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Yamamoto S, Okamura M, Akashi YJ, Tanaka S, Shimizu M, Tsuchikawa Y, Ashikaga K, Kamiya K, Kato Y, Nakayama A, Makita S, Isobe M. Impact of Long-Term Exercise-Based Cardiac Rehabilitation in Patients With Chronic Heart Failure - A Systematic Review and Meta-Analysis. Circ J 2024:CJ-23-0820. [PMID: 38220206 DOI: 10.1253/circj.cj-23-0820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND This study aimed to clarify the effects of exercise-based cardiac rehabilitation (CR) on patients with heart failure.Methods and Results: Patients were divided into groups according to intervention duration (<6 and ≥6 months). We searched for studies published up to July 2023 in Embase, MEDLINE, PubMed, and the Cochrane Library, without limitations on data, language, or publication status. We included randomized controlled trials comparing the efficacy of CR and usual care on mortality, prehospitalization, peak oxygen uptake (V̇O2), and quality of life. Seventy-two studies involving 8,495 patients were included in this review. It was found that CR reduced the risk of rehospitalization for any cause (risk ratio [RR] 0.80; 95% confidence interval [CI] 0.70-0.92) and for heart failure (RR 0.88; 95% CI 0.78-1.00). Furthermore, CR was found to improve exercise tolerance (measured by peak V̇O2and the 6-min walk test) and quality of life. A subanalysis performed based on intervention duration (<6 and ≥6 months) revealed a similar trend. CONCLUSIONS Our meta-analysis showed that although CR does not reduce mortality, it is effective in reducing rehospitalization rates and improving exercise tolerance and quality of life, regardless of the intervention duration.
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Affiliation(s)
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin
| | | | - Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital
| | - Masashi Shimizu
- Department of Rehabilitation, Osaka Metropolitan University Hospital
| | | | - Kohei Ashikaga
- Department of Sports Medicine, St. Marianna University School of Medicine
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Yuko Kato
- Department of Cardiology, The Cardiovascular Institute
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2
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Gomes-Neto M, Rodrigues Durães A, Roever L, Magalhães Silva C, Gonzalez Nogueira Alves I, Bernardone Saquetto M, Ellingsen Ø, Oliveira Carvalho V. Effects of Exercise Interventions on Aerobic Capacity in Patients With Heart Failure With Preserved Left Ventricular Ejection Fraction: Systematic Review and Network Meta-Analysis. Cardiol Rev 2024; 32:45-50. [PMID: 35290247 DOI: 10.1097/crd.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Exercise is an important component of rehabilitation care for patients with heart failure with preserved ejection fraction (HFpEF). However, it is unclear which type of physical rehabilitation exercise is most effective. Thus, the aim of this study was to determine the relative effects of different types of exercise interventions on aerobic capacity measured by peak oxygen consumption (VO 2 peak; in mL/kg·min) in patients with HFpEF. We searched different electronic databases until December 2020 for randomized controlled trials that evaluated the effects of different types of exercise interventions on VO 2 peak of patients with HFpEF. Mean difference, standardized mean difference (SMD), and 95% confidence intervals (CIs) were calculated. Fixed and random-effects Bayesian network meta-analysis was used to compare the relative effectiveness of the different exercise interventions. Nineteen studies met the study criteria, including 720 patients. Comparing the physical rehabilitation interventions with usual care (control group), inspiratory muscle training was the highest ranked exercise intervention with an SMD of 3.6 mL/kg·min (95% CI, 2.3-4.8), followed by the group undergoing high-intensity interval training with a significant pooled improvement in VO 2 peak 3.5 (95% CI, 2.6-4.4) and combined aerobic and resistance exercise with an SMD of 3.2 (95% CI, 1.4-5.0). The inspiratory muscle training, high-intensity interval training, and combined aerobic and resistance exercise were the highest ranked physical rehabilitation intervention to improve VO 2 peak. These interventions should be considered as a component in the care of patients with HFpEF. Registration: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42021256442.
