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Fallahtafti F, Samson K, Salamifar Z, Johanning J, Pipinos I, Myers SA. Enhancing walking performance in patients with peripheral arterial disease: An intervention with ankle-foot orthosis. Int J Cardiol 2024; 407:131992. [PMID: 38527630 DOI: 10.1016/j.ijcard.2024.131992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
Lower extremity peripheral artery disease (PAD) is a cardiovascular condition manifesting from narrowed or blocked arteries supplying the legs. Gait is impaired in patients with PAD. Recent evidence suggests that walking with carbon fiber ankle foot orthoses (AFOs) can improve patient mobility and delay claudication time. This study aimed to employ advanced biomechanical gait analysis to evaluate the impact of AFO intervention on gait performance among patients with PAD. Patients with claudication had hip, knee, and ankle joint kinetics and kinematics assessed using a cross-over intervention design. Participants walked over the force platforms with and without AFOs while kinematic data was recorded with motion analysis cameras. Kinetics and kinematics were combined to quantify torques and powers during the stance period of the gait cycle. The AFOs effectively reduced the excessive ankle plantar flexion and knee extension angles, bringing the patients' joint motions closer to those observed in healthy individuals. After 3 months of the AFO intervention, the hip range of motion decreased, likely due to changes occurring within the ankle chain. With the assistance of the AFOs, the biological power generation required from the ankle and hip during the push-off phase of walking decreased. Wearing AFOs resulted in increased knee flexor torque during the loading response phase of the gait. Based on this study, AFOs may allow patients with PAD to maintain or improve gait performance. More investigation is needed to fully understand and improve the potential benefits of ankle assistive devices.
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Affiliation(s)
- Farahnaz Fallahtafti
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA.
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, USA
| | - Zahra Salamifar
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA
| | - Jason Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68105, USA; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Iraklis Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68105, USA; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA.
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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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Ghantous E, Shetrit A, Erez Y, Noam N, Zamanzadeh RS, Zahler D, Granot Y, Levi E, Perl ML, Banai S, Topilsky Y, Havakuk O. The Mechanism of Effort Intolerance in Patients with Peripheral Arterial Disease: A Combined Stress Echocardiography and Cardiopulmonary Exercise Test. J Clin Med 2023; 12:5817. [PMID: 37762757 PMCID: PMC10531883 DOI: 10.3390/jcm12185817] [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: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
AIM We used a combined stress echocardiography and cardiopulmonary exercise test (CPET) to explore effort intolerance in peripheral arterial disease (PAD) patients. METHODS Twenty-three patients who had both PAD and coronary artery disease (CAD) were compared with twenty-four sex- and age-matched CAD patients and fifteen normal controls using a symptom-limited ramp bicycle CPET on a tilting dedicated ergometer. Echocardiographic images were obtained concurrently with gas exchange measurements along predefined stages of exercise. Oxygen extraction was calculated using the Fick equation at each activity level. RESULTS Along the stages of exercise (unloaded; anaerobic threshold; peak), in PAD + CAD patients compared with CAD or controls, diastolic function worsened (p = 0.051 and p = 0.013, respectively), and oxygen consumption (p < 0.001 and p < 0.001, respectively) and oxygen pulse (p = 0.0024 and p = 0.0027, respectively) were reduced. Notably, oxygen pulse was blunted due to an insufficient increase in both stroke volume (p = 0.025 and p = 0.028, respectively) and peripheral oxygen extraction (p = 0.031 and p = 0.038, respectively). Chronotropic incompetence was more prevalent in PAD patients and persisted after correction for beta-blocker use (62% vs. 42% and 11%, respectively). CONCLUSIONS In PAD patients, exercise limitation is associated with diastolic dysfunction, chronotropic incompetence and peripheral factors.
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Affiliation(s)
- Eihab Ghantous
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Aviel Shetrit
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Yonatan Erez
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Natalie Noam
- Vascular Surgery Department, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Ryan S. Zamanzadeh
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - David Zahler
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Yoav Granot
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Erez Levi
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Michal Laufer Perl
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Shmuel Banai
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Yan Topilsky
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Ofer Havakuk
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
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Rontoyanni VG, Blears E, Nunez Lopez O, Ogunbileje J, Moro T, Bhattarai N, Randolph AC, Fry CS, Fankhauser GT, Cheema ZF, Murton AJ, Volpi E, Rasmussen BB, Porter C. Skeletal Muscle Bioenergetics in Critical Limb Ischemia and Diabetes. J Surg Res 2023; 288:108-117. [PMID: 36963297 PMCID: PMC10192034 DOI: 10.1016/j.jss.2023.02.015] [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: 07/26/2022] [Revised: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Mitochondrial dysfunction is implicated in the metabolic myopathy accompanying peripheral artery disease (PAD) and critical limb ischemia (CLI). Type-2 diabetes mellitus (T2DM) is a major risk factor for PAD development and progression to CLI and may also independently be related to mitochondrial dysfunction. We set out to determine the effect of T2DM in the relationship between CLI and muscle mitochondrial respiratory capacity and coupling control. METHODS We studied CLI patients undergoing revascularization procedures or amputation, and non-CLI patients with or without T2DM of similar age. Mitochondrial respiratory capacity and function were determined in lower limb permeabilized myofibers by high-resolution respirometry. RESULTS Fourteen CLI patients (65 ± 10y) were stratified into CLI patients with (n = 8) or without (n = 6) T2DM and were compared to non-CLI patients with (n = 18; 69 ± 5y) or without (n = 19; 71 ± 6y) T2DM. Presence of CLI but not T2DM had a marked impact on all mitochondrial respiratory states in skeletal muscle, adjusted for the effects of sex. Leak respiration (State 2, P < 0.025 and State 4o, P < 0.01), phosphorylating respiration (P < 0.001), and maximal respiration in the uncoupled state (P < 0.001), were all suppressed in CLI patients, independent of T2DM. T2DM had no significant effect on mitochondrial respiratory capacity and function in adults without CLI. CONCLUSIONS Skeletal muscle mitochondrial respiratory capacity was blunted by ∼35% in patients with CLI. T2DM was not associated with muscle oxidative capacity and did not moderate the relationship between muscle mitochondrial respiratory capacity and CLI.
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Affiliation(s)
| | - Elizabeth Blears
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - John Ogunbileje
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Tatiana Moro
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas
| | - Nisha Bhattarai
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Amanda C Randolph
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas
| | - Christopher S Fry
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas; Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Grant T Fankhauser
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Zulfiqar F Cheema
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Andrew J Murton
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
| | - Elena Volpi
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas; Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Blake B Rasmussen
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas; Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Craig Porter
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas; Department of Pediatrics, University of Arkansas for Medical Sciences & Arkansas Children's Research Institute, Little Rock, Arkansas.
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Zhang Z, Wang K, Park S, Li A, Li Y, Weiss R, Xu J. The exchange rate of creatine CEST in mouse brain. Magn Reson Med 2023; 90:373-384. [PMID: 37036030 PMCID: PMC11054327 DOI: 10.1002/mrm.29662] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE To estimate the exchange rate of creatine (Cr) CEST and to evaluate the pH sensitivity of guanidinium (Guan) CEST in the mouse brain. METHODS Polynomial and Lorentzian line-shape fitting (PLOF) were implemented to extract the amine, amide, and Guan CEST signals from the brain Z-spectrum at 11.7T. Wild-type (WT) and knockout mice with the guanidinoacetate N-methyltransferase deficiency (GAMT-/- ) that have low Cr and phosphocreatine (PCr) concentrations in the brain were used to extract the CrCEST signal. To quantify the CrCEST exchange rate, a two-step Bloch-McConnell (BM) fitting was used to fit the CrCEST line-shape, B1 -dependent CrCEST, and the pH response with different B1 values. The pH in the brain cells was altered by hypercapnia to measure the pH sensitivity of GuanCEST. RESULTS Comparison between the Z-spectra of WT and GAMT-/- mice suggest that the CrCEST is between 20% and 25% of the GuanCEST in the Z-spectrum at 1.95 ppm between B1 = 0.8 and 2 μT. The CrCEST exchange rate was found to be around 240-480 s-1 in the mouse brain, which is significantly lower than that in solutions (∼1000 s-1 ). The hypercapnia study on the mouse brain revealed that CrCEST at B1 = 2 μT and amineCEST at B1 = 0.8 μT are highly sensitive to pH change in the WT mouse brain. CONCLUSIONS The in vivo CrCEST exchange rate is slow, and the acquisition parameters for the CrCEST should be adjusted accordingly. CrCEST is the major contribution to the opposite pH-dependence of GuanCEST signal under different conditions of B1 in the brain.
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Affiliation(s)
- Ziqin Zhang
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Kexin Wang
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Sooyeon Park
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA
| | - Anna Li
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
| | - Yuguo Li
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiadi Xu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Park SY, Pekas EJ, Anderson CP, Kambis TN, Mishra PK, Schieber MN, Wooden TK, Thompson JR, Kim KS, Pipinos II. Impaired microcirculatory function, mitochondrial respiration, and oxygen utilization in skeletal muscle of claudicating patients with peripheral artery disease. Am J Physiol Heart Circ Physiol 2022; 322:H867-H879. [PMID: 35333113 PMCID: PMC9018007 DOI: 10.1152/ajpheart.00690.2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
Peripheral artery disease (PAD) is an atherosclerotic disease that impairs blood flow and muscle function in the lower limbs. A skeletal muscle myopathy characterized by mitochondrial dysfunction and oxidative damage is present in PAD; however, the underlying mechanisms are not well established. We investigated the impact of chronic ischemia on skeletal muscle microcirculatory function and its association with leg skeletal muscle mitochondrial function and oxygen delivery and utilization capacity in PAD. Gastrocnemius samples and arterioles were harvested from patients with PAD (n = 10) and age-matched controls (Con, n = 11). Endothelium-dependent and independent vasodilation was assessed in response to flow (30 μL·min-1), acetylcholine, and sodium nitroprusside (SNP). Skeletal muscle mitochondrial respiration was quantified by high-resolution respirometry, microvascular oxygen delivery, and utilization capacity (tissue oxygenation index, TOI) were assessed by near-infrared spectroscopy. Vasodilation was attenuated in PAD (P < 0.05) in response to acetylcholine (Con: 71.1 ± 11.1%, PAD: 45.7 ± 18.1%) and flow (Con: 46.6 ± 20.1%, PAD: 29.3 ± 10.5%) but not SNP (P = 0.30). Complex I + II state 3 respiration (P < 0.01) and TOI recovery rate were impaired in PAD (P < 0.05). Both flow and acetylcholine-mediated vasodilation were positively associated with complex I + II state 3 respiration (r = 0.5 and r = 0.5, respectively, P < 0.05). Flow-mediated vasodilation and complex I + II state 3 respiration were positively associated with TOI recovery rate (r = 0.8 and r = 0.7, respectively, P < 0.05). These findings suggest that chronic ischemia attenuates skeletal muscle arteriole endothelial function, which may be a key mediator for mitochondrial and microcirculatory dysfunction in the PAD leg skeletal muscle. Targeting microvascular dysfunction may be an effective strategy to prevent and/or reverse disease progression in PAD.NEW & NOTEWORTHY Ex vivo skeletal muscle arteriole endothelial function is impaired in claudicating patients with PAD, and this is associated with attenuated skeletal muscle mitochondrial respiration. In vivo skeletal muscle oxygen delivery and utilization capacity is compromised in PAD, and this may be due to microcirculatory and mitochondrial dysfunction. These results suggest that targeting skeletal muscle arteriole function may lead to improvements in skeletal muscle mitochondrial respiration and oxygen delivery and utilization capacity in claudicating patients with PAD.
