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Palzkill VR, Tan J, Tice AL, Ferriera LF, Ryan TE. A 6-minute Limb Function Assessment for Therapeutic Testing in Experimental Peripheral Artery Disease Models. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.21.586197. [PMID: 38585832 PMCID: PMC10996543 DOI: 10.1101/2024.03.21.586197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background The translation of promising therapies from pre-clinical models of hindlimb ischemia (HLI) to patients with peripheral artery disease (PAD) has been inadequate. While this failure is multifactorial, primary outcome measures in preclinical HLI models and clinical trials involving patients with PAD are not aligned well. For example, laser Doppler perfusion recovery measured under resting conditions is the most used outcome in HLI studies, whereas clinical trials involving patients with PAD primarily assess walking performance. Here, we sought to develop a 6-min limb function test for preclinical HLI models that assess muscular performance and hemodynamics congruently. Methods We developed an in situ 6-min limb function test that involves repeated isotonic (shortening) contractions performed against a submaximal load. Continuous measurement of muscle blood flow was performed using laser Doppler flowmetry. Quantification of muscle power, work, and perfusion are obtained across the test. To assess the efficacy of this test, we performed HLI via femoral artery ligation on several mouse strains: C57BL6J, BALBc/J, and MCK-PGC1α (muscle-specific overexpression of PGC1α). Additional experiments were performed using an exercise intervention (voluntary wheel running) following HLI. Results The 6-min limb function test was successful at detecting differences in limb function of C57BL6/J and BALBc/J mice subjected to HLI with effect sizes superior to laser Doppler perfusion recovery. C57BL6/J mice randomized to exercise therapy following HLI had smaller decline in muscle power, greater hyperemia, and performed more work across the 6-min limb function test compared to non-exercise controls with HLI. Mice with muscle-specific overexpression of PGC1α had no differences in perfusion recovery in resting conditions, but exhibited greater capillary density, increased muscle mass and absolute force levels, and performed more work across the 6-min limb function test compared to their wildtype littermates without the transgene. Conclusion These results demonstrate the efficacy of the 6-min limb function test to detect differences in the response to HLI across several interventions including where traditional perfusion recovery, capillary density, and muscle strength measures were unable to detect therapeutic differences.
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Affiliation(s)
- Victoria R. Palzkill
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Jianna Tan
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | | | - Leonardo F. Ferriera
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
- Center for Exercise Science, The University of Florida, Gainesville, FL, USA
- The Myology Institute, The University of Florida, Gainesville, FL, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Terence E. Ryan
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
- Center for Exercise Science, The University of Florida, Gainesville, FL, USA
- The Myology Institute, The University of Florida, Gainesville, FL, USA
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Mei C, Ma T. Roles of isometric contraction training in promoting neuroprotection and angiogenesis after stroke in adult rats. Physiol Res 2022; 71:425-438. [PMID: 35616043 DOI: 10.33549/physiolres.934849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
100 rats were randomly divided into a sham-operated group and middle cerebral artery occlusion (MCAO) modeling groups. The sham group after surgery was observed for 14 days. After MCAO, some rats received isometric contraction training (ICT) which was as follows: an atraumatic tourniquet was placed around left or right hind limb to achieve hind limb ischemia for 5 min, followed by 5 min of reperfusion, 4 cycles for one time, once a day, and five days per week. The MCAO modeling groups included the following four groups: i) a group only received MCAO, and was observed for seven days (MCAO-7d), ii) a group only received MCAO, and was observed for 14 days (MCAO-14d), iii) a group, after MCAO, received ICT for seven days (ICT-7d), and iv) a group, after MCAO, received ICT for 14 days (ICT-14d). Brain infarct area, behavioral outcomes, the number of neurons, apoptosis, cerebral edema and cerebral water content were assessed, respectively. The mRNA expression of vascular endothelial growth factor (VEGF) was assayed with RT-PCR, and protein expression of VEGF was quantified with western blot. compared with MCAO controls, cerebral infarction, neurological deficits and neuronal apoptosis were reduced significantly in the ICT groups, while the number of neurons was increased. Moreover, the mRNA expression of VEGF and protein expression of VEGF were enhanced after 1 and 2 weeks of ICT. ICT may promote angiogenesis and neuroprotection after ischemic stroke and this new remodeling method provide a novel strategy for rehabilitation of stroke patients.