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Affiliation(s)
- Mansueto Gomes-Neto
- From the Physical Therapy Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Federal University of Bahia, Salvador, Bahia, Brazil
- Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil
- Grupo de Estudos em Atividade Física, Brazil
| | - André Rodrigues Durães
- Programa de Pós-Graduação em Medicina e Saúde, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Leonador Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Cassio Magalhães Silva
- From the Physical Therapy Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Micheli Bernardone Saquetto
- From the Physical Therapy Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Federal University of Bahia, Salvador, Bahia, Brazil
- Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Øyvind Ellingsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, K.G. Jebsen Center for Exercise in Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vitor Oliveira Carvalho
- Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil
- Grupo de Estudos em Atividade Física, Brazil
- Physical Therapy Department, Federal University of Sergipe-UFS, Aracaju, Sergipe, Brazil
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3
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Carella MC, Forleo C, Stanca A, Carulli E, Basile P, Carbonara U, Amati F, Mushtaq S, Baggiano A, Pontone G, Ciccone MM, Guaricci AI. Heart Failure and Erectile Dysfunction: a Review of the Current Evidence and Clinical Implications. Curr Heart Fail Rep 2023; 20:530-541. [PMID: 37962749 PMCID: PMC10746762 DOI: 10.1007/s11897-023-00632-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW Heart failure (HF) and erectile dysfunction (ED) are two common conditions that affect millions of men worldwide and impair their quality of life. ED is a frequent complication of HF, as well as a possible predictor of cardiovascular events and mortality. ED deserves more attention from clinicians and researchers. RECENT FINDINGS The pathophysiology of ED in HF involves multiple factors, such as endothelial dysfunction, reduced cardiac output, neurohormonal activation, autonomic imbalance, oxidative stress, inflammation, and drug side effects. The diagnosis of ED in HF patients should be based on validated questionnaires or objective tests, as part of the routine cardiovascular risk assessment. The therapeutic management of ED in HF patients should be individualized and multidisciplinary, considering the patient's preferences, expectations, comorbidities, and potential drug interactions. The first-line pharmacological treatment for ED in HF patients with mild to moderate symptoms (NYHA class I-II) is phosphodiesterase type 5 inhibitors (PDE5Is), which improve both sexual function and cardiopulmonary parameters. PDE5Is are contraindicated in patients who use nitrates or nitric oxide donors for angina relief, and these patients should be advised to avoid sexual activity or to use alternative treatments for ED. Non-pharmacological treatments for ED, such as psychotherapy or couples therapy, should also be considered if there are significant psychosocial factors affecting the patient's sexual function or relationship. This review aims to summarize the most recent evidence regarding the prevalence of ED, the pathophysiology of this condition with an exhaustive analysis of factors involved in ED development in HF patients, a thorough discussion on diagnosis and management of ED in HF patients, providing practical recommendations for clinicians.
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Affiliation(s)
- Maria Cristina Carella
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Cinzia Forleo
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Alessandro Stanca
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Eugenio Carulli
- Cardiology Unit, Madonna Delle Grazie Hospital, Matera, Italy
| | - Paolo Basile
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Umberto Carbonara
- Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation-Urology, University of Bari Aldo Moro, Bari, Italy
| | - Fabio Amati
- Department of Basic Medicine Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Saima Mushtaq
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Baggiano
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Andrea Igoren Guaricci
- Cardiovascular Disease Section, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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4
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Büttner P, Werner S, Böttner J, Ossmann S, Schwedhelm E, Thiele H. Systemic Effects of Homoarginine Supplementation on Arginine Metabolizing Enzymes in Rats with Heart Failure with Preserved Ejection Fraction. Int J Mol Sci 2023; 24:14782. [PMID: 37834229 PMCID: PMC10572665 DOI: 10.3390/ijms241914782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/30/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