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Affiliation(s)
- Song-Young Park
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
| | - Elizabeth J Pekas
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
| | - Cody P Anderson
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
| | - Tyler N Kambis
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paras K Mishra
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Molly N Schieber
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - TeSean K Wooden
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska
| | - Jonathan R Thompson
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kyung Soo Kim
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
- Department of Surgery and Veterans Affairs Research Service, Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
- Department of Surgery and Veterans Affairs Research Service, Nebraska-Western Iowa Health Care System, Omaha, Nebraska
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Ryan TE, Kim K, Scali ST, Berceli SA, Thome T, Salyers ZR, O'Malley KA, Green TD, Karnekar R, Fisher‐Wellman KH, Yamaguchi DJ, McClung JM. Interventional- and amputation-stage muscle proteomes in the chronically threatened ischemic limb. Clin Transl Med 2022; 12:e658. [PMID: 35073463 PMCID: PMC8785983 DOI: 10.1002/ctm2.658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite improved surgical approaches for chronic limb-threatening ischemia (CLTI), amputation rates remain high and contributing tissue-level factors remain unknown. The purpose of this study was twofold: (1) to identify differences between the healthy adult and CLTI limb muscle proteome, and (2) to identify differences in the limb muscle proteome of CLTI patients prior to surgical intervention or at the time of amputation. METHODS AND RESULTS Gastrocnemius muscle was collected from non-ischemic controls (n = 19) and either pre-interventional surgery (n = 10) or at amputation outcome (n = 29) CLTI patients. All samples were subjected to isobaric tandem-mass-tag-assisted proteomics. The mitochondrion was the primary classification of downregulated proteins (> 70%) in CLTI limb muscles and paralleled robust functional mitochondrial impairment. Upregulated proteins (> 38%) were largely from the extracellular matrix. Across the two independent sites, 39 proteins were downregulated and 12 upregulated uniformly. Pre-interventional CLTI muscles revealed a robust upregulation of mitochondrial proteins but modest functional impairments in fatty acid oxidation as compared with controls. Comparison of pre-intervention and amputation CLTI limb muscles revealed mitochondrial proteome and functional deficits similar to that between amputation and non-ischemic controls. Interestingly, these observed changes occurred despite 62% of the amputation CLTI patients having undergone a prior surgical intervention. CONCLUSIONS The CLTI proteome supports failing mitochondria as a phenotype that is unique to amputation outcomes. The signature of pre-intervention CLTI muscle reveals stable mitochondrial protein abundance that is insufficient to uniformly prevent functional impairments. Taken together, these findings support the need for future longitudinal investigations aimed to determine whether mitochondrial failure is causally involved in amputation outcomes from CLTI.
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Affiliation(s)
- Terence E. Ryan
- Department of Applied Physiology and KinesiologyUniversity of FloridaGainesvilleFloridaUSA
- Center for Exercise ScienceUniversity of FloridaGainesvilleFloridaUSA
- Myology InstituteUniversity of FloridaGainesvilleFloridaUSA
| | - Kyoungrae Kim
- Department of Applied Physiology and KinesiologyUniversity of FloridaGainesvilleFloridaUSA
| | - Salvatore T. Scali
- Division of Vascular Surgery and Endovascular TherapyUniversity of FloridaGainesvilleFloridaUSA
- Malcom Randall Veteran Affairs Medical CenterGainesvilleFloridaUSA
| | - Scott A. Berceli
- Division of Vascular Surgery and Endovascular TherapyUniversity of FloridaGainesvilleFloridaUSA
- Malcom Randall Veteran Affairs Medical CenterGainesvilleFloridaUSA
| | - Trace Thome
- Department of Applied Physiology and KinesiologyUniversity of FloridaGainesvilleFloridaUSA
| | - Zachary R. Salyers
- Department of Applied Physiology and KinesiologyUniversity of FloridaGainesvilleFloridaUSA
| | - Kerri A. O'Malley
- Division of Vascular Surgery and Endovascular TherapyUniversity of FloridaGainesvilleFloridaUSA
- Malcom Randall Veteran Affairs Medical CenterGainesvilleFloridaUSA
| | - Thomas D. Green
- Department of PhysiologyBrody School of MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
- East Carolina Diabetes and Obesity InstituteEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Reema Karnekar
- Department of PhysiologyBrody School of MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
- East Carolina Diabetes and Obesity InstituteEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Kelsey H. Fisher‐Wellman
- Department of PhysiologyBrody School of MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
- East Carolina Diabetes and Obesity InstituteEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Dean J. Yamaguchi
- Department of Cardiovascular ScienceEast Carolina UniversityGreenvilleNorth CarolinaUSA
- Division of SurgeryEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Joseph M. McClung
- Department of PhysiologyBrody School of MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
- East Carolina Diabetes and Obesity InstituteEast Carolina UniversityGreenvilleNorth CarolinaUSA
- Department of Cardiovascular ScienceEast Carolina UniversityGreenvilleNorth CarolinaUSA
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8
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The Role of Mitochondrial Function in Peripheral Arterial Disease: Insights from Translational Studies. Int J Mol Sci 2021; 22:ijms22168478. [PMID: 34445191 PMCID: PMC8395190 DOI: 10.3390/ijms22168478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 12/03/2022] Open
Abstract
Recent evidence demonstrates an involvement of impaired mitochondrial function in peripheral arterial disease (PAD) development. Specific impairments have been assessed by different methodological in-vivo (near-infrared spectroscopy, 31P magnetic resonance spectroscopy), as well as in-vitro approaches (Western blotting of mitochondrial proteins and enzymes, assays of mitochondrial function and content). While effects differ with regard to disease severity, chronic malperfusion impacts subcellular energy homeostasis, and repeating cycles of ischemia and reperfusion contribute to PAD disease progression by increasing mitochondrial reactive oxygen species production and impairing mitochondrial function. With the leading clinical symptom of decreased walking capacity due to intermittent claudication, PAD patients suffer from a subsequent reduction of quality of life. Different treatment modalities, such as physical activity and revascularization procedures, can aid mitochondrial recovery. While the relevance of these modalities for mitochondrial functional recovery is still a matter of debate, recent research indicates the importance of revascularization procedures, with increased physical activity levels being a subordinate contributor, at least during mild stages of PAD. With an additional focus on the role of revascularization procedures on mitochondria and the identification of suitable mitochondrial markers in PAD, this review aims to critically evaluate the relevance of mitochondrial function in PAD development and progression.
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Unique Metabolomic Profile of Skeletal Muscle in Chronic Limb Threatening Ischemia. J Clin Med 2021; 10:jcm10030548. [PMID: 33540726 PMCID: PMC7867254 DOI: 10.3390/jcm10030548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic limb threatening ischemia (CLTI) is the most severe manifestation of peripheral atherosclerosis. Patients with CLTI have poor muscle quality and function and are at high risk for limb amputation and death. The objective of this study was to interrogate the metabolome of limb muscle from CLTI patients. To accomplish this, a prospective cohort of CLTI patients undergoing either a surgical intervention (CLTI Pre-surgery) or limb amputation (CLTI Amputation), as well as non-peripheral arterial disease (non-PAD) controls were enrolled. Gastrocnemius muscle biopsy specimens were obtained and processed for nuclear magnetic resonance (NMR)-based metabolomics analyses using solution state NMR on extracted aqueous and organic phases and 1H high-resolution magic angle spinning (HR-MAS) on intact muscle specimens. CLTI Amputation specimens displayed classical features of ischemic/hypoxic metabolism including accumulation of succinate, fumarate, lactate, alanine, and a significant decrease in the pyruvate/lactate ratio. CLTI Amputation muscle also featured aberrant amino acid metabolism marked by elevated branched chain amino acids. Finally, both Pre-surgery and Amputation CLTI muscles exhibited pronounced accumulation of lipids, suggesting the presence of myosteatosis, including cholesterol, triglycerides, and saturated fatty acids. Taken together, these metabolite differences add to a growing body of literature that have characterized profound metabolic disturbance’s in the failing ischemic limb of CLTI patients.
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10
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Hersant J, Ramondou P, Picquet J, Feuilloy M, Abraham P, Henni S. Calf and non-calf hemodynamic recovery in patients with arterial claudication: Implication for exercise training. Microvasc Res 2021; 135:104143. [PMID: 33515566 DOI: 10.1016/j.mvr.2021.104143] [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: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies in patients with arterial claudication have focused on calf hemodynamic recovery. We hypothesized that the duration of hemodynamic recovery with TcpO2 at calf and non-calf levels would be shorter than 10 min. We analyzed the factors that influence the recovery time. METHODS We monitored limb changes minus chest changes from rest (DROP) of transcutaneous oximetry on buttocks, thighs and calves, during and following a treadmill test (3.2 km/h; 10% grade). We calculated the time required to reach 50% (50%RT) and 10% (90%RT) of minimal DROP value (DROPm) from walking cessation. Regression analyses were used to determine the factors associated to 50%RT and 90%RT. RESULTS Of the 132 patients studied, 18.2% reported isolated non-calf pain by history. Of the 792 recovery time values, only 3 (0.4%) and 23 (2.9%) were in excess of 10 min for 50%RT and for 90%RT, respectively. A weak correlation was found between each of the 792 DROPm and 50%RT (r = -0.270, p < 0.001) as well as for 90%RT (r = -0.311 p < 0.001). Lowest DROPm and BMI (but not age, sex, the use of beta-blockers, the duration of the walking period) were associated to both 50%RT and 90%RT. CONCLUSION Although recovery duration correlates significantly with the severity of ischemia of the same location, a wide discrepancy exists and the longest recovery time does not always correlate to the localization of the most severe ischemia. Non-calf ischemia should be measured when one aims at objectifying the biological effects of exercise or the effects of treatments on recovery from exercise.
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Affiliation(s)
| | | | - Jean Picquet
- MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France; Thoracic and Vascular Surgery, University Hospital, Angers, France
| | | | - Pierre Abraham
- MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France; Sports Medicine, University Hospital Center, Angers, France.
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France; MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France
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11
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Skeletal Muscle Mitochondrial Dysfunction and Oxidative Stress in Peripheral Arterial Disease: A Unifying Mechanism and Therapeutic Target. Antioxidants (Basel) 2020; 9:antiox9121304. [PMID: 33353218 PMCID: PMC7766400 DOI: 10.3390/antiox9121304] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022] Open
Abstract
Peripheral artery disease (PAD) is caused by atherosclerosis in the lower extremities, which leads to a spectrum of life-altering symptomatology, including claudication, ischemic rest pain, and gangrene requiring limb amputation. Current treatments for PAD are focused primarily on re-establishing blood flow to the ischemic tissue, implying that blood flow is the decisive factor that determines whether or not the tissue survives. Unfortunately, failure rates of endovascular and revascularization procedures remain unacceptably high and numerous cell- and gene-based vascular therapies have failed to demonstrate efficacy in clinical trials. The low success of vascular-focused therapies implies that non-vascular tissues, such as skeletal muscle and oxidative stress, may substantially contribute to PAD pathobiology. Clues toward the importance of skeletal muscle in PAD pathobiology stem from clinical observations that muscle function is a strong predictor of mortality. Mitochondrial impairments in muscle have been documented in PAD patients, although its potential role in clinical pathology is incompletely understood. In this review, we discuss the underlying mechanisms causing mitochondrial dysfunction in ischemic skeletal muscle, including causal evidence in rodent studies, and highlight emerging mitochondrial-targeted therapies that have potential to improve PAD outcomes. Particularly, we will analyze literature data on reactive oxygen species production and potential counteracting endogenous and exogenous antioxidants.