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Affiliation(s)
- C Mei
- Pukou Branch of Jiangsu People's Hospital, Nanjing City, Jiangsu Province, P. R. China.
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Baffour-Awuah B, Dieberg G, Pearson MJ, Smart NA. The effect of remote ischaemic conditioning on blood pressure response: A systematic review and meta-analysis. Int J Cardiol Hypertens 2021; 8:100081. [PMID: 33748739 PMCID: PMC7972960 DOI: 10.1016/j.ijchy.2021.100081] [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: 12/21/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous work has evaluated the effect of remote ischaemic conditioning (RIC) in a number of clinical conditions (e.g. cardiac surgery and acute kidney injury), but only one analysis has examined blood pressure (BP) changes. While individual studies have reported the effects of acute bouts and repeated RIC exposure on resting BP, efficacy is equivocal. We conducted a systematic review and meta-analysis to evaluate the effects of acute and repeat RIC on BP. METHODS A systematic search was performed using PubMed, Web of Science, EMBASE, and Cochrane Library of Controlled Trials up until October 31, 2020. Additionally, manual searches of reference lists were performed. Studies that compared BP responses after exposing participants to either an acute bout or repeated cycles of RIC with a minimum one-week intervention period were considered. RESULTS Eighteen studies were included in this systematic review, ten examined acute effects while eight investigated repeat effects of RIC. Mean differences (MD) for outcome measures from acute RIC studies were: systolic BP 0.18 mmHg (95%CI -0.95, 1.31; p = 0.76), diastolic BP -0.43 mmHg (95%CI -2.36, 1.50; p = 0.66), MAP -1.73 mmHg (95%CI -3.11, -0.34; p = 0.01) and HR -1.15 bpm (95%CI -2.92, 0.62; p = 0.20). Only MAP was significantly reduced. Repeat RIC exposure showed non-significant change in systolic BP -3.23 mmHg (95%CI -6.57, 0.11; p = 0.06) and HR -0.16 bpm (95%CI -7.08, 6.77; p = 0.96) while diastolic BP -2.94 mmHg (95%CI -4.08, -1.79; p < 0.00001) and MAP -3.21 mmHg (95%CI -4.82, -1.61; p < 0.0001) were significantly reduced. CONCLUSIONS Our data suggests repeated, but not acute, RIC produced clinically meaningful reductions in diastolic BP and MAP.
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Affiliation(s)
- Biggie Baffour-Awuah
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia
| | - Gudrun Dieberg
- Biomedical Sciences, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia
| | - Melissa J. Pearson
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia
| | - Neil A. Smart
- Clinical Exercise Physiology, School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia
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Chen W, Shen J, Chen R, You H, Ye F, Zheng J, Lu L, Lu X, Ni J, Wu Y, Qiao Z. Amelioration of ischemic cardiomyopathy in patients using physiological ischemic training. Herz 2020; 46:173-179. [PMID: 32886131 DOI: 10.1007/s00059-020-04975-3] [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: 04/27/2020] [Revised: 07/01/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aimed to observe the effect and potential mechanism of physiological ischemic training (PIT) in patients with ischemic cardiomyopathy. METHODS A total of 165 patients with ischemic cardiomyopathy were randomly selected by the convenience sampling method and were divided into the control and experimental groups. The control group received conventional drug treatment, while the experimental group received additional PIT. All patients were followed up for 6 months and renin-angiotensin-aldosterone system (RAS) activity parameters and myocardial remodeling indicators were recorded. RESULTS After the 6‑month intervention, cardiac function indicators in the two groups were significantly improved compared with before intervention (all P < 0.01), but the experimental group showed significantly more improvement compared with the control group (all P < 0.01). Similarly, RAS activity parameters and myocardial remodeling indicators of the two groups were significantly reduced after intervention compared with before intervention (all P < 0.01). However, the experimental group showed significantly lower myocardial remodeling indicators than the control group (all P < 0.01). Vascular endothelial growth factor (VEGF) and nitric oxide (NO) concentrations in peripheral blood in the experimental group were significantly increased after intervention compared with before intervention (both P < 0.01). CONCLUSIONS PIT can be applied in patients with ischemic cardiomyopathy on the basis of the original standardized drug treatment. PIT ameliorates cardiac blood flow reserve by increasing VEGF and NO concentrations in the peripheral blood, as well as by inhibiting the RAS system and myocardial remodeling. This ultimately improves the patient's cardiac function to a greater extent.
