improvement of therapeutical options, heart failure (HF) remains associated with high mortality and morbidity. While new developments in guideline-recommended therapies can prolong survival and postpone HF hospitalizations, impaired exercise capacity remains one of the most debilitating symptoms of HF. Exercise intolerance in HF is multifactorial in origin, as the underlying cardiovascular pathology and reactive changes in skeletal muscle composition and metabolism both contribute. Recently, sodium-related glucose transporter 2 (SGLT2) inhibitors were found to improve cardiovascular outcomes significantly. Whilst much effort has been devoted to untangling the mechanisms responsible for these cardiovascular benefits of SGLT2 inhibitors, little is known about the effect of SGLT2 inhibitors on exercise performance in HF. This review provides an overview of the pathophysiological mechanisms that are responsible for exercise intolerance in HF, elaborates on the potential SGLT2-inhibitor-mediated effects on these phenomena, and provides an up-to-date overview of existing studies on the effect of SGLT2 inhibitors on clinical outcome parameters that are relevant to the assessment of exercise capacity. Finally, current gaps in the evidence and potential future perspectives on the effects of SGLT2 inhibitors on exercise intolerance in chronic HF are discussed.
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Affiliation(s)
- Suzanne N. Voorrips
- Correspondence: (S.N.V.); (B.D.W.); Tel.: +31-50-361-2355 (S.N.V. & B.D.W.); Fax: +31-50-361-4391 (S.N.V. & B.D.W.)
| | | | | | | | | | - B. Daan Westenbrink
- Correspondence: (S.N.V.); (B.D.W.); Tel.: +31-50-361-2355 (S.N.V. & B.D.W.); Fax: +31-50-361-4391 (S.N.V. & B.D.W.)
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