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12
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McDermott MM, Ferrucci L, Gonzalez-Freire M, Kosmac K, Leeuwenburgh C, Peterson CA, Saini S, Sufit R. Skeletal Muscle Pathology in Peripheral Artery Disease: A Brief Review. Arterioscler Thromb Vasc Biol 2020; 40:2577-2585. [PMID: 32938218 DOI: 10.1161/atvbaha.120.313831] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This brief review summarizes current evidence regarding lower extremity peripheral artery disease (PAD) and lower extremity skeletal muscle pathology. Lower extremity ischemia is associated with reduced calf skeletal muscle area and increased calf muscle fat infiltration and fibrosis on computed tomography or magnetic resonance imaging. Even within the same individual, the leg with more severe ischemia has more adverse calf muscle characteristics than the leg with less severe ischemia. More adverse computed tomography-measured calf muscle characteristics, such as reduced calf muscle density, are associated with higher rates of mobility loss in people with PAD. Calf muscle in people with PAD may also have reduced mitochondrial activity compared with those without PAD, although evidence is inconsistent. Muscle biopsy document increased oxidative stress in PAD. Reduced calf muscle perfusion, impaired mitochondrial activity, and smaller myofibers are associated with greater walking impairment in PAD. Preliminary evidence suggests that calf muscle pathology in PAD may be reversible. In a small uncontrolled trial, revascularization improved both the ankle-brachial index and mitochondrial activity, measured by calf muscle phosphocreatine recovery time. A pilot clinical trial showed that cocoa flavanols increased measures of myofiber health, mitochondrial activity, and capillary density while simultaneously improving 6-minute walk distance in PAD. Calf muscle pathological changes are associated with impaired walking performance in people with PAD, and interventions that both increase calf perfusion and improve calf muscle health are promising therapies to improve walking performance in PAD.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine and Preventive Medicine (M.M.M.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging, Baltimore, MD (L.F.)
| | - Marta Gonzalez-Freire
- Health Research Institute of the Balearic Islands (IdISBa), Vascular and Metabolic Pathologies Group, Spain (M.G.-F.)
| | - Kate Kosmac
- Department of Physical Therapy, University of Kentucky Center for Muscle Biology, Lexington (K.K., C.A.P.)
| | | | - Charlotte A Peterson
- Department of Physical Therapy, University of Kentucky Center for Muscle Biology, Lexington (K.K., C.A.P.)
| | - Sunil Saini
- Department of Aging and Geriatric Research, University of Florida, Gainesville (C.L., S.S.)
| | - Robert Sufit
- Department of Neurology (R.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
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13
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Pizzimenti M, Riou M, Charles AL, Talha S, Meyer A, Andres E, Chakfé N, Lejay A, Geny B. The Rise of Mitochondria in Peripheral Arterial Disease Physiopathology: Experimental and Clinical Data. J Clin Med 2019; 8:jcm8122125. [PMID: 31810355 PMCID: PMC6947197 DOI: 10.3390/jcm8122125] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022] Open
Abstract
Peripheral arterial disease (PAD) is a frequent and serious condition, potentially life-threatening and leading to lower-limb amputation. Its pathophysiology is generally related to ischemia-reperfusion cycles, secondary to reduction or interruption of the arterial blood flow followed by reperfusion episodes that are necessary but also—per se—deleterious. Skeletal muscles alterations significantly participate in PAD injuries, and interestingly, muscle mitochondrial dysfunctions have been demonstrated to be key events and to have a prognosis value. Decreased oxidative capacity due to mitochondrial respiratory chain impairment is associated with increased release of reactive oxygen species and reduction of calcium retention capacity leading thus to enhanced apoptosis. Therefore, targeting mitochondria might be a promising therapeutic approach in PAD.
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Affiliation(s)
- Mégane Pizzimenti
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Marianne Riou
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Anne-Laure Charles
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
| | - Samy Talha
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Alain Meyer
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Emmanuel Andres
- Internal Medicine, Diabete and Metabolic Diseases Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France;
| | - Nabil Chakfé
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Vascular Surgery and Kidney Transplantation Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Anne Lejay
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Vascular Surgery and Kidney Transplantation Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
| | - Bernard Geny
- Unistra, Translational Medicine Federation of Strasbourg (FMTS), Faculty of Medicine, Team 3072 «Mitochondria, Oxidative Stress and Muscle Protection», 11 Rue Humann, 67000 Strasbourg, France; (M.P.); (M.R.); (A.-L.C.); (S.T.); (A.M.); (A.L.)
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg CEDEX, France
- Correspondence:
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14
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Fuglestad MA, Hernandez H, Gao Y, Ybay H, Schieber MN, Brunette KE, Myers SA, Casale GP, Pipinos II. A low-cost, wireless near-infrared spectroscopy device detects the presence of lower extremity atherosclerosis as measured by computed tomographic angiography and characterizes walking impairment in peripheral artery disease. J Vasc Surg 2019; 71:946-957. [PMID: 31445826 DOI: 10.1016/j.jvs.2019.04.493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/28/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) who experience intermittent claudication report a range of symptoms. Patients with symptoms other than classically described intermittent claudication may be at the highest risk for functional decline and mobility loss. Therefore, technologies allowing for characterization of PAD severity are desirable. Near-infrared spectroscopy (NIRS) allows for measurements of muscle heme oxygen saturation (StO2) during exercise. We hypothesized lower extremities affected by PAD would exhibit distinct NIRS profiles as measured by a low-cost, wireless NIRS device and that NIRS during exercise predicts walking limitation. METHODS We recruited 40 patients with PAD and 10 control participants. All patients with PAD completed a computed tomographic angiography, 6-minute walk test, and a standardized treadmill test. Controls completed a 540-second treadmill test for comparison. StO2 measurements were continuously taken from the gastrocnemius during exercise. Variables were analyzed by Fischer's exact, χ2, Wilcoxon rank-sum, and Kruskal-Wallis tests as appropriate. Correlations were assessed by partial Spearman correlation coefficients adjusted for occlusive disease pattern. RESULTS Patients with PAD experienced claudication onset at a median of 108 seconds with a median peak walking time of 288 seconds. The baseline StO2 was similar between PAD and control. The StO2 of PAD and control participants dropped below baseline at a median of 1 and 104 seconds of exercise, respectively (P < .0001). Patients with PAD reached minimum StO2 earlier than control participants (119 seconds vs 522 seconds, respectively; P < .001) and experienced a greater change in StO2 at 1 minute of exercise (-73.2% vs 8.3%; P < .0001) and a greater decrease at minimum exercise StO2 (-83.4% vs -16.1%; P < .0001). For patients with PAD, peak walking time, and 6-minute walking distance correlated with percent change in StO2 at 1 minute of exercise (r = -0.76 and -0.67, respectively; P < .001) and time to minimum StO2 (r = 0.79 and 0.70, respectively; P < .0001). CONCLUSIONS In this initial evaluation of a novel, low-cost NIRS device, lower extremities affected by PAD exhibited characteristic changes in calf muscle StO2, which differentiated them from healthy controls and were strongly correlated with walking impairment. These findings confirm and expand on previous work demonstrating the potential clinical value of NIRS devices and the need for further research investigating the ability of low-cost NIRS technology to evaluate, diagnose, and monitor treatment response in PAD.
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Affiliation(s)
| | - Hernan Hernandez
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Yue Gao
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Henamari Ybay
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb
| | - Molly N Schieber
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb
| | | | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb
| | - George P Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, Neb; Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb; Department of Surgery, Veterans Affairs Medical Center, Omaha, Neb.
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15
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Chung JJ, Jin T, Lee JH, Kim SG. Chemical exchange saturation transfer imaging of phosphocreatine in the muscle. Magn Reson Med 2019; 81:3476-3487. [PMID: 30687942 DOI: 10.1002/mrm.27655] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/10/2018] [Accepted: 12/16/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE To determine the exchange parameters for the CEST of phosphocreatine (PCrCEST) in phantoms and to characterize PCrCEST in vivo in the muscle at different saturation powers and magnetic fields. METHODS Exchange parameters were measured in PCr solutions using varying saturation power at 15.2 T. Z-spectra were analyzed using multipool Lorentzian fitting in the hindlimb using various powers at 2 different fields: 9.4 T and 15.2 T. Modulation of PCr signal in PCrCEST and phosphorus MRS was observed in the mouse hindlimb before and after euthanasia. RESULTS The exchange rate of PCr at physiological pH in phantoms was confirmed to be in a much slower exchange regime compared with Cr: kex at pH 7.3 and below was less than 400 s-1 . There was insufficient signal for detection of PCrCEST in the brain, but PCrCEST in the hindlimb was measured to be 2.98% ± 0.43 at a B1 of 0.47 μT at 15.2 T, which is 29% higher than 9.4T values. The value of PCrCEST at a B1 of 0.71 μT was not significantly different than that measured at a B1 of 0.47 μT. After euthanasia, PCrCEST signal dropped by 82.3% compared with an 85% decrease in PCr in phosphorus MRS, whereas CrCEST signal increased by 90.6%. CONCLUSION The PCrCEST technique has viable sensitivity in the muscle at high fields and shows promise for the study of metabolic dysfunction and cardiac systems.
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Affiliation(s)
- Julius Juhyun Chung
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Korea.,Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Tao Jin
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jung Hee Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Korea.,Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Seoul, Korea.,Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Korea.,Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.,Department of Biomedical Engineering, Sungkyunkwan University, Seoul, Korea
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16
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Treat-Jacobson D, McDermott MM, Bronas UG, Campia U, Collins TC, Criqui MH, Gardner AW, Hiatt WR, Regensteiner JG, Rich K. Optimal Exercise Programs for Patients With Peripheral Artery Disease: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e10-e33. [DOI: 10.1161/cir.0000000000000623] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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17
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Murrow JR, Brizendine JT, Djire B, Young HJ, Rathbun S, Nilsson KR, McCully KK. Near infrared spectroscopy-guided exercise training for claudication in peripheral arterial disease. Eur J Prev Cardiol 2018; 26:471-480. [DOI: 10.1177/2047487318795192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Rationale Supervised treadmill exercise for claudication in peripheral arterial disease is effective but poorly tolerated because of ischemic leg pain. Near infrared spectroscopy allows non-invasive detection of muscle ischemia during exercise, allowing for characterization of tissue perfusion and oxygen utilization during training. Objective We evaluated walking time, muscle blood flow, and muscle mitochondrial capacity in patients with peripheral artery disease after a traditional pain-based walking program and after a muscle oxygen-guided walking program. Method and results Patients with peripheral artery disease trained thrice weekly in 40-minute-long sessions for 12 weeks, randomized to oxygen-guided training ( n = 8, age 72 ± 9.7 years, 25% female) versus traditional pain-based training ( n = 10, age 71.6 ± 8.8 years, 20% female). Oxygen-guided training intensity was determined by maintaining a 15% reduction in skeletal muscle oxygenation by near infrared spectroscopy rather than relying on symptoms of pain to determine exercise effort. Pain free and maximal walking times were measured with a 12-minute Gardner treadmill test. Gastrocnemius mitochondrial capacity and blood flow were measured using near infrared spectroscopy. Baseline pain-free walking time was similar on a Gardner treadmill test (2.5 ± 0.9 vs. 3.6 ± 1.0 min, p = 0.5). After training, oxygen-guided cohorts improved similar to pain-guided cohorts (pain-free walking time 6.7 ± 0.9 vs. 6.9 ± 1.1 min, p < 0.01 for change from baseline and p = 0.97 between cohorts). Mitochondrial capacity improved in both groups but more so in the pain-guided cohort than in the oxygen-guided cohort (38.8 ± 8.3 vs. 14.0 ± 9.3, p = 0.018). Resting muscle blood flow did not improve significantly in either group with training. Conclusions Oxygen-guided exercise training improves claudication comparable to pain-based training regimens. Adaptations in mitochondrial function rather than increases in limb perfusion may account for functional improvement. Increases in mitochondrial oxidative capacity may be proportional to the degree of tissue hypoxia during exercise.
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Affiliation(s)
| | | | | | | | | | - Kent R Nilsson
- Augusta University – University of Georgia Medical Partnership, USA
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18
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Cree-Green M, Scalzo RL, Harrall K, Newcomer BR, Schauer IE, Huebschmann AG, McMillin S, Brown MS, Orlicky D, Knaub L, Nadeau KJ, McClatchey PM, Bauer TA, Regensteiner JG, Reusch JEB. Supplemental Oxygen Improves In Vivo Mitochondrial Oxidative Phosphorylation Flux in Sedentary Obese Adults With Type 2 Diabetes. Diabetes 2018; 67:1369-1379. [PMID: 29643061 PMCID: PMC6463751 DOI: 10.2337/db17-1124] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/29/2018] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes is associated with impaired exercise capacity. Alterations in both muscle perfusion and mitochondrial function can contribute to exercise impairment. We hypothesized that impaired muscle mitochondrial function in type 2 diabetes is mediated, in part, by decreased tissue oxygen delivery and would improve with oxygen supplementation. Ex vivo muscle mitochondrial content and respiration assessed from biopsy samples demonstrated expected differences in obese individuals with (n = 18) and without (n = 17) diabetes. Similarly, in vivo mitochondrial oxidative phosphorylation capacity measured in the gastrocnemius muscle via 31P-MRS indicated an impairment in the rate of ADP depletion with rest (27 ± 6 s [diabetes], 21 ± 7 s [control subjects]; P = 0.008) and oxidative phosphorylation (P = 0.046) in type 2 diabetes after isometric calf exercise compared with control subjects. Importantly, the in vivo impairment in oxidative capacity resolved with oxygen supplementation in adults with diabetes (ADP depletion rate 5.0 s faster, P = 0.012; oxidative phosphorylation 0.046 ± 0.079 mmol/L/s faster, P = 0.027). Multiple in vivo mitochondrial measures related to HbA1c These data suggest that oxygen availability is rate limiting for in vivo mitochondrial oxidative exercise recovery measured with 31P-MRS in individuals with uncomplicated diabetes. Targeting muscle oxygenation could improve exercise function in type 2 diabetes.