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Affiliation(s)
- Weihai Chen
- Department of Cardiology, Suzhou Ninth People's Hospital, Affiliated Wujiang Hospital of Nantong University, Ludang Road, 2666, Suzhou, China
| | - Jun Shen
- Department of Cardiology, Suzhou Ninth People's Hospital, Affiliated Wujiang Hospital of Nantong University, Ludang Road, 2666, Suzhou, China
| | - Rongrong Chen
- Department of Geriatric Medicine, Suzhou Municipal Hospital, Suzhou Cancer Medical Center, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Hua You
- Department of Cardiology, Suzhou Ninth People's Hospital, Affiliated Wujiang Hospital of Nantong University, Ludang Road, 2666, Suzhou, China
| | - Fulong Ye
- Department of Cardiology, Suzhou Ninth People's Hospital, Affiliated Wujiang Hospital of Nantong University, Ludang Road, 2666, Suzhou, China
| | - Ju Zheng
- Department of Cardiology, Suzhou Ninth People's Hospital, Affiliated Wujiang Hospital of Nantong University, Ludang Road, 2666, Suzhou, China
| | - Lijuan Lu
- Department of Gynecology and Obstetrics, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, China
| | - Xiao Lu
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Ni
- Department of Rehabilitation, Affiliated Hospital of Nantong University, Nantong, China
| | - Yanming Wu
- Department of Cardiology, Suzhou Ninth People's Hospital, Affiliated Wujiang Hospital of Nantong University, Ludang Road, 2666, Suzhou, China.
| | - Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Affiliated Wujiang Hospital of Nantong University, 2666 Ludang Road, 215200, Suzhou, China.
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The importance of physiologic ischemia training in preventing the development of atherosclerosis: the role of endothelial progenitor cells in atherosclerotic rabbits. Coron Artery Dis 2020; 30:377-383. [PMID: 30724819 PMCID: PMC6635124 DOI: 10.1097/mca.0000000000000723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to investigate the effects of physiologic ischemia training (PIT) on the proliferation of endothelial progenitor cells (EPCs) and the corresponding changes in the influencing factors in atherosclerotic rabbits, including vascular endothelial growth factor (VEGF) and nitric oxide (NO). Materials and methods Eighteen rabbits were assigned randomly to three groups: a high-fat diet (HD) group, an HD-with-training (HT) group, and a control group. Rabbits in the HD and HT groups were fed high-fat food and those in the HT group were administered PIT from the seventh week onward. Atherosclerotic plaques in the thoracic aorta were stained with Oil Red O and measured by Image-Pro Plus 6.0; VEGF expression was measured using an enzyme-linked immunosorbent assay and real-time PCR to determine both protein and mRNA levels. EPCs were counted using a fluorescence-activated cell sorter; NO in plasma was measured by the Griess reaction; and the levels of blood lipids were measured using a biochemical analyzer. Results More lipid-containing lesions were found in the HD group than in the HT group (P<0.01), whereas atherosclerotic plaques were not observed in the control group. In addition, the expression of VEGF, production of NO, and levels of blood lipids were consistent with the proportion of plaques. It is noteworthy that the proliferation of EPCs increased in the HT group throughout the 10 weeks, whereas those in the control and HD groups increased in the first 6 weeks and declined during the 10th week (P<0.01). Conclusion PIT may prevent the development of aortic atherosclerosis by promoting the proliferation of EPCs in atherosclerotic rabbits.
