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Nicholson PR, Raymond-Pope CJ, Lillquist TJ, Bruzina AS, Call JA, Greising SM. In Sequence Antifibrotic Treatment and Rehabilitation after Volumetric Muscle Loss Injury. Adv Wound Care (New Rochelle) 2024. [PMID: 39119810 DOI: 10.1089/wound.2024.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Affiliation(s)
- Peter R Nicholson
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Thomas J Lillquist
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Angela S Bruzina
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jarrod A Call
- Department of Physiology and Pharmacology, University of Georgia, Athens, Georgia, USA
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
| | - Sarah M Greising
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
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Motherwell JM, Dolan CP, Kanovka SS, Edwards JB, Franco SR, Janakiram NB, Valerio MS, Goldman SM, Dearth CL. Effects of Adjunct Antifibrotic Treatment within a Regenerative Rehabilitation Paradigm for Volumetric Muscle Loss. Int J Mol Sci 2023; 24:3564. [PMID: 36834976 PMCID: PMC9964131 DOI: 10.3390/ijms24043564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
The use of a rehabilitation approach that promotes regeneration has the potential to improve the efficacy of pro-regenerative therapies and maximize functional outcomes in the treatment of volumetric muscle loss (VML). An adjunct antifibrotic treatment could further enhance functional gains by reducing fibrotic scarring. This study aimed to evaluate the potential synergistic effects of losartan, an antifibrotic pharmaceutical, paired with a voluntary wheel running rehabilitation strategy to enhance a minced muscle graft (MMG) pro-regenerative therapy in a rodent model of VML. The animals were randomly assigned into four groups: (1) antifibrotic with rehabilitation, (2) antifibrotic without rehabilitation, (3) vehicle treatment with rehabilitation, and (4) vehicle treatment without rehabilitation. At 56 days, the neuromuscular function was assessed, and muscles were collected for histological and molecular analysis. Surprisingly, we found that the losartan treatment decreased muscle function in MMG-treated VML injuries by 56 days, while the voluntary wheel running elicited no effect. Histologic and molecular analysis revealed that losartan treatment did not reduce fibrosis. These findings suggest that losartan treatment as an adjunct therapy to a regenerative rehabilitation strategy negatively impacts muscular function and fails to promote myogenesis following VML injury. There still remains a clinical need to develop a regenerative rehabilitation treatment strategy for traumatic skeletal muscle injuries. Future studies should consider optimizing the timing and duration of adjunct antifibrotic treatments to maximize functional outcomes in VML injuries.
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Affiliation(s)
- Jessica M. Motherwell
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Montgomery, MD 20815, USA
- Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Montgomery, MD 20815, USA
| | - Connor P. Dolan
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Montgomery, MD 20815, USA
- Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Montgomery, MD 20815, USA
| | - Sergey S. Kanovka
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Montgomery, MD 20815, USA
- Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Montgomery, MD 20815, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Montgomery, MD 20817, USA
| | - Jorge B. Edwards
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Montgomery, MD 20815, USA
- Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Montgomery, MD 20815, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Montgomery, MD 20817, USA
| | - Sarah R. Franco
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Montgomery, MD 20815, USA
- Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Montgomery, MD 20815, USA
| | - Naveena B. Janakiram
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Montgomery, MD 20815, USA
- Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Montgomery, MD 20815, USA
| | - Michael S. Valerio
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Montgomery, MD 20815, USA
- Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Montgomery, MD 20815, USA
| | - Stephen M. Goldman
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Montgomery, MD 20815, USA
- Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Montgomery, MD 20815, USA
| | - Christopher L. Dearth
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Montgomery, MD 20815, USA
- Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Montgomery, MD 20815, USA
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Greising SM, Weiner JI, Garry DJ, Sachs DH, Garry MG. Human muscle in gene edited pigs for treatment of volumetric muscle loss. Front Genet 2022; 13:948496. [PMID: 35957684 PMCID: PMC9358139 DOI: 10.3389/fgene.2022.948496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Focusing on complex extremity trauma and volumetric muscle loss (VML) injuries, this review highlights: 1) the current pathophysiologic limitations of the injury sequela; 2) the gene editing strategy of the pig as a model that provides a novel treatment approach; 3) the notion that human skeletal muscle derived from gene edited, humanized pigs provides a groundbreaking treatment option; and 4) the impact of this technologic platform and how it will advance to far more multifaceted applications. This review seeks to shed insights on a novel treatment option using gene edited pigs as a platform which is necessary to overcome the clinical challenges and limitations in the field.