A restoration of low homoarginine (hArg) levels in obese ZSF1 rats (O-ZSF1) before (S1-ZSF1) and after (S2-ZSF1) the manifestation of heart failure with preserved ejection fraction (HFpEF) did not affect the worsening of cardiac HFpEF characteristics. Here, potential regulation of key enzymes of arginine metabolism in other organs was analyzed. Arginase 2 (ARG2) was reduced >35% in the kidney and small intestine of hArg-supplemented rats compared to O-ZSF1. Glycine amidinotransferase (GATM) was 29% upregulated in the kidneys of S1-ZSF1. Dimethylarginine dimethylaminohydrolase 1 (DDAH1) levels were reduced >50% in the livers of O-ZSF1 but restored in S2-ZSF1 compared to healthy rats (L-ZSF1). In the skeletal muscle, iNOS was lower in O-ZSF1 and further decreased in S1-ZSF1 and S2-ZSF1 compared to L-ZSF1. iNOS levels were lower in the liver of the S2-ZSF1 group but higher in the kidneys of S1-ZSF1 compared to L-ZSF1. Supplementation with hArg in an in vivo HFpEF model resulted in the inhibition of renal ARG2 and an increase in GATM expression. This supplementation might contribute to the stabilization of intestinal iNOS and ARG2 imbalances, thereby enhancing barrier function. Additionally, it may offer protective effects in skeletal muscle by downregulating iNOS. In the conceptualization of hArg supplementation studies, the current disease progression stage as well as organ-specific enzyme regulation should be considered.
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Affiliation(s)
- Petra Büttner
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
| | - Sarah Werner
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
| | - Julia Böttner
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
| | - Susann Ossmann
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
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5
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Does exercise training improve exercise tolerance, quality of life, and echocardiographic parameters in patients with heart failure with preserved ejection fraction? A systematic review and meta-analysis of randomized controlled trials. Heart Fail Rev 2022:10.1007/s10741-022-10285-z. [DOI: 10.1007/s10741-022-10285-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/08/2022]
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6
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Büttner P, Adams V, Werner S, Ossmann S, Besler C, Schwedhelm E, Thiele H. Effects of homoarginine supplementation on heart and skeletal muscle of rats with heart failure with preserved ejection fraction. ESC Heart Fail 2022; 9:4348-4351. [PMID: 36043453 PMCID: PMC9773648 DOI: 10.1002/ehf2.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/04/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023] Open
Abstract
AIM Heart failure with preserved ejection fraction (HFpEF) is associated with left ventricular stiffness, impaired diastolic relaxation, and severe exercise intolerance. Decreased homoarginine (hArg) levels are an independent predictor of mortality in cardiovascular disease and correlate with impaired exercise performance. We recently reported alterations in arginine, hArg, and related amino acids in obese ZSF1 rats (O-ZSF1), with a HFpEF phenotype. Although low hArg is associated with diastolic dysfunction in humans, potential effects of hArg supplementation were not tested yet. METHODS AND RESULTS At an age of 6 weeks, 12 O-ZSF1 were randomized into two groups: (1) O-ZSF1 rats supplemented with hArg in their drinking water (sO-ZSF1) or (2) O-ZSF1 rats receiving no hArg supplementation (O-ZSF1). At an age of 32 weeks, effects of primary prevention by hArg supplementation on echocardiographic, histological, and functional parameters of heart and skeletal muscle were determined. Lean ZSF1 rats (L-ZSF1) served as controls. hArg supplementation did not prevent impairment of diastolic relaxation (E/e': O-ZSF1 21 ± 3 vs. sO-ZSF1 22 ± 3, P = 0.954, L-ZSF1 18 ± 5) but resulted in more cardiac fibrosis (histological collagen staining: +57% in sO-ZSF1 vs. O-ZSF1, P = 0.027) and increased collagen gene expression (Col1a1: +48% in sO-ZSF1 vs. O-ZSF1, P = 0.026). In contrary, right ventricular function was preserved by hArg supplementation (TAPSE (mm): O-ZSF1 1.2 ± 0.3 vs. sO-ZSF1 1.7 ± 0.3, P = 0.020, L-ZSF1 1.8 ± 0.4). Musculus soleus maximal specific muscle force (N/cm2 ) in O-ZSF1 (30.4 ± 0.8) and sO-ZSF1 (31.9 ± 0.9) was comparable but significantly reduced compared with L-ZSF1 (36.4 ± 0.7; both P < 0.05). Maximal absolute muscle force (g) (O-ZSF1: 177.6 ± 7.8, sO-ZSF1: 187.8 ± 5.0, L-ZSF1: 181.5 ± 7.9, all P > 0.05) and cross-sectional fibre area (arbitrary units) (O-ZSF1: 1697 ± 57, sO-ZSF1: 1965 ± 121, L-ZSF1: 1691 ± 104, all P > 0.05) were not altered. CONCLUSIONS Preservation of physiological hArg level in HFpEF may not be suited to prevent alterations in left ventricular and skeletal muscle function and structure. However, hArg supplementation may be beneficial for right ventricular function especially in pulmonary hypertension in HFpEF. We may speculate that clinically observed decreased hArg level are not the cause but the consequence of a yet unrecognized pathomechanism that underpins HFpEF.