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Chen W, Ni J, Qiao Z, Wu Y, Lu L, Zheng J, Chen R, Lu X. Comparison of the Clinical Outcomes of Two Physiological Ischemic Training Methods in Patients with Coronary Heart Disease. Open Med (Wars) 2019; 14:224-233. [PMID: 30847399 PMCID: PMC6401491 DOI: 10.1515/med-2019-0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/29/2018] [Indexed: 11/24/2022] Open
Abstract
The aim of the present study was to verify the effectiveness of physiological ischemic training (PIT) in patients with coronary heart disease (CHD) and compare differences in clinical outcomes between isometric exercise training (IET) and cuff inflation training (CIT). Fifty-five CHD patients were randomized into three groups: IET group (n=19), CIT group (n=18), and no-exercise group (n=18). PIT was practiced in the IET and CIT groups. Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. The cardiac structure and function were evaluated and vascular endothelial growth factor (VEGF) measured. SBP and DBP decreased significantly in both PIT groups after 3-month training (P<0.01). Cardiac function and structure were significantly improved in both PIT groups after 3-month training (P<0.01). Cardiac structure and function in the IET group were both superior to those in the CIT group by the end of training (P<0.01). The VEGF level in both PIT groups increased significantly after 3-month training (P<0.01). PIT was safe and feasible when performed in CHD patients. An appropriate period of PIT helped improve blood pressure and the cardiac structure and function, with the outcome more positive in the IET group.
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Affiliation(s)
- Weihai Chen
- Department of Cardiology, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200 China
| | - Jun Ni
- Department of Rehabilitation, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
| | - Zhenguo Qiao
- Department of Gastroenterology, The First People's Hospital of Wujiang District, 169 Gongyuan Road, Suzhou, Jiangsu 215200, China
| | - Yanming Wu
- Department of Cardiology, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200 China
| | - Lijuan Lu
- Department of Gynecology and Obstetrics, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu 215003, China
| | - Ju Zheng
- Department of Cardiology, The First People's Hospital of Wujiang District, Suzhou, Jiangsu 215200 China
| | - Rongrong Chen
- Department of Geriatric, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, China
| | - Xiao Lu
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
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A new analytical model for the changes of vascular endothelial growth factor in ischemic diseases. Med Hypotheses 2017; 109:73-76. [DOI: 10.1016/j.mehy.2017.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/19/2017] [Accepted: 09/25/2017] [Indexed: 11/19/2022]
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Zheng Y, Xiao M, Li L, Li J, Reinhardt JD, Lu X. Remote physiological ischemic training promotes coronary angiogenesis via molecular and cellular mobilization after myocardial ischemia. Cardiovasc Ther 2017; 35. [PMID: 28261920 DOI: 10.1111/1755-5922.12257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/20/2017] [Accepted: 02/27/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yu Zheng
- Department of Rehabilitation Medicine, West China Hospital; Sichuan University; Chengdu Sichuan China
- Institute for Disaster Management and Reconstruction; Sichuan University - Hong Kong Polytechnic University; Chengdu Sichuan China
| | - Mingyue Xiao
- Department of Neuro Rehabilitation Medicine; Beijing United Family Rehabilitation Hospital; Beijing China
| | - Ling Li
- Department of Physical and Rehabilitation Medicine; Xuzhou Central Hospital; Xuzhou Jiangsu China
| | - Jianan Li
- The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
| | - Jan D. Reinhardt
- Institute for Disaster Management and Reconstruction; Sichuan University - Hong Kong Polytechnic University; Chengdu Sichuan China
- Swiss Paraplegic Research; Nottwil Switzerland
| | - Xiao Lu
- Department of Neuro Rehabilitation Medicine; Beijing United Family Rehabilitation Hospital; Beijing China
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Hess NCL, Smart NA. Isometric Exercise Training for Managing Vascular Risk Factors in Mild Cognitive Impairment and Alzheimer's Disease. Front Aging Neurosci 2017; 9:48. [PMID: 28316570 PMCID: PMC5334511 DOI: 10.3389/fnagi.2017.00048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 02/20/2017] [Indexed: 12/12/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common form of dementia diagnosed amongst the elderly. Mild cognitive impairment (MCI) is a condition often indicative of the earliest symptomatology of AD with 10%–15% of MCI patients reportedly progressing to a diagnosis of AD. Individuals with a history of vascular risk factors (VRF’s) are considered high risk candidates for developing cognitive impairment in later life. Evidence suggests that vascular injury resulting from untreated VRF’s promotes progression from MCI to AD and exacerbates the severity of dementia in AD, and neuroimaging studies have found that the neurodegenerative processes associated with AD are heavily driven by VRF’s that promote cerebral hypoperfusion. Subsequently, common links between vascular disorders such as hypertension and neurodegenerative disorders such as AD include compromised vasculature, cerebral hypoperfusion and chronic low grade inflammation (a hallmark of both hypertension and AD). Exercise has been demonstrated to be an effective intervention for blood pressure management, chronic low grade inflammation and improvements in cognition. Data from recent analyses suggests that isometric exercise training (IET) may improve vascular integrity and elicit blood pressure reductions in hypertensives greater than those seen with dynamic aerobic and resistance exercise. IET may also play an effective role in the management of VRF’s at the MCI stage of AD and may prove to be a significant strategy in the prevention, attenuation or delay of progression to AD. A plausible hypothesis is that the reactive hyperemia stimulated by IET initiates a cascade of vascular, neurotrophic and neuro-endocrine events that lead to improvements in cognitive function.