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Affiliation(s)
- Melanie Cree-Green
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca L Scalzo
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kylie Harrall
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Irene E Schauer
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Veterans Affairs Medical Center, Denver, CO
| | - Amy G Huebschmann
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shawna McMillin
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mark S Brown
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - David Orlicky
- Division of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Leslie Knaub
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kristen J Nadeau
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - P Mason McClatchey
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Timothy A Bauer
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Judith G Regensteiner
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jane E B Reusch
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Veterans Affairs Medical Center, Denver, CO
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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19
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Hart CR, Layec G, Trinity JD, Le Fur Y, Gifford JR, Clifton HL, Richardson RS. Oxygen availability and skeletal muscle oxidative capacity in patients with peripheral artery disease: implications from in vivo and in vitro assessments. Am J Physiol Heart Circ Physiol 2018; 315:H897-H909. [PMID: 29932772 DOI: 10.1152/ajpheart.00641.2017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Evidence suggests that the peak skeletal muscle mitochondrial ATP synthesis rate ( Vmax) in patients with peripheral artery disease (PAD) may be attenuated due to disease-related impairments in O2 supply. However, in vitro assessments suggest intrinsic deficits in mitochondrial respiration despite ample O2 availability. To address this conundrum, Doppler ultrasound, near-infrared spectroscopy, phosphorus magnetic resonance spectroscopy, and high-resolution respirometry were combined to assess convective O2 delivery, tissue oxygenation, Vmax, and skeletal muscle mitochondrial capacity (complex I + II, state 3 respiration), respectively, in the gastrocnemius muscle of 10 patients with early stage PAD and 11 physical activity-matched healthy control (HC) subjects. All participants were studied in free-flow control conditions (FF) and with reactive hyperemia (RH) induced by a period of brief ischemia during the last 30 s of submaximal plantar flexion exercise. Patients with PAD repeated the FF and RH trials under hyperoxic conditions (FF + 100% O2 and RH + 100% O2). Compared with HC subjects, patients with PAD exhibited attenuated O2 delivery at the same absolute work rate and attenuated tissue reoxygenation and Vmax after relative intensity-matched exercise. Compared with the FF condition, only RH + 100% O2 significantly increased convective O2 delivery (~44%), tissue reoxygenation (~54%), and Vmax (~60%) in patients with PAD ( P < 0.05), such that Vmax was now not different from HC subjects. Furthermore, there was no evidence of an intrinsic mitochondrial deficit in PAD, as assessed in vitro with adequate O2. Thus, in combination, this comprehensive in vivo and in vitro investigation implicates O2 supply as the predominant factor limiting mitochondrial oxidative capacity in early stage PAD. NEW & NOTEWORTHY Currently, there is little accord as to the role of O2 availability and mitochondrial function in the skeletal muscle dysfunction associated with peripheral artery disease. This is the first study to comprehensively use both in vivo and in vitro approaches to document that the skeletal muscle dysfunction associated with early stage peripheral artery disease is predominantly a consequence of limited O2 supply and not the impact of an intrinsic mitochondrial defect in this pathology.
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Affiliation(s)
- Corey R Hart
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center , Salt Lake City, Utah.,Department of Exercise and Sport Science, University of Utah , Salt Lake City, Utah
| | - Gwenael Layec
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center , Salt Lake City, Utah.,Department of Medicine, Division of Geriatrics, University of Utah , Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah , Salt Lake City, Utah
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center , Salt Lake City, Utah.,Department of Medicine, Division of Geriatrics, University of Utah , Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah , Salt Lake City, Utah
| | - Yann Le Fur
- Centre de Résonance Magnétique Biologique et Médicale Unité Mixte de Recherché 7339, Aix-Marseille Université, Centre National de la Recherche Scientifique, Marseille , France
| | - Jayson R Gifford
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center , Salt Lake City, Utah
| | - Heather L Clifton
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center , Salt Lake City, Utah.,Department of Medicine, Division of Geriatrics, University of Utah , Salt Lake City, Utah
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, George E. Whalen Veterans Affairs Medical Center , Salt Lake City, Utah.,Department of Medicine, Division of Geriatrics, University of Utah , Salt Lake City, Utah.,Department of Nutrition and Integrative Physiology, University of Utah , Salt Lake City, Utah
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20
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Mitochondrial function is impaired in the skeletal muscle of pre-frail elderly. Sci Rep 2018; 8:8548. [PMID: 29867098 PMCID: PMC5986740 DOI: 10.1038/s41598-018-26944-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/23/2018] [Indexed: 01/15/2023] Open
Abstract
Aging is accompanied by a gradual decline in both muscle mass and strength over time, which can eventually lead to pathologies, such as frailty and sarcopenia. While these two conditions are well characterized, further investigation of the early biological signs present in pre-frail elderly is still needed to help identify strategies for preventative therapeutic intervention. The goal of the present clinical study was to evaluate the level of mitochondrial (dys)function in a well-defined population of pre-frail elderly (>60 years of age). Pre-frail elderly were compared with an age-matched population of active elderly. Muscle mitochondrial function was assessed in vivo using phosphorus magnetic resonance spectroscopy (31P-MRS) and a comprehensive set of biological biomarkers were measured ex vivo in vastus lateralis muscle biopsies. In pre-frail subjects, phosphocreatine recovery was impaired and mitochondrial respiratory complex protein and activity levels were significantly lower when compared with active elderly. Analysis of microarray data showed that mitochondrial genes were also significantly down-regulated in muscle of pre-frail compared to active elderly. These results show that mitochondrial impairment is a hallmark of pre-frailty development and the onset of decline in muscle function in the elderly.
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21
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Woessner MN, VanBruggen MD, Pieper CF, O'Reilly EK, Kraus WE, Allen JD. Combined Dietary Nitrate and Exercise Intervention in Peripheral Artery Disease: Protocol Rationale and Design. JMIR Res Protoc 2017; 6:e139. [PMID: 28974486 PMCID: PMC5645641 DOI: 10.2196/resprot.7596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/25/2017] [Accepted: 05/26/2017] [Indexed: 12/12/2022] Open
Abstract
Background Peripheral artery disease (PAD) is caused by atherosclerotic occlusions in the legs. It affects approximately 8-12 million people in the United States alone, one-third of whom suffer from intermittent claudication (IC), defined as ischemic leg pain that occurs with walking and improves with rest. Patients with IC suffer a markedly impaired quality of life and a high perception of disability. Improving pain-free walking time is a primary goal of rehabilitation in this population. Objective The nitric oxide (NO)-PAD trial is designed to compare the effects that 12 weeks of supervised exercise training, in combination with a high inorganic nitrate-content (beetroot [BR] juice) beverage or placebo (PL) beverage, has on clinical outcomes of exercise and functional capacity in two groups of PAD+IC patients: exercise training plus beetroot (EX+BR) and exercise training plus placebo (EX+PL). The primary aims of this randomized controlled, double-blind pilot study are to determine group differences following 12 weeks of EX+BR versus EX+PL in the changes for (1) exercise capacity: pain-free walking time (claudication onset time, COT), peak walk time (PWT), and maximal exercise capacity (peak oxygen uptake, VO2peak) during a maximal-graded cardiopulmonary exercise test (max CPX) and (2) functional capacity: 6-minute walk (6MW) distance. The secondary aims will provide mechanistic insights into the exercise outcome measures and will include (1) gastrocnemius muscle oxygenation during exercise via near-infrared spectroscopy (NIRS); (2) gastrocnemius muscle angiogenesis: capillaries per unit area and per muscle fiber, and relative fraction of type I, IIa, IIb, and IId/x fibers; and (3) vascular health/function via brachial artery flow-mediated dilation, lower-limb blood flow via plethysmography, and pulse wave velocity and reflection. Methods A total of 30 subjects between 40 and 80 years of age with PAD who are limited by IC will undergo exercise training 3 days per week for 12 weeks (ie, 36 sessions). They will be randomized to either the EX+BR or EX+PL group where participants will consume a beverage high in inorganic nitrate (4.2 mmol) or a low-nitrate placebo, respectively, 3 hours prior to each training session. Results Data collection from this study has been completed and is in the process of analysis and write-up. While the study is too underpowered—EX+BR, n=11; EX+PL, n=13—to determine between-group differences in the primary outcomes of COT, PWT, and 6MW, preliminary observations are promising with Cohen d effect sizes of medium to large. Conclusions Exercise training is currently the most effective therapy to increase functional capacity in PAD+IC. If the addition of inorganic nitrate to an exercise regimen elicits greater benefits, it may redefine the current standard of care for PAD+IC. Trial Registration ClinicalTrials.gov NCT01684930; https://clinicaltrials.gov/ct2/show/NCT01684930 (Archived by WebCite at http://www.webcitation.org/6raXFyEcP)
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Affiliation(s)
- Mary N Woessner
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia.,Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - Mitch D VanBruggen
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - Carl F Pieper
- Duke University Medical Center, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Erin K O'Reilly
- Office of Regulatory Affairs and Quality, Duke University Medical Center, Durham, NC, United States
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - Jason D Allen
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia.,Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
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22
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Harwood AE, King S, Totty J, Smith GE, Vanicek N, Chetter IC. A systematic review of muscle morphology and function in intermittent claudication. J Vasc Surg 2017; 66:1241-1257. [PMID: 28822657 DOI: 10.1016/j.jvs.2017.05.106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Intermittent claudication (IC) is frequently associated with deterioration in walking capacity and physical function, and it can often result in an impairment in balance. Whereas supervised exercise is recommended by the National Institute for Health and Care Excellence as the first-line treatment, the mechanism behind walking improvement is poorly understood. The existing literature suggests that there may be some physiologic change to the skeletal muscle contributing to the functional impairment, but these data are conflicting. We therefore sought to undertake a systematic review to clarify the muscle properties of patients with IC. METHODS A systematic review of randomized and nonrandomized trials that investigated the role of muscle function in patients diagnosed with IC was undertaken using MEDLINE, Cochrane Central Register of Controlled Trials, and Embase databases. The searches were limited from 1947 to June 2016 in the English language. RESULTS The search yielded a total of 506 articles, of which 206 were duplicate articles. Of the remaining 300, a total of 201 were excluded from full-text analysis; 99 full-text articles were assessed for eligibility, with 30 articles deemed appropriate for inclusion in the review. There were four main categories of functional outcome measures: muscle strength, muscle size, muscle fiber type, and muscle metabolism. A total of 2837 patients were included in the study. Nine studies reported on muscle strength, incorporating isometric, concentric, eccentric, and endurance measures. Eight studies reported on muscle size, incorporating circumference, computed tomography scans, and ultrasound imaging techniques. Eleven studies reported on muscle fibers, incorporating fiber type proportions, fiber size, and capillarity measures. Seven papers reported on muscle metabolism, incorporating adenosine diphosphate recovery and phosphocreatine recovery measures. CONCLUSIONS Previous literature has found clear evidence that strength (of the calf and thigh musculature) and calf characteristics are related to mortality and functional declines. However, this review has demonstrated the vast array of muscle groups assessed and multiple methods employed to determine strength; therefore, it is unclear exactly what measure of "strength" is impaired. Furthermore, the underlying morphologic causes of potential changes in strength are unclear. This information is essential for designing optimal exercise interventions. The data acquired during this systematic review are heterogeneous, with a substantial lack of high-quality intervention-based studies. Future research should endeavor to establish standardized testing procedures and to implement randomized controlled trials for targeted therapeutic interventions.