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Affiliation(s)
- Petra Büttner
- Department of CardiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | - Volker Adams
- Laboratory of Molecular and Experimental CardiologyTU Dresden, Heart Center DresdenDresdenGermany
| | - Sarah Werner
- Department of CardiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | - Susann Ossmann
- Department of Cardiac SurgeryHeart Center Leipzig at University LeipzigLeipzigGermany
| | - Christian Besler
- Department of CardiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and ToxicologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/LübeckHamburgGermany
| | - Holger Thiele
- Department of CardiologyHeart Center Leipzig at University LeipzigLeipzigGermany
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7
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Cao J, Qiu X, Gao Y, Cai L. Puerarin promotes the osteogenic differentiation of rat dental follicle cells by promoting the activation of the nitric oxide pathway. Tissue Cell 2021; 73:101601. [PMID: 34371290 DOI: 10.1016/j.tice.2021.101601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 01/02/2023]
Abstract
Puerarin regulates the osteoblast differentiation of umbilical cord mesenchymal stem cells. This study, hereby, explored the effects of puerarin on the osteogenic differentiation of dental follicle cells (DFCs) for the first time. Rat DFCs (rDFCs) were isolated and identified. After the rDFCs were treated by Puerarin and cultured in osteogenic induction medium, the viability, osteogenic differentiation, and the activities of alkaline phosphatase (ALP) and nitric oxide (NO) were detected. Besides, the secretion of cyclic guanosine monophosphate (cGMP) and expressions of collagen I, osteocalcin (OC), osteopontin (OPN), runt-related transcription factor 2 (RUNX2), soluble guanylate cyclase (SGC), and protein kinase G 1 (PKG-1) were further determined or quantified. Puerarin enhanced the viability and osteogenic differentiation, and increased the activities of ALP, NO, and cGMP and the expressions of Collagen I, OC, OPN, RUNX2, SGC, and PKG-1 in rDFCs. After the co-treatment with puerarin and L-NMMA (NO synthase inhibitor), the promotive effects of Puerarin on cell viability, osteogenic differentiation, and the expressions of collagen I, OC, OPN, RUNX2, SGC, and PKG-1 in rDFCs were reversed by L-NMMA. Puerarin boosted the osteogenic differentiation of rDFCs by activating the NO pathway.
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Affiliation(s)
- Jianyun Cao
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Shihezi University, China
| | - Xuebing Qiu
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Shihezi University, China.