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Affiliation(s)
- Nicole C L Hess
- School of Science and Technology, University of New England Armidale, NSW, Australia
| | - Neil A Smart
- School of Science and Technology, University of New England Armidale, NSW, Australia
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Zhen X, Zheng Y, Hong X, Chen Y, Gu P, Tang J, Cheng H, Yuan TF, Lu X. Physiological Ischemic Training Promotes Brain Collateral Formation and Improves Functions in Patients with Acute Cerebral Infarction. Front Neurol 2016; 7:235. [PMID: 28066319 PMCID: PMC5177612 DOI: 10.3389/fneur.2016.00235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/08/2016] [Indexed: 02/05/2023] Open
Abstract
Objectives To observe the effectiveness and mechanisms of physiological ischemic training (PIT) on brain cerebral collateral formation and functional recovery in patients with acute cerebral infarction. Methods 20 eligible patients with acute cerebral infarction were randomly assigned to either PIT group (n = 10) or Control group (n = 10). Both groups received 4 weeks of routine rehabilitation therapy, while an additional session of PIT, which consisted of 10 times of maximal voluntary isometric handgrip for 1 min followed by 1 min rest, was prescribed for patients in the PIT groups. Each patient was trained with four sections a day and 5 days a week for 4 weeks. The Fugl–Meyer Assessment (FMA), the Modified Barthel Index (MBI), and the short-form 36-item health survey questionnaire (SF-36) were applied for the evaluation of motor impairment, activity of daily living, and quality of life at the baseline and endpoint. MRI was applied to detect the collateral formation in the brain. The concentration of vascular endothelial growth factor (VEGF) and endothelial progenitor cells (EPCs) number in plasma were also tested at the endpoint. Results Demographic data were consistent between experimental groups. At the endpoint, the scores of the FMA, MBI, and SF-36 were significantly higher than that at baseline. As compared to the Control group, the score of FMA and SF-36 in PIT group was significantly higher, while no significant difference was detected between groups in terms of MBI. Both groups had significantly higher cerebral blood flow (CBF) level at endpoint as compared to that at baseline. Moreover, the CBF level was even higher in the PIT group as compared to that in the Control group after 4 weeks of training. The same situations were also found in the plasma VEGF and EPCs assessment. In addition, positive correlations were found between FMA score and CBF level (r = 0.686, p < 0.01), CBF level and VEGF concentration (r = 0.675, p < 0.01), and VEGF concentration and EPC number (r = 0.722, p < 0.01). Conclusion PIT may be effective in increasing the expression of VEGF and recruitment of EPCs and in turn promote the formation of brain collateral circulation. The positive correlations may demonstrate a potential association between biological and functional parameters, and PIT may be able to improve the motor function, activity of daily living, and quality of life in patients with stroke.