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Affiliation(s)
- Amy E Harwood
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, United Kingdom.
| | - Stephanie King
- Department of Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, United Kingdom
| | - Joshua Totty
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, United Kingdom
| | - George E Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, United Kingdom
| | - Natalie Vanicek
- Department of Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, United Kingdom
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, United Kingdom
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23
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Schieber MN, Hasenkamp RM, Pipinos II, Johanning JM, Stergiou N, DeSpiegelaere HK, Chien JH, Myers SA. Muscle strength and control characteristics are altered by peripheral artery disease. J Vasc Surg 2017. [PMID: 28647034 DOI: 10.1016/j.jvs.2017.01.051] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Peripheral artery disease (PAD), a common manifestation of atherosclerosis, is characterized by lower leg ischemia and myopathy in association with leg dysfunction. Patients with PAD have impaired gait from the first step they take with consistent defects in the movement around the ankle joint, especially in plantar flexion. Our goal was to develop muscle strength profiles to better understand the problems in motor control responsible for the walking impairment in patients with PAD. METHODS Ninety-four claudicating PAD patients performed maximal isometric plantar flexion contractions lasting 10 seconds in two conditions: pain free (patient is well rested and has no claudication symptoms) and pain induced (patient has walked and has claudication symptoms). Sixteen matched healthy controls performed the pain-free condition only. Torque curves were analyzed for dependent variables of muscle strength and motor control. Independent t-tests were used to compare variables between groups, and dependent t-tests determined differences between conditions. RESULTS Patients with PAD had significantly reduced peak torque and area under the curve compared with controls. Measures of control differed between PAD conditions only. Load rate and linear region duration were greater in the pain condition. Time to peak torque was shorter in the pain condition. CONCLUSIONS This study conclusively demonstrates that the plantar flexor muscles of the PAD patient at baseline and without pain are weaker in patients with PAD compared with controls. With the onset of claudication pain, patients with PAD exhibit altered muscle control strategies and further strength deficits are manifest compared to baseline levels. The myopathy of PAD legs appears to have a central role in the functional deterioration of the calf muscles, as it is evident both before and after onset of ischemic pain.
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Affiliation(s)
- Molly N Schieber
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb
| | - Ryan M Hasenkamp
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb
| | - Iraklis I Pipinos
- Department of Surgery, Veterans Affairs Medical Center of Nebraska and Western Iowa, Omaha, Neb; Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Jason M Johanning
- Department of Surgery, Veterans Affairs Medical Center of Nebraska and Western Iowa, Omaha, Neb; Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Nicholas Stergiou
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb; College of Public Health, University of Nebraska Medical Center, Omaha, Neb
| | - Holly K DeSpiegelaere
- Department of Surgery, Veterans Affairs Medical Center of Nebraska and Western Iowa, Omaha, Neb
| | - Jung H Chien
- Department of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Neb
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Neb; Department of Surgery, Veterans Affairs Medical Center of Nebraska and Western Iowa, Omaha, Neb.
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24
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Sfyri P, Matsakas A. Crossroads between peripheral atherosclerosis, western-type diet and skeletal muscle pathophysiology: emphasis on apolipoprotein E deficiency and peripheral arterial disease. J Biomed Sci 2017; 24:42. [PMID: 28688452 PMCID: PMC5502081 DOI: 10.1186/s12929-017-0346-8] [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: 02/22/2017] [Accepted: 06/07/2017] [Indexed: 12/16/2022] Open
Abstract
Atherosclerosis is a chronic inflammatory process that, in the presence of hyperlipidaemia, promotes the formation of atheromatous plaques in large vessels of the cardiovascular system. It also affects peripheral arteries with major implications for a number of other non-vascular tissues such as the skeletal muscle, the liver and the kidney. The aim of this review is to critically discuss and assimilate current knowledge on the impact of peripheral atherosclerosis and its implications on skeletal muscle homeostasis. Accumulating data suggests that manifestations of peripheral atherosclerosis in skeletal muscle originates in a combination of increased i)-oxidative stress, ii)-inflammation, iii)-mitochondrial deficits, iv)-altered myofibre morphology and fibrosis, v)-chronic ischemia followed by impaired oxygen supply, vi)-reduced capillary density, vii)- proteolysis and viii)-apoptosis. These structural, biochemical and pathophysiological alterations impact on skeletal muscle metabolic and physiologic homeostasis and its capacity to generate force, which further affects the individual's quality of life. Particular emphasis is given on two major areas representing basic and applied science respectively: a)-the abundant evidence from a well-recognised atherogenic model; the Apolipoprotein E deficient mouse and the role of a western-type diet and b)-on skeletal myopathy and oxidative stress-induced myofibre damage from human studies on peripheral arterial disease. A significant source of reactive oxygen species production and oxidative stress in cardiovascular disease is the family of NADPH oxidases that contribute to several pathologies. Finally, strategies targeting NADPH oxidases in skeletal muscle in an attempt to attenuate cellular oxidative stress are highlighted, providing a better understanding of the crossroads between peripheral atherosclerosis and skeletal muscle pathophysiology.
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Affiliation(s)
- Peggy Sfyri
- Molecular Physiology Laboratory, Centre for Atherothrombotic & Metabolic Disease, Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, United Kingdom
| | - Antonios Matsakas
- Molecular Physiology Laboratory, Centre for Atherothrombotic & Metabolic Disease, Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, United Kingdom.
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25
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Luck JC, Miller AJ, Aziz F, Radtka JF, Proctor DN, Leuenberger UA, Sinoway LI, Muller MD. Blood pressure and calf muscle oxygen extraction during plantar flexion exercise in peripheral artery disease. J Appl Physiol (1985) 2017; 123:2-10. [PMID: 28385920 DOI: 10.1152/japplphysiol.01110.2016] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/14/2017] [Accepted: 04/05/2017] [Indexed: 12/14/2022] Open
Abstract
Peripheral artery disease (PAD) is an atherosclerotic vascular disease that affects 200 million people worldwide. Although PAD primarily affects large arteries, it is also associated with microvascular dysfunction, an exaggerated blood pressure (BP) response to exercise, and high cardiovascular mortality. We hypothesized that fatiguing plantar flexion exercise that evokes claudication elicits a greater reduction in skeletal muscle oxygenation (SmO2) and a higher rise in BP in PAD compared with age-matched healthy subjects, but low-intensity steady-state plantar flexion elicits similar responses between groups. In the first experiment, eight patients with PAD and eight healthy controls performed fatiguing plantar flexion exercise (from 0.5 to 7 kg for up to 14 min). In the second experiment, seven patients with PAD and seven healthy controls performed low-intensity plantar flexion exercise (2.0 kg for 14 min). BP, heart rate (HR), and SmO2 were measured continuously using near-infrared spectroscopy (NIRS). SmO2 is the ratio of oxygenated hemoglobin to total hemoglobin, expressed as a percent. At fatigue, patients with PAD had a greater increase in mean arterial BP (18 ± 2 vs. vs. 10 ± 2 mmHg, P = 0.029) and HR (14 ± 2 vs. 6 ± 2 beats/min, P = 0.033) and a greater reduction in SmO2 (-54 ± 10 vs. -12 ± 4%, P = 0.001). However, both groups had similar physiological responses to low-intensity, nonpainful plantar flexion exercise. These data suggest that patients with PAD have altered oxygen uptake and/or utilization during fatiguing exercise coincident with an augmented BP response.NEW & NOTEWORTHY In this laboratory study, patients with peripheral artery disease performed plantar flexion exercise in the supine posture until symptoms of claudication occurred. Relative to age- and sex-matched healthy subjects we found that patients had a higher blood pressure response, a higher heart rate response, and a greater reduction in skeletal muscle oxygenation as determined by near-infrared spectroscopy. Our data suggest that muscle ischemia contributes to the augmented exercise pressor reflex in peripheral artery disease.
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Affiliation(s)
- J Carter Luck
- Penn State Heart and Vascular Institute, The Pennsylvania State University College of Medicine, Hershey Pennsylvania; and
| | - Amanda J Miller
- Penn State Heart and Vascular Institute, The Pennsylvania State University College of Medicine, Hershey Pennsylvania; and
| | - Faisal Aziz
- Penn State Heart and Vascular Institute, The Pennsylvania State University College of Medicine, Hershey Pennsylvania; and
| | - John F Radtka
- Penn State Heart and Vascular Institute, The Pennsylvania State University College of Medicine, Hershey Pennsylvania; and
| | - David N Proctor
- Department of Kinesiology, Noll Laboratory, The Pennsylvania State University, Hershey, Pennsylvania
| | - Urs A Leuenberger
- Penn State Heart and Vascular Institute, The Pennsylvania State University College of Medicine, Hershey Pennsylvania; and
| | - Lawrence I Sinoway
- Penn State Heart and Vascular Institute, The Pennsylvania State University College of Medicine, Hershey Pennsylvania; and
| | - Matthew D Muller
- Penn State Heart and Vascular Institute, The Pennsylvania State University College of Medicine, Hershey Pennsylvania; and
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26
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Rontoyanni VG, Nunez Lopez O, Fankhauser GT, Cheema ZF, Rasmussen BB, Porter C. Mitochondrial Bioenergetics in the Metabolic Myopathy Accompanying Peripheral Artery Disease. Front Physiol 2017; 8:141. [PMID: 28348531 PMCID: PMC5346567 DOI: 10.3389/fphys.2017.00141] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/23/2017] [Indexed: 11/14/2022] Open
Abstract
Peripheral artery disease (PAD) is a serious but relatively underdiagnosed and undertreated clinical condition associated with a marked reduction in functional capacity and a heightened risk of morbidity and mortality. The pathophysiology of lower extremity PAD is complex, and extends beyond the atherosclerotic arterial occlusion and subsequent mismatch between oxygen demand and delivery to skeletal muscle mitochondria. In this review, we evaluate and summarize the available evidence implicating mitochondria in the metabolic myopathy that accompanies PAD. Following a short discussion of the available in vivo and in vitro methodologies to quantitate indices of muscle mitochondrial function, we review the current evidence implicating skeletal muscle mitochondrial dysfunction in the pathophysiology of PAD myopathy, while attempting to highlight questions that remain unanswered. Given the rising prevalence of PAD, the detriment in quality of life for patients, and the associated significant healthcare resource utilization, new alternate therapies that ameliorate lower limb symptoms and the functional impairment associated with PAD are needed. A clear understanding of the role of mitochondria in the pathophysiology of PAD may contribute to the development of novel therapeutic interventions.
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Affiliation(s)
- Victoria G. Rontoyanni
- Metabolism Unit, Shriners Hospitals for ChildrenGalveston, TX, USA
- Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
| | - Omar Nunez Lopez
- Metabolism Unit, Shriners Hospitals for ChildrenGalveston, TX, USA
- Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
| | | | - Zulfiqar F. Cheema
- Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
| | - Blake B. Rasmussen
- Department of Nutrition and Metabolism, University of Texas Medical BranchGalveston, TX, USA
| | - Craig Porter
- Metabolism Unit, Shriners Hospitals for ChildrenGalveston, TX, USA
- Department of Surgery, University of Texas Medical BranchGalveston, TX, USA
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27
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Ueta CB, Gomes KS, Ribeiro MA, Mochly-Rosen D, Ferreira JCB. Disruption of mitochondrial quality control in peripheral artery disease: New therapeutic opportunities. Pharmacol Res 2017; 115:96-106. [PMID: 27876411 PMCID: PMC5205542 DOI: 10.1016/j.phrs.2016.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 01/25/2023]
Abstract
Peripheral artery disease (PAD) is a multifactorial disease initially triggered by reduced blood supply to the lower extremities due to atherosclerotic obstructions. It is considered a major public health problem worldwide, affecting over 200 million people. Management of PAD includes smoking cessation, exercise, statin therapy, antiplatelet therapy, antihypertensive therapy and surgical intervention. Although these pharmacological and non-pharmacological interventions usually increases blood flow to the ischemic limb, morbidity and mortality associated with PAD continue to increase. This scenario raises new fundamental questions regarding the contribution of intrinsic metabolic changes in the distal affected skeletal muscle to the progression of PAD. Recent evidence suggests that disruption of skeletal muscle mitochondrial quality control triggered by intermittent ischemia-reperfusion injury is associated with increased morbidity in individuals with PAD. The mitochondrial quality control machinery relies on surveillance systems that help maintaining mitochondrial homeostasis upon stress. In this review, we describe some of the most critical mechanisms responsible for the impaired skeletal muscle mitochondrial quality control in PAD. We also discuss recent findings on the central role of mitochondrial bioenergetics and quality control mechanisms including mitochondrial fusion-fission balance, turnover, oxidative stress and aldehyde metabolism in the pathophysiology of PAD, and highlight their potential as therapeutic targets.