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Affiliation(s)
- Sarah M. Greising
- School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Sarah M. Greising, ; Mary G. Garry,
| | - Joshua I. Weiner
- Departments of Surgery, Columbia Center for Translations Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Daniel J. Garry
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, United States
- Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, United States
- NorthStar Genomics, Eagan, MN, United States
| | - David H. Sachs
- Departments of Surgery, Columbia Center for Translations Immunology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Mary G. Garry
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, United States
- Lillehei Heart Institute, University of Minnesota, Minneapolis, MN, United States
- NorthStar Genomics, Eagan, MN, United States
- *Correspondence: Sarah M. Greising, ; Mary G. Garry,
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Towards bioengineered skeletal muscle: recent developments in vitro and in vivo. Essays Biochem 2021; 65:555-567. [PMID: 34342361 DOI: 10.1042/ebc20200149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 12/11/2022]
Abstract
Skeletal muscle is a functional tissue that accounts for approximately 40% of the human body mass. It has remarkable regenerative potential, however, trauma and volumetric muscle loss, progressive disease and aging can lead to significant muscle loss that the body cannot recover from. Clinical approaches to address this range from free-flap transfer for traumatic events involving volumetric muscle loss, to myoblast transplantation and gene therapy to replace muscle loss due to sarcopenia and hereditary neuromuscular disorders, however, these interventions are often inadequate. The adoption of engineering paradigms, in particular materials engineering and materials/tissue interfacing in biology and medicine, has given rise to the rapidly growing, multidisciplinary field of bioengineering. These methods have facilitated the development of new biomaterials that sustain cell growth and differentiation based on bionic biomimicry in naturally occurring and synthetic hydrogels and polymers, as well as additive fabrication methods to generate scaffolds that go some way to replicate the structural features of skeletal muscle. Recent advances in biofabrication techniques have resulted in significant improvements to some of these techniques and have also offered promising alternatives for the engineering of living muscle constructs ex vivo to address the loss of significant areas of muscle. This review highlights current research in this area and discusses the next steps required towards making muscle biofabrication a clinical reality.
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Sorensen JR, Hoffman DB, Corona BT, Greising SM. Secondary denervation is a chronic pathophysiologic sequela of volumetric muscle loss. J Appl Physiol (1985) 2021; 130:1614-1625. [PMID: 33830817 DOI: 10.1152/japplphysiol.00049.2021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Volumetric muscle loss (VML) is the traumatic loss of muscle tissue that results in long-term functional impairments. Despite the loss of myofibers, there remains an unexplained significant decline in muscle function. VML injury likely extends beyond the defect area, causing negative secondary outcomes to the neuromuscular system, including the neuromuscular junctions (NMJs), yet the extent to which VML induces denervation is unclear. This study systematically examined NMJs surrounding the VML injury, hypothesizing that the sequela of VML includes denervation. The VML injury removed ∼20% of the tibialis anterior (TA) muscle in adult male inbred Lewis rats (n = 43), the noninjured leg served as an intra-animal control. Muscles were harvested up to 48 days post-VML. Synaptic terminals were identified immunohistochemically, and quantitative confocal microscopy evaluated 2,613 individual NMJ. Significant denervation was apparent by 21 and 48 days post-VML. Initially, denervation increased ∼10% within 3 days of injury; with time, denervation further increased to ∼22% and 32% by 21 and 48 days post-VML, respectively, suggesting significant secondary denervation. The appearance of terminal axon sprouting and polyinnervation were observed as early as 7 days post-VML, increasing in number and complexity throughout 48 days. There was no evidence of VML-induced NMJ size alteration, which may be beneficial for interventions aimed at restoring muscle function. This work recognizes VML-induced secondary denervation and poor remodeling of the NMJ as part of the sequela of VML injury; moreover, secondary denervation is a possible contributing factor to the chronic functional impairments and potentially an overlooked treatment target.NEW & NOTEWORTHY This work advances our understanding of the pathophysiologic complexity of volumetric muscle loss injury. Specifically, we identified secondary denervation in the muscle remaining after volumetric muscle loss injuries as a novel aspect of the injury sequela. Denervation increased chronically, in parallel with the appearance of irregular morphological characteristics and destabilization of the neuromuscular junction, which is expected to further confound chronic functional impairments.
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Affiliation(s)
- Jacob R Sorensen
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Daniel B Hoffman
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Benjamin T Corona
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Sarah M Greising
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
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Greising SM, Wang VM. Cross-talk with skeletal muscle and its nexus with regenerative rehabilitation. Connect Tissue Res 2021; 62:1-3. [PMID: 33269630 DOI: 10.1080/03008207.2020.1834909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sarah M Greising
- School of Kinesiology, University of Minnesota , Minneapolis, MN, USA
| | - Vincent M Wang
- Department of Biomedical Engineering and Mechanics, Virginia Tech , Blacksburg, VA, USA
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