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Affiliation(s)
- Xiaoyue Zhen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Yu Zheng
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China; Institute for Disaster Management and Reconstruction, Sichuan University - Hong Kong Polytechnic University, Chengdu, China; Interdisciplinary Division of Biomedical Engineering, Hong Kong Polytechnic University, King's Park, Hong Kong
| | - Xunning Hong
- The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Yan Chen
- The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Ping Gu
- The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Jinrong Tang
- The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Hong Cheng
- The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
| | - Ti-Fei Yuan
- School of Psychology, Nanjing Normal University , Nanjing , China
| | - Xiao Lu
- The First Affiliated Hospital of Nanjing Medical University , Nanjing , China
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Ni J, Lu H, Lu X, Jiang M, Peng Q, Ren C, Xiang J, Mei C, Li J. The evolving concept of physiological ischemia training vs. ischemia preconditioning. J Biomed Res 2015; 29:445-50. [PMID: 26664354 PMCID: PMC4662205 DOI: 10.7555/jbr.29.20140142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/24/2015] [Accepted: 05/22/2015] [Indexed: 01/08/2023] Open
Abstract
Ischemic heart diseases are the leading cause of death with increasing numbers of patients worldwide. Despite advances in revascularization techniques, angiogenic therapies remain highly attractive. Physiological ischemia training, which is first proposed in our laboratory, refers to reversible ischemia training of normal skeletal muscles by using a tourniquet or isometric contraction to cause physiologic ischemia for about 4 weeks for the sake of triggering molecular and cellular mechanisms to promote angiogenesis and formation of collateral vessels and protect remote ischemia areas. Physiological ischemia training therapy augments angiogenesis in the ischemic myocardium by inducing differential expression of proteins involved in energy metabolism, cell migration, protein folding, and generation. It upregulates the expressions of vascular endothelial growth factor, and induces angiogenesis, protects the myocardium when infarction occurs by increasing circulating endothelial progenitor cells and enhancing their migration, which is in accordance with physical training in heart disease rehabilitation. These findings may lead to a new approach of therapeutic angiogenesis for patients with ischemic heart diseases. On the basis of the promising results in animal studies, studies were also conducted in patients with coronary artery disease without any adverse effect in vivo, indicating that physiological ischemia training therapy is a safe, effective and non-invasive angiogenic approach for cardiovascular rehabilitation. Preconditioning is considered to be the most protective intervention against myocardial ischemia-reperfusion injury to date. Physiological ischemia training is different from preconditioning. This review summarizes the preclinical and clinical data of physiological ischemia training and its difference from preconditioning.
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Affiliation(s)
- Jun Ni
- Department of Rehabilitation Medicine, the Affiliated Hospital of Nantong University , Nantong, Jiangsu 226000 , China
| | - Hongjian Lu
- The Second People's Hospital , Nantong, Jiangsu 226002 , China
| | - Xiao Lu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Minghui Jiang
- Department of Cardiology, the Affiliated Hospital of Nantong University , Nantong, Jiangsu 226000 , China
| | - Qingyun Peng
- Department of Cardiology, the Affiliated Hospital of Nantong University , Nantong, Jiangsu 226000 , China
| | - Caili Ren
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Jie Xiang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Chengyao Mei
- Department of Rehabilitation Medicine, the Affiliated Hospital of Nantong University , Nantong, Jiangsu 226000 , China
| | - Jianan Li
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
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Zheng Y, Lu X, Li J, Zhang Q, Reinhardt JD. Impact of remote physiological ischemic training on vascular endothelial growth factor, endothelial progenitor cells and coronary angiogenesis after myocardial ischemia. Int J Cardiol 2014; 177:894-901. [PMID: 25453408 DOI: 10.1016/j.ijcard.2014.10.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 09/08/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This experimental study investigates the potential role of physiological ischemic training (PIT) of remote limbs on vascular endothelial growth factor (VEGF), endothelial progenitor cells (EPCs) and myocardial angiogenesis after myocardial ischemia. METHODS Forty-two rabbits were assigned into six groups at random: sham-operated (SO), training only (TO), myocardial ischemia (MI), PIT, EPC promoter (PIT+), and EPC inhibitor (PIT-). MI was experimentally induced by implanting a constrictor around the left ventricular branch. The PIT procedure included three 3-min cycles of cuff inflations on the hind limbs followed by a 5 min reperfusion. VEGF mRNA, protein and EPC numbers were measured in plasma and myocardium. Capillary density (CD), coronary blood flow (CBF) and coronary collateral blood flow (CCBF) were also determined. RESULTS Groups were compared using non-parametric statistics and associations between agents were explored with fractional polynomial regression. VEGF-mRNA and -protein levels were highest in PIT+ and PIT. PIT differed significantly from SO, TO, MI, and PIT- regarding VEGF-mRNA and -protein in plasma and VEGF-protein in myocardium. EPCs were highest in PIT+ followed by PIT. PIT differed significantly from SO, TO, MI, and PIT- regarding plasma EPCs. CD, CCBF and CCBF/CBF were significantly increased in PIT+ and PIT as compared to controls. PIT- did not differ significantly from SO and TO. VEGF explained up to 43% of variance in EPCs. EPCs explained up to 87% of variance in CD. CD explained up to 97% of variance in CCBF and CCBF/CBF. CONCLUSION PIT stimulates VEGF-mediated mobilization of EPCs as well as angiogenesis and might be proven as a new treatment strategy for patients with coronary heart disease.