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Affiliation(s)
- Cintia B Ueta
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | - Katia S Gomes
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | - Márcio A Ribeiro
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, Brazil
| | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, Stanford University School of Medicine, USA
| | - Julio C B Ferreira
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, Brazil.
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28
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Valkovič L, Chmelík M, Meyerspeer M, Gagoski B, Rodgers CT, Krššák M, Andronesi OC, Trattnig S, Bogner W. Dynamic 31 P-MRSI using spiral spectroscopic imaging can map mitochondrial capacity in muscles of the human calf during plantar flexion exercise at 7 T. NMR IN BIOMEDICINE 2016; 29:1825-1834. [PMID: 27862510 PMCID: PMC5132121 DOI: 10.1002/nbm.3662] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/19/2016] [Accepted: 09/28/2016] [Indexed: 05/06/2023]
Abstract
Phosphorus MRSI (31 P-MRSI) using a spiral-trajectory readout at 7 T was developed for high temporal resolution mapping of the mitochondrial capacity of exercising human skeletal muscle. The sensitivity and localization accuracy of the method was investigated in phantoms. In vivo performance was assessed in 12 volunteers, who performed a plantar flexion exercise inside a whole-body 7 T MR scanner using an MR-compatible ergometer and a surface coil. In five volunteers the knee was flexed (~60°) to shift the major workload from the gastrocnemii to the soleus muscle. Spiral-encoded MRSI provided 16-25 times faster mapping with a better point spread function than elliptical phase-encoded MRSI with the same matrix size. The inevitable trade-off for the increased temporal resolution was a reduced signal-to-noise ratio, but this was acceptable. The phosphocreatine (PCr) depletion caused by exercise at 0° knee angulation was significantly higher in both gastrocnemii than in the soleus (i.e. 64.8 ± 19.6% and 65.9 ± 23.6% in gastrocnemius lateralis and medialis versus 15.3 ± 8.4% in the soleus). Spiral-encoded 31 P-MRSI is a powerful tool for dynamic mapping of exercising muscle oxidative metabolism, including localized assessment of PCr concentrations, pH and maximal oxidative flux with high temporal and spatial resolution.
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Affiliation(s)
- Ladislav Valkovič
- High‐Field MR CentreMedical University of ViennaViennaAustria
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
- Christian Doppler Laboratory for Clinical Molecular MR ImagingViennaAustria
- Department of Imaging Methods, Institute of Measurement ScienceSlovak Academy of SciencesBratislavaSlovakia
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR)University of OxfordOxfordUK
| | - Marek Chmelík
- High‐Field MR CentreMedical University of ViennaViennaAustria
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
- Christian Doppler Laboratory for Clinical Molecular MR ImagingViennaAustria
| | - Martin Meyerspeer
- High‐Field MR CentreMedical University of ViennaViennaAustria
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaViennaAustria
| | - Borjan Gagoski
- Fetal Neonatal Neuroimaging and Developmental Science CenterBoston Children's HospitalBostonMassachusettsUSA
| | - Christopher T. Rodgers
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR)University of OxfordOxfordUK
| | - Martin Krššák
- High‐Field MR CentreMedical University of ViennaViennaAustria
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
- Christian Doppler Laboratory for Clinical Molecular MR ImagingViennaAustria
- Division of Endocrinology and Metabolism, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Ovidiu C. Andronesi
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Siegfried Trattnig
- High‐Field MR CentreMedical University of ViennaViennaAustria
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
- Christian Doppler Laboratory for Clinical Molecular MR ImagingViennaAustria
| | - Wolfgang Bogner
- High‐Field MR CentreMedical University of ViennaViennaAustria
- Department of Biomedical Imaging and Image‐Guided TherapyMedical University of ViennaViennaAustria
- Christian Doppler Laboratory for Clinical Molecular MR ImagingViennaAustria
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29
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Brass EP, Hiatt WR, Green S. Skeletal muscle metabolic changes in peripheral arterial disease contribute to exercise intolerance: a point-counterpoint discussion. Vasc Med 2016; 9:293-301. [PMID: 15678622 DOI: 10.1191/1358863x04vm572ra] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with claudication have a marked impairment in exercise performance. Several factors contribute to this limitation, including reductions in large vessel blood flow and oxygen delivery as well as metabolic abnormalities in skeletal muscle. The relative contribution of these factors and their role in the pathophysiology of the exercise limitation is discussed using a point-counterpoint approach. Future directions for research conclude the discussion.
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Affiliation(s)
- Eric P Brass
- Center for Clinical Pharmacology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
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Ryan TE, Schmidt CA, Green TD, Brown DA, Neufer PD, McClung JM. Mitochondrial Regulation of the Muscle Microenvironment in Critical Limb Ischemia. Front Physiol 2015; 6:336. [PMID: 26635622 PMCID: PMC4649016 DOI: 10.3389/fphys.2015.00336] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/02/2015] [Indexed: 01/11/2023] Open
Abstract
Critical limb ischemia (CLI) is the most severe clinical presentation of peripheral arterial disease and manifests as chronic limb pain at rest and/or tissue necrosis. Current clinical interventions are largely ineffective and therapeutic angiogenesis based trials have shown little efficacy, highlighting the dire need for new ideas and novel therapeutic approaches. Despite a decade of research related to skeletal muscle as a determinant of morbidity and mortality outcomes in CLI, very little progress has been made toward an effective therapy aimed directly at the muscle myopathies of this disease. Within the muscle cell, mitochondria are well positioned to modulate the ischemic cellular response, as they are the principal sites of cellular energy production and the major regulators of cellular redox charge and cell death. In this mini review, we update the crucial importance of skeletal muscle to CLI pathology and examine the evolving influence of muscle and endothelial cell mitochondria in the complex ischemic microenvironment. Finally, we discuss the novelty of muscle mitochondria as a therapeutic target for ischemic pathology in the context of the complex co-morbidities often associated with CLI.
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Affiliation(s)
- Terence E Ryan
- Department of Physiology, Brody School of Medicine, East Carolina University Greenville, NC, USA ; East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University Greenville, NC, USA
| | - Cameron A Schmidt
- Department of Physiology, Brody School of Medicine, East Carolina University Greenville, NC, USA ; East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University Greenville, NC, USA
| | - Tom D Green
- Department of Physiology, Brody School of Medicine, East Carolina University Greenville, NC, USA ; East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University Greenville, NC, USA
| | - David A Brown
- Department of Physiology, Brody School of Medicine, East Carolina University Greenville, NC, USA ; East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University Greenville, NC, USA
| | - P Darrell Neufer
- Department of Physiology, Brody School of Medicine, East Carolina University Greenville, NC, USA ; East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University Greenville, NC, USA
| | - Joseph M McClung
- Department of Physiology, Brody School of Medicine, East Carolina University Greenville, NC, USA ; East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University Greenville, NC, USA
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31
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McDermott MM. Lower extremity manifestations of peripheral artery disease: the pathophysiologic and functional implications of leg ischemia. Circ Res 2015; 116:1540-50. [PMID: 25908727 DOI: 10.1161/circresaha.114.303517] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lower extremity peripheral artery disease (PAD) is frequently underdiagnosed, in part because of the wide variety of leg symptoms manifested by patients with PAD and in part because of the high prevalence of asymptomatic PAD. In primary care medical practices, 30% to 60% of patients with PAD report no exertional leg symptoms and ≈45% to 50% report exertional leg symptoms that are not consistent with classic intermittent claudication. The prevalence and extent of functional impairment and functional decline in PAD may also be underappreciated. Functional impairment and functional decline are common in PAD, even among those who are asymptomatic. Lower extremity ischemia is also associated with pathophysiologic changes in calf skeletal muscle, including smaller calf muscle area, increased calf muscle fat content, impaired leg strength, and impaired metabolic function. People with severe PAD have poorer peroneal nerve conduction velocity compared with people with mild PAD or no PAD. The degree of ischemia-related pathophysiologic changes in lower extremity muscles and peripheral nerves of people with PAD are associated with the degree of functional impairment. New interventions are needed to improve functional performance and prevent mobility loss in the large number of patients with PAD, including in those who are asymptomatic or who have exertional leg symptoms other than claudication.
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Affiliation(s)
- Mary McGrae McDermott
- From the Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
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32
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Koutakis P, Miserlis D, Myers SA, Kim JKS, Zhu Z, Papoutsi E, Swanson SA, Haynatzki G, Ha DM, Carpenter LA, McComb RD, Johanning JM, Casale GP, Pipinos II. Abnormal accumulation of desmin in gastrocnemius myofibers of patients with peripheral artery disease: associations with altered myofiber morphology and density, mitochondrial dysfunction and impaired limb function. J Histochem Cytochem 2015; 63:256-69. [PMID: 25575565 DOI: 10.1369/0022155415569348] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Patients with peripheral artery disease (PAD) develop a myopathy in their ischemic lower extremities, which is characterized by myofiber degeneration, mitochondrial dysfunction and impaired limb function. Desmin, a protein of the cytoskeleton, is central to maintenance of the structure, shape and function of the myofiber and its organelles, especially the mitochondria, and to translation of sarcomere contraction into muscle contraction. In this study, we investigated the hypothesis that disruption of the desmin network occurs in gastrocnemius myofibers of PAD patients and correlates with altered myofiber morphology, mitochondrial dysfunction, and impaired limb function. Using fluorescence microscopy, we evaluated desmin organization and quantified myofiber content in the gastrocnemius of PAD and control patients. Desmin was highly disorganized in PAD but not control muscles and myofiber content was increased significantly in PAD compared to control muscles. By qPCR, we found that desmin gene transcripts were increased in the gastrocnemius of PAD patients as compared with control patients. Increased desmin and desmin gene transcripts in PAD muscles correlated with altered myofiber morphology, decreased mitochondrial respiration, reduced calf muscle strength and decreased walking performance. In conclusion, our studies identified disruption of the desmin system in gastrocnemius myofibers as an index of the myopathy and limitation of muscle function in patients with PAD.
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Affiliation(s)
- Panagiotis Koutakis
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Dimitrios Miserlis
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Sara A Myers
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Nebraska (SAM)
| | - Julian Kyung-Soo Kim
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Zhen Zhu
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Evlampia Papoutsi
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Stanley A Swanson
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Gleb Haynatzki
- Department of Biostatistics, College of Public Health (GH)
| | - Duy M Ha
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Lauren A Carpenter
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | | | - Jason M Johanning
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP),Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska (JMJ, IIP)
| | - George P Casale
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP)
| | - Iraklis I Pipinos
- Department of Surgery (PK, DM, JKK, ZZ, EP, SAS, DMH, LAC, JMJ, GPC, IIP),Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska (JMJ, IIP)
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33
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Kemp GJ, Ahmad RE, Nicolay K, Prompers JJ. Quantification of skeletal muscle mitochondrial function by 31P magnetic resonance spectroscopy techniques: a quantitative review. Acta Physiol (Oxf) 2015; 213:107-44. [PMID: 24773619 DOI: 10.1111/apha.12307] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/30/2013] [Accepted: 04/23/2014] [Indexed: 12/16/2022]
Abstract
Magnetic resonance spectroscopy (MRS) can give information about cellular metabolism in vivo which is difficult to obtain in other ways. In skeletal muscle, non-invasive (31) P MRS measurements of the post-exercise recovery kinetics of pH, [PCr], [Pi] and [ADP] contain valuable information about muscle mitochondrial function and cellular pH homeostasis in vivo, but quantitative interpretation depends on understanding the underlying physiology. Here, by giving examples of the analysis of (31) P MRS recovery data, by some simple computational simulation, and by extensively comparing data from published studies using both (31) P MRS and invasive direct measurements of muscle O2 consumption in a common analytical framework, we consider what can be learnt quantitatively about mitochondrial metabolism in skeletal muscle using MRS-based methodology. We explore some technical and conceptual limitations of current methods, and point out some aspects of the physiology which are still incompletely understood.