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Affiliation(s)
- Yu Zheng
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Institute for Disaster Management and Reconstruction, Sichuan University-Hong Kong Polytechnic University, Chengdu, China; Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiao Lu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Jianan Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Qingsha Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University-Hong Kong Polytechnic University, Chengdu, China; Swiss Paraplegic Research, Nottwil, Switzerland; University of Lucerne, Department of Health Sciences and Health Policy, Lucerne, Switzerland
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Physical ischaemia induced by isometric exercise facilitated collateral development in the remote ischaemic myocardium of humans. Clin Sci (Lond) 2014; 127:581-8. [PMID: 24888429 DOI: 10.1042/cs20130618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Isometric-handgrip-exercise-induced local ischaemia in the normal limb facilitated collateral recruitment in acutely occluded vessels in patients with coronary artery disease. Ischaemic-handgrip-exercise-induced physical ischaemic training for 3 months facilitated myocardial collateral growth.
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Xiao M, Lu X, Li J, Li L, Li Y. Physiologic ischaemic training induces endothelial progenitor cell mobilization and myocardial angiogenesis via endothelial nitric oxide synthase related pathway in rabbits. J Cardiovasc Med (Hagerstown) 2014; 15:280-7. [DOI: 10.2459/jcm.0b013e32836009fe] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Vasiliadis AV, Zafeiridis A, Dipla K, Galanis N, Chatzidimitriou D, Kyparos A, Nikolaidis MG, Vrabas IS. Circulating angiogenic biomolecules at rest and in response to upper-limb exercise in individuals with spinal cord injury. J Spinal Cord Med 2014; 37:226-32. [PMID: 24090471 PMCID: PMC4066432 DOI: 10.1179/2045772313y.0000000141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Individuals with spinal cord injury (SCI) show structural and functional vascular maladaptations and muscle loss in their lower limbs. Angiogenic biomolecules play important roles in physiological and pathological angiogenesis, and are implicated in the maintenance of muscle mass. This study examined the responses of angiogenic molecules during upper-limb aerobic exercise in patients with SCI and in able-bodied (AB) individuals. METHODS Eight SCI patients with thoracic lesions (T6-T12, ASIA A) and eight AB individuals performed an arm-cranking exercise for 30 minutes at 60% of their VO2max. Plasma concentrations of vascular endothelial growth factor (VEGF-A165), VEGF receptor 1 (sVEGFr-1), VEGF receptor 2 (sVEGFr-2), metalloproteinase 2 (MMP-2), and endostatin were measured at rest, after exercise, and at 1.5 and 3.0 hours during recovery. RESULTS The two-way analysis of variance showed non-significant main effects of "group" and significant main effects of "time/exercise" for all angiogenic biomolecules examined (P < 0.01-0.001). The arm-cranking exercise significantly increased plasma concentrations of VEGF, sVEGFr-1, sVEGFr-2, MMP-2, and endostatin in both groups (P < 0.001-0.01). The magnitude of the increase was similar in both patients with SCI and AB individuals, as shown by the non-significant group × time interaction for all angiogenic parameters. CONCLUSIONS Upper-limb exercise (arm-cranking for 30 minutes at 60% of VO2max) is a sufficient stimulus to trigger a coordinated circulating angiogenic response in patients with SCI. The response of angiogenic molecules to upper-limb aerobic exercise in SCI appears relatively similar to that observed in AB individuals.