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Affiliation(s)
- G. J. Kemp
- Department of Musculoskeletal Biology, and Magnetic Resonance and Image Analysis Research Centre; University of Liverpool; Liverpool UK
| | - R. E. Ahmad
- Department of Musculoskeletal Biology, and Magnetic Resonance and Image Analysis Research Centre; University of Liverpool; Liverpool UK
| | - K. Nicolay
- Biomedical NMR; Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven the Netherlands
| | - J. J. Prompers
- Biomedical NMR; Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven the Netherlands
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34
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West MA, Loughney L, Lythgoe D, Barben CP, Adams VL, Bimson WE, Grocott MPW, Jack S, Kemp GJ. The effect of neoadjuvant chemoradiotherapy on whole-body physical fitness and skeletal muscle mitochondrial oxidative phosphorylation in vivo in locally advanced rectal cancer patients--an observational pilot study. PLoS One 2014; 9:e111526. [PMID: 25478898 PMCID: PMC4257525 DOI: 10.1371/journal.pone.0111526] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/26/2014] [Indexed: 11/18/2022] Open
Abstract
Background In the United Kingdom, patients with locally advanced rectal cancer routinely receive neoadjuvant chemoradiotherapy. However, the effects of this on physical fitness are unclear. This pilot study is aimed to investigate the effect of neoadjuvant chemoradiotherapy on objectively measured in vivo muscle mitochondrial function and whole-body physical fitness. Methods We prospectively studied 12 patients with rectal cancer who completed standardized neoadjuvant chemoradiotherapy, recruited from a large tertiary cancer centre, between October 2012 and July 2013. All patients underwent a cardiopulmonary exercise test and a phosphorus magnetic resonance spectroscopy quadriceps muscle exercise-recovery study before and after neoadjuvant chemoradiotherapy. Data were analysed and reported blind to patient identity and clinical course. Primary variables of interest were the two physical fitness measures; oxygen uptake at estimated anaerobic threshold and oxygen uptake at Peak exercise (ml.kg−1.min−1), and the post-exercise phosphocreatine recovery rate constant (min−1), a measure of muscle mitochondrial capacity in vivo. Results Median age was 67 years (IQR 64–75). Differences (95%CI) in all three primary variables were significantly negative post-NACRT: Oxygen uptake at estimated anaerobic threshold −2.4 ml.kg−1.min−1 (−3.8, −0.9), p = 0.004; Oxygen uptake at Peak −4.0 ml.kg−1.min−1 (−6.8, −1.1), p = 0.011; and post-exercise phosphocreatine recovery rate constant −0.34 min−1 (−0.51, −0.17), p<0.001. Conclusion The significant decrease in both whole-body physical fitness and in vivo muscle mitochondrial function raises the possibility that muscle mitochondrial mechanisms, no doubt multifactorial, may be important in deterioration of physical fitness following neoadjuvant chemoradiotherapy. This may have implications for targeted interventions to improve physical fitness pre-surgery. Trial Registration Clinicaltrials.gov registration NCT01859442
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Affiliation(s)
- Malcolm A. West
- Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Department of Musculoskeletal Biology and MRC – Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Magnetic Resonance and Image Analysis Research Centre (MARIARC), University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Lisa Loughney
- Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, United Kingdom
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Daniel Lythgoe
- Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, United Kingdom
| | - Christopher P. Barben
- Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Valerie L. Adams
- Magnetic Resonance and Image Analysis Research Centre (MARIARC), University of Liverpool, Liverpool, United Kingdom
| | - William E. Bimson
- Magnetic Resonance and Image Analysis Research Centre (MARIARC), University of Liverpool, Liverpool, United Kingdom
| | - Michael P. W. Grocott
- Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Department of Musculoskeletal Biology and MRC – Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, United Kingdom
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sandy Jack
- Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Department of Musculoskeletal Biology and MRC – Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, United Kingdom
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Graham J. Kemp
- Department of Musculoskeletal Biology and MRC – Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Magnetic Resonance and Image Analysis Research Centre (MARIARC), University of Liverpool, Liverpool, United Kingdom
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35
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(31)P-MRS using visual stimulation protocols with different durations in healthy young adult subjects. Neurochem Res 2014; 39:2343-50. [PMID: 25227748 DOI: 10.1007/s11064-014-1433-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/29/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
Abstract
Phosphorus magnetic resonance spectroscopy ((31)P-MRS) combined with visual stimulation in functional experiments allows the non-invasive dynamic study of brain energy metabolism. (31)P-MRS has been applied to several diseases and to healthy subjects, but works have shown variable findings and non-reproducible results, possibly caused by low numbers of subjects combined with different stimulation paradigms. In the present work, we used (31)P-MRS at 3 T with two different visual stimulation protocols with different block duration ("short" and "long") to evaluate metabolic changes under different workloads in 38 healthy subjects. We found a 15 % (short protocol-blocks of 1.5 min stimulation) and 3 % (long protocol-blocks of 5 min stimulation) increase in the inorganic phosphate (Pi) to α-adenosine triphosphate (α-ATP) ratio, and a 5 % (short protocol) and 2 % (long protocol) decrease in the nicotinamide adenine nucleotide (NADH + NAD(+)) to α-ATP ratio. The NADH + NAD(+) results are, to the best of our knowledge, the first functional magnetic resonance spectroscopy in vivo assessment of these compounds, but their interpretation is difficult since they cannot be separately quantified at 3 T. Our results show that longer stimulations produce smaller concentration changes in Pi/α-ATP and (NADH + NAD(+))/α-ATP ratios, which suggests a possible adaptation effect during longer stimulations that leads metabolic concentrations towards the initial equilibrium.
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36
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Oxidative damage in the gastrocnemius of patients with peripheral artery disease is myofiber type selective. Redox Biol 2014; 2:921-8. [PMID: 25180168 PMCID: PMC4143812 DOI: 10.1016/j.redox.2014.07.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/07/2014] [Indexed: 01/12/2023] Open
Abstract
Background Peripheral artery disease (PAD), a manifestation of systemic atherosclerosis that produces blockages in the arteries supplying the legs, affects approximately 5% of Americans. We have previously, demonstrated that a myopathy characterized by myofiber oxidative damage and degeneration is central to PAD pathophysiology. Objectives In this study, we hypothesized that increased oxidative damage in the myofibers of the gastrocnemius of PAD patients is myofiber-type selective and correlates with reduced myofiber size. Methods Needle biopsies were taken from the gastrocnemius of 53 PAD patients (28 with early PAD and 25 with advanced PAD) and 25 controls. Carbonyl groups (marker of oxidative damage), were quantified in myofibers of slide-mounted tissue, by quantitative fluorescence microscopy. Myofiber cross-sectional area was determined from sarcolemma labeled with wheat germ agglutinin. The tissues were also labeled for myosin I and II, permitting quantification of oxidative damage to and relative frequency of the different myofiber Types (Type I, Type II and mixed Type I/II myofibers). We compared PAD patients in early (N=28) vs. advanced (N=25) disease stage for selective, myofiber oxidative damage and altered morphometrics. Results The carbonyl content of gastrocnemius myofibers was higher in PAD patients compared to control subjects, for all three myofiber types (p<0.05). In PAD patients carbonyl content was higher (p<0.05) in Type II and I/II fibers compared to Type I fibers. Furthermore, the relative frequency and cross-sectional area of Type II fibers were lower, while the relative frequencies and cross-sectional area of Type I and Type I/II fibers were higher, in PAD compared to control gastrocnemius (p<0.05). Lastly, the type II-selective oxidative damage increased and myofiber size decreased as the disease progressed from the early to advanced stage. Conclusions Our data confirm increased myofiber oxidative damage and reduced myofiber size in PAD gastrocnemius and demonstrate that the damage is selective for type II myofibers and is worse in the most advanced stage of PAD. Peripheral artery disease, is characterized by the formation of atherosclerotic plaques that limit blood flow to the legs. There was increased myofiber oxidative damage and degeneration in the gastrocnemius of PAD patients compared to controls. Myofiber oxidative damage and morphology were worse for Type II myofibers. Type II-selective oxidative damage and abnormal morphology worsened as the PAD progressed from the early to advanced stage. Myofiber oxidative damage and degeneration is a significant contributors to the pathophysiology of PAD.
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Lejay A, Meyer A, Schlagowski AI, Charles AL, Singh F, Bouitbir J, Pottecher J, Chakfé N, Zoll J, Geny B. Mitochondria: Mitochondrial participation in ischemia–reperfusion injury in skeletal muscle. Int J Biochem Cell Biol 2014; 50:101-5. [DOI: 10.1016/j.biocel.2014.02.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/07/2014] [Accepted: 02/16/2014] [Indexed: 11/25/2022]
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38
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Urbanik A. Phosphorus Spectroscopy of Calf Muscles before and after Exercise. Pol J Radiol 2014; 79:328-32. [PMID: 25276259 PMCID: PMC4173860 DOI: 10.12659/pjr.890601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/08/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Andrzej Urbanik
- Department of Radiology, Jagiellonian University Collegium Medicum, Cracow, Poland
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39
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Weiss DJ, Casale GP, Koutakis P, Nella AA, Swanson SA, Zhu Z, Miserlis D, Johanning JM, Pipinos II. Oxidative damage and myofiber degeneration in the gastrocnemius of patients with peripheral arterial disease. J Transl Med 2013; 11:230. [PMID: 24067235 PMCID: PMC3849592 DOI: 10.1186/1479-5876-11-230] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/04/2013] [Indexed: 01/18/2023] Open
Abstract
Peripheral arterial disease (PAD), a manifestation of systemic atherosclerosis that produces blockages in arteries supplying the legs, affects an estimated 27 million people in Europe and North America. Increased production of reactive oxygen species by dysfunctional mitochondria in leg muscles of PAD patients is viewed as a key mechanism of initiation and progression of the disease. Previous studies demonstrated increased oxidative damage in homogenates of biopsy specimens from PAD gastrocnemius compared to controls, but did not address myofiber-specific damage. In this study, we investigated oxidative damage to myofibers as a possible cause of the myopathy of PAD. To achieve this, we developed and validated fluorescence microscopy procedures for quantitative analysis of carbonyl groups and 4-hydroxy-2-nonenal (HNE) adducts in myofibers of biopsy specimens from human gastrocnemius. PAD and control specimens were evaluated for differences in 1) myofiber content of these two forms of oxidative damage and 2) myofiber cross-sectional area. Furthermore, oxidative damage to PAD myofibers was tested for associations with clinical stage of disease, degree of ischemia in the affected leg, and myofiber cross-sectional area. Carbonyl groups and HNE adducts were increased 30% (p < 0.0001) and 40% (p < 0.0001), respectively, in the myofibers of PAD (N = 34) compared to control (N = 21) patients. Mean cross-sectional area of PAD myofibers was reduced 29.3% compared to controls (p < 0.0003). Both forms of oxidative damage increased with clinical stage of disease, blood flow limitation in the ischemic leg, and reduced myofiber cross-sectional area. The data establish oxidative damage to myofibers as a possible cause of PAD myopathy.
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Affiliation(s)
- Dustin J Weiss
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-5182, USA.
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Tecilazich F, Dinh T, Lyons TE, Guest J, Villafuerte RA, Sampanis C, Gnardellis C, Zuo CS, Veves A. Postexercise phosphocreatine recovery, an index of mitochondrial oxidative phosphorylation, is reduced in diabetic patients with lower extremity complications. J Vasc Surg 2013; 57:997-1005. [PMID: 23465172 DOI: 10.1016/j.jvs.2012.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/01/2012] [Accepted: 10/05/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To identify differences in postexercise phosphocreatine (PCr) recovery, an index of mitochondrial function, in diabetic patients with and without lower extremity complications. METHODS We enrolled healthy control subjects and three groups of patients with type 2 diabetes mellitus: without complications, with peripheral neuropathy, and with both peripheral neuropathy and peripheral arterial disease. We used magnetic resonance spectroscopic measurements to perform continuous measurements of phosphorous metabolites (PCr and inorganic phosphate [Pi]) during a 3-minute graded exercise at the level of the posterior calf muscles (gastrocnemius and soleus muscles). Micro- and macrovascular reactivity measurements also were performed. RESULTS The resting Pi/PCr ratio and PCr at baseline and the maximum reached during exercise were similar in all groups. The postexercise time required for recovery of Pi/PCr ratio and PCr levels to resting levels, an assessment of mitochondrial oxidative phosphorylation, was significantly higher in diabetic patients with neuropathy and those with both neuropathy and peripheral arterial disease (P < .01 for both measurements). These two groups also had higher levels of tumor necrosis factor-α (P < .01) and granulocyte colony-stimulating factor (P < .05). Multiple regression analysis showed that only granulocyte colony-stimulating factor, osteoprotegerin, and tumor necrosis factor-α were significant contributing factors in the variation of the Pi/PCr ratio recovery time. No associations were observed between micro- and macrovascular reactivity measurements and Pi/PCr ratio or PCr recovery time. CONCLUSIONS Mitochondrial oxidative phosphorylation is impaired only in type 2 diabetes mellitus patients with neuropathy whether or not peripheral arterial disease is present and is associated with the increased proinflammatory state observed in these groups.
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Affiliation(s)
- Francesco Tecilazich
- Joslin-Beth Israel Deaconess Foot Center and Microcirculation Lab, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
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Oxygenation and flow in the limbs: Novel methods to characterize peripheral artery disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013; 6:150-157. [PMID: 23504569 DOI: 10.1007/s12410-013-9191-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Peripheral arterial disease (PAD) affects approximately 8 million Americans and is associated with high morbidity and increased mortality. Current therapies for PAD are limited and development of new therapeutic agents is needed. Present diagnostic methods for PAD are insensitive to the subtle microvascular and metabolic changes that occur beyond macrovacular stenosis and therefore may be less useful endpoints for clinical trials. Phosphorus-31 magnetic resonance (MR) spectroscopy, MR muscle perfusion, and MR oximetry are novel methods capable of evaluating both the macrovascular and microvascular changes that occur in PAD patients.
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Gohil R, Lane TRA, Coughlin P. Review of the adaptation of skeletal muscle in intermittent claudication. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.34055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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44
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West AM, Anderson JD, Epstein FH, Meyer CH, Hagspiel KD, Berr SS, Harthun NL, Weltman AL, Annex BH, Kramer CM. Percutaneous intervention in peripheral artery disease improves calf muscle phosphocreatine recovery kinetics: a pilot study. Vasc Med 2012; 17:3-9. [PMID: 22363013 DOI: 10.1177/1358863x11431837] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We hypothesized that percutaneous intervention in the affected lower extremity artery would improve calf muscle perfusion and cellular metabolism in patients with claudication and peripheral artery disease (PAD) as measured by magnetic resonance imaging (MRI) and spectroscopy (MRS). Ten patients with symptomatic PAD (mean ± SD: age 57 ± 9 years; ankle-brachial index (ABI) 0.62 ± 0.17; seven males) were studied 2 months before and 10 months after lower extremity percutaneous intervention. Calf muscle phosphocreatine recovery time constant (PCr) in the revascularized leg was measured by (31)P MRS immediately after symptom-limited exercise on a 1.5-T scanner. Calf muscle perfusion was measured using first-pass gadolinium-enhanced MRI at peak exercise. A 6-minute walk and treadmill test were performed. The PCr recovery time constant improved significantly following intervention (91 ± 33 s to 52 ± 34 s, p < 0.003). Rest ABI also improved (0.62 ± 0.17 to 0.93 ± 0.25, p < 0.003). There was no difference in MRI-measured tissue perfusion or exercise parameters, although the study was underpowered for these endpoints. In conclusion, in this pilot study, successful large vessel percutaneous intervention in patients with symptomatic claudication, results in improved ABI and calf muscle phosphocreatine recovery kinetics.
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Affiliation(s)
- Amy M West
- Department of Medicine, University of Virginia Health System, University of Virginia, Charlottesville, VA 22908, USA
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Rajagopalan S, Mihai G. Perspectives on optimizing trial design and endpoints in peripheral arterial disease: a case for imaging-based surrogates as endpoints of functional efficacy. Cardiol Clin 2011; 29:419-31. [PMID: 21803230 DOI: 10.1016/j.ccl.2011.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surrogate endpoints are important for validation of mechanism, early proof of concept, and the rational design of clinical trials for regulatory approval of drugs. The recent failure of several drugs in peripheral arterial disease (PAD) and in atherosclerosis highlights the importance of understanding drug effect and is a clarion call for better endpoints. This review focuses on aspects relating to the current state of surrogate endpoints in PAD and reviews emerging endpoints using imaging approaches that may have the potential of improving study design in PAD.
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Affiliation(s)
- Sanjay Rajagopalan
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, 473 West 12 Avenue, Columbus, OH 43210, USA.
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Koutakis P, Johanning JM, Haynatzki GR, Myers SA, Stergiou N, Longo GM, Pipinos II. Abnormal joint powers before and after the onset of claudication symptoms. J Vasc Surg 2010; 52:340-7. [PMID: 20670775 DOI: 10.1016/j.jvs.2010.03.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 03/01/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Claudication is the most common manifestation of peripheral arterial disease, producing significant ambulatory compromise. Our study evaluated patients with bilateral lower limb claudication and characterized their gait abnormality based on advanced biomechanical analysis using joint torques and powers. METHODS Twenty patients with bilateral claudication (10 with isolated aortoiliac disease and 10 with combined aortoiliac and femoropopliteal disease) and 16 matched controls ambulated on a walkway while 3-dimensional biomechanical data were collected. Patients walked before and after onset of claudication pain. Joint torques and powers at early, mid, and late stance for the hip, knee, and ankle joints were calculated for claudicating patients before and after the onset of claudication pain and were compared to controls. RESULTS Claudicating patients exhibited significantly reduced hip and knee power at early stance (weight-acceptance phase) due to decreased torques produced by the hip and knee extensors. In mid stance (single-limb support phase), patients had significantly reduced knee and hip power due to the decreased torques produced by the knee extensors and the hip flexors. In late stance (propulsion phase), reduced propulsion was noted with significant reduction in ankle plantar flexor torques and power. These differences were present before and after the onset of pain, with certain parameters worsening in association with pain. CONCLUSIONS The gait of claudication is characterized by failure of specific and identifiable muscle groups needed to perform normal walking (weight acceptance, single-limb support, and propulsion). Parameters of gait are abnormal with the first steps taken, in the absence of pain, and certain of these parameters worsen after the onset of claudication pain.
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Affiliation(s)
- Panagiotis Koutakis
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Neb, USA
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Parmenter BJ, Raymond J, Fiatarone Singh MA. The effect of exercise on haemodynamics in intermittent claudication: a systematic review of randomized controlled trials. Sports Med 2010; 40:433-47. [PMID: 20433214 DOI: 10.2165/11531330-000000000-00000] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Changes in lower limb haemodynamics such as arterial pressure and/or flow have often been, and continue to be, cited as possible mechanisms for the improvement in walking performance that occurs with exercise training in individuals with peripheral arterial disease (PAD), but data are conflicting in this regard. There are a small number of literature reviews examining the effects of exercise on PAD, however, there has been insufficient analysis synthesizing possible mechanisms of effect, overall benefits and limitations of these trials. Our objective was therefore to systematically review the evidence for the effect of exercise on lower limb haemodynamic measures of resting and post-exercise ankle brachial index (ABI), resting toe pressure, and resting and reactive hyperaemic calf blood flow in PAD. A systematic search of studies published between 1934 and March 2010 was conducted using MEDLINE, EMBASE, AMED, SportDiscus, CINAHL, PEDro, Premedline, Google Scholar and Web of Knowledge databases. Eligible studies included randomized controlled trials using an exercise intervention for the treatment of intermittent claudication with haemodynamic measures of disease severity as outcomes. Relative effect sizes (ESs) and 95% confidence intervals were calculated for outcomes. Correlation and regression analyses were performed to establish relationships between symptoms and haemodynamic outcomes. Thirty-three trials including 1237 subjects with mild to moderate claudication met the eligibility criteria. Exercise did not significantly change lower extremity haemodynamics in most trials; nor were clinical improvements related to changes in resting ABI (mean ES 0.09 +/- 0.26; r = 0.02; p = 0.94), post-exercise ABI (mean ES 0.18 +/- 0.3; r = -0.33; p = 0.52) or reactive hyperaemic calf blood flow (mean ES 0.38 +/- 0.67; r = 0.35; p = 0.26). A relationship may exist between a change in symptoms and changes in resting toe pressure (mean ES 0.22 +/- 0.22; r = 0.75; p = 0.25) and resting calf blood flow (mean ES 0.09 +/- 0.16; r = 0.59; p = 0.22). Changes in resting and post-exercise ABI and reactive hyperaemic calf blood flow do not appear to explain the clinical benefits of exercise in PAD. More study is required in the areas of resting toe pressure and resting calf blood flow.
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Affiliation(s)
- Belinda J Parmenter
- Exercise, Health and Performance Faculty Research Group, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
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Myers SA, Stergiou N, Pipinos II, Johanning JM. Gait variability patterns are altered in healthy young individuals during the acute reperfusion phase of ischemia-reperfusion. J Surg Res 2010; 164:6-12. [PMID: 20828731 DOI: 10.1016/j.jss.2010.04.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 04/06/2010] [Accepted: 04/20/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND The role of ischemia reperfusion contributing to functional impairment in lower extremity peripheral arterial disease (PAD) patients has not previously been elucidated. The evaluation of gait variability patterns has proven useful in many pathologic populations. Therefore, the purpose of this study is to isolate and determine the specific effect of the acute reperfusion phase of ischemia-reperfusion on gait variability in young individuals with no vascular disease. MATERIALS AND METHODS Thirty healthy young individuals walked on a treadmill during baseline and the acute reperfusion phase of ischemia-reperfusion conditions while lower extremity joint kinematics were captured. Stride to stride variability was assessed using the largest Lyapunov exponent, approximate entropy, standard deviation, and coefficient of variation. Differences in gait variability between conditions were assessed using dependent t-tests. RESULTS The largest Lyapunov exponent values and approximate entropy values were significantly higher in the acute reperfusion phase of ischemia-reperfusion condition for the ankle, knee, and the hip. Coefficient of variation was significantly higher at the hip and standard deviation was higher at the knee and the hip during the acute reperfusion phase of ischemia-reperfusion condition. CONCLUSIONS The acute reperfusion phase of the ischemia-reperfusion cycle alters gait variability patterns at the ankle, knee, and the hip in healthy young individuals. Our findings indicate increased noise and irregularity of gait variability patterns post-ischemia. In young healthy individuals who do not have neuromuscular impairments, significant gait alterations are present during walking after a period of interruption of blood flow.
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Affiliation(s)
- Sara A Myers
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68198-3280, USA
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Mellon EA, Lee SC, Pickup S, Kim S, Goldstein SC, Floyd TF, Poptani H, Delikatny EJ, Reddy R, Glickson JD. Detection of lactate with a hadamard slice selected, selective multiple quantum coherence, chemical shift imaging sequence (HDMD-SelMQC-CSI) on a clinical MRI scanner: Application to tumors and muscle ischemia. Magn Reson Med 2010; 62:1404-13. [PMID: 19785016 DOI: 10.1002/mrm.22141] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lactate is an important metabolite in normal and malignant tissues detectable by NMR spectroscopy; however, it has been difficult to clinically detect the lactate methyl resonance because it is obscured by lipid resonances. The selective homonuclear multiple quantum coherence transfer technique offers a method for distinguishing lipid and lactate resonances. We implemented a three-dimensional selective homonuclear multiple quantum coherence transfer version with Hadamard slice selection and two-dimensional phase encoding (Hadamard encoded-selective homonuclear multiple quantum coherence transfer-chemical shift imaging) on a conventional clinical MR scanner. Hadamard slice selection is explained and demonstrated in vivo. This is followed by 1-cm(3) resolution lactate imaging with detection to 5-mM concentration in 20 min on a 3-T clinical scanner. An analysis of QSel gradient duration and amplitude effects on lactate and lipid signal is presented. To demonstrate clinical feasibility, a 5-min lactate scan of a patient with a non-Hodgkin's lymphoma in the superficial thigh is reported. The elevated lactate signal coincides with the T(2)-weighted image of this tumor. As a test of selective homonuclear multiple quantum coherence transfer sensitivity, a thigh tourniquet was applied to a normal volunteer and an increase in lactate was detected immediately after tourniquet flow constriction. In conclusion, the Hadamard encoded-selective homonuclear multiple quantum coherence transfer-chemical shift imaging sequence is demonstrated on a phantom and in two lipid-rich, clinically relevant, in vivo conditions.
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Affiliation(s)
- Eric A Mellon
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Vaquero Morillo F, Ballesteros Pomar M, Fernández Morán M. La miopatía isquémica en la enfermedad arterial periférica. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70006-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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