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Affiliation(s)
- Angelo V. Vasiliadis
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece,Correspondence to: Andreas Zafeiridis, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Ag. Ioannis, 62110 Serres, Greece.
| | - Konstantina Dipla
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Nikiforos Galanis
- Department of Orthopedics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Chatzidimitriou
- 2nd Department of Microbiology and National Influenza Center for Northern Greece, Medical School, Aristotle University of Thessaloniki, Greece
| | - Antonios Kyparos
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Michalis G. Nikolaidis
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Ioannis S. Vrabas
- Exercise Physiology and Biochemistry Laboratory, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
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Abstract
Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients. PAD leads to exercise intolerance that can progress in severity to greatly limit mobility, and in advanced cases leads to frank ischemia with pain at rest. It is estimated that 12 to 15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. The presence of PAD predicts a 50% to 1500% increase in morbidity and mortality, depending on severity. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. Extended exercise programs that involve walking approximately five times per week, at a significant intensity that requires frequent rest periods, are most significant. Preclinical studies and virtually all clinical trials demonstrate the benefits of exercise therapy, including improved walking tolerance, modified inflammatory/hemostatic markers, enhanced vasoresponsiveness, adaptations within the limb (angiogenesis, arteriogenesis, and mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. A synthesis is provided as to how these adaptations can develop in the context of our current state of knowledge and events known to be orchestrated by exercise. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. Obviously, selecting for a lifestyle pattern that includes enhanced physical activity prior to the advance of PAD limitations is the most desirable and beneficial.
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Affiliation(s)
- Tara L Haas
- Angiogenesis Research Group, Muscle Health Research Centre, Faculty of Health, York University, Toronto, Ontario, Canada
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17
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Muscle perfusion of posterior trunk and lower-limb muscles at rest and during upper-limb exercise in spinal cord-injured and able-bodied individuals. Spinal Cord 2012; 50:822-6. [PMID: 22487954 DOI: 10.1038/sc.2012.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Nonrandomized-controlled trial. OBJECTIVES To assess muscle perfusion at rest and during arm-cranking exercise (ACE) in upper and lower posterior trunk and vastus lateralis (VL) muscles in individuals with spinal cord injury (SCI) and controls (C). SETTING Exercise Physiology-Biochemistry Laboratory. METHODS Eight SCI with thoracic lesion and eight C received injections of radioactive tracer to trapezius (TRAP), latissimus dorsi (LAT) and VL. Radioactive counts were recorded with a γ-camera for 10 min at rest and during ACE (60% VO(2max) for 20 min). Time-count curves were generated and the isotope clearance rate, expressed as half-life time (T(1/2),min), was calculated to assess muscle perfusion. RESULTS Resting T(1/2) was lower in TRAP and LAT vs VL (P<0.05) in SCI, however, there were no differences among muscles in C. Arm-cranking increased (P<0.001) the isotope clearance in TRAP and LAT in SCI and C, whereas no effect was found on T(1/2) in VL in both groups. T(1/2) was longer (P<0.05) in SCI vs C in VL at rest and during ACE, whereas there were no differences between groups in posterior trunk muscles. CONCLUSIONS Resting muscle perfusion was reduced in the paralyzed limbs of SCI compared with C, whereas there was no evidence of impaired microcirculation in upper and lower back muscles in SCI. Although ACE did not induce a hyperemic response in VL, it increased hyperemia in upper and lower posterior trunk muscles in SCI, suggesting beneficial effects of this type of activity on muscle microvasculature in this region.
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Effect of Physiologic Ischemic Training on Protection of Myocardial Infarction in Rabbits. Am J Phys Med Rehabil 2011; 90:97-105. [DOI: 10.1097/phm.0b013e3182017483] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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