| | - Yun Gao
- Department of Stomatology, First Affiliated Hospital, School of Medicine, Shihezi University, China
| | - Liangliang Cai
- Department of Stomatology, Hongxing Hospital, Division XIII Xinjiang Production and Construction Corps, China
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8
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Arginine metabolism and nitric oxide turnover in the ZSF1 animal model for heart failure with preserved ejection fraction. Sci Rep 2021; 11:20684. [PMID: 34667218 PMCID: PMC8526609 DOI: 10.1038/s41598-021-00216-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/07/2021] [Indexed: 12/21/2022] Open
Abstract
Endothelial dysfunction and altered nitric oxide (NO) metabolism are considered causal factors in heart failure with preserved ejection fraction (HFpEF). NO synthase activity depends on the availability of arginine and its derivatives. Thus, we analyzed arginine, associated metabolites, arginine-metabolizing enzymes and NO turnover in 20-week-old female healthy lean (L-ZSF1) and obese ZSF1 rats (O-ZSF1) with HFpEF. Serum, urine and lysates of liver, kidney and heart were analyzed. There were significantly lower lysine (− 28%), arginine (− 31%), homoarginine (− 72%) and nitrite (− 32%) levels in serum of O-ZSF1 rats. Ornithine (+ 60%) and citrulline (+ 20%) levels were higher. Similar results were found in the heart. Expression of arginine consuming enzymes in liver and kidney was unchanged. Instead, we observed a 5.8-fold higher arginase 1 expression, presumably of granulocyte origin, in serum and > fourfold increased cardiac macrophage invasion in O-ZSF1. We conclude that inflammatory cells in blood and heart consume arginine and probably homoarginine via arginase 1 and inducible NO synthase and release ornithine and citrulline. In combination with evidence for decreased NO turnover in O-ZSF1 rats, we assume lower arginine bioavailability to endothelial NO synthase.
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9
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Baskal S, Büttner P, Werner S, Besler C, Lurz P, Thiele H, Tsikas D. Profile of urinary amino acids and their post-translational modifications (PTM) including advanced glycation end-products (AGEs) of lysine, arginine and cysteine in lean and obese ZSF1 rats. Amino Acids 2021; 54:643-652. [PMID: 34250558 PMCID: PMC9117358 DOI: 10.1007/s00726-021-03042-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 01/01/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is associated with high mortality and has an increasing prevalence associated with the demographic change and limited therapeutic options. Underlying mechanisms are largely elusive and need to be explored to identify specific biomarkers and new targets, which mirror disease progression and intervention success. Obese ZSF1 (O-ZSF1) rats are a useful animal model, as they spontaneously develop hypertension, hyperlipidemia and glucose intolerance and finally HFpEF. The urinary profile of amino acids and their metabolites of post-translational modifications (PTM), including the advanced glycation end-products (AGEs) of lysine, arginine and cysteine, are poorly investigated in HFpEF and ZSF1 rats. The aim of the present study was to characterize the status of free amino acids and their metabolites of PTM and glycation in lean ZSF1 (L-ZSF1) and O-ZSF1 rats in urine aiming to find possible effects of glucose on the excretion of native and modified amino acids. In the urine of twelve L-ZSF1 and twelve O-ZFS1 rats collected at the age of 20 weeks, we measured the concentration of native and modified amino acids by reliable previously validated stable-isotope dilution gas chromatography-mass spectrometry (GC–MS) approaches. Serum glucose was 1.39-fold higher in the O-ZSF1 rats, while urinary creatinine concentration was 2.5-fold lower in the O-ZSF1 rats. We observed many differences in urinary amino acids excretion between L-ZSF1 and O-ZSF1 rats. The creatinine-corrected homoarginine excretion was twofold lower in the O-ZSF1 rats. We also observed distinct associations between the concentrations of serum glucose and urinary amino acids including their PTM and AGE metabolites in the L-ZSF1 and O-ZSF1 rats. Our study shows that PTM metabolites and AGEs are consistently lower in the L-ZSF1 than in the O-ZSF1 rats. Serum malondialdehyde (MDA) concentration was higher in the O-ZSF1 rats. These results suggest that hyperglycemia, hyperlipidemia and elevated oxidative stress in the O-ZSF1 rats favor PTM methylation of arginine and lysine and the glycation of lysine and cysteine. The area under the receiver operation characteristic (ROC) curve values were 0.996 for serum glucose, 0.951 for urinary creatinine, 0.939 for serum MDA, 0.885 for Nε-carboxyethyl-lysine, 0.830 for carboxyethyl-cysteine, and 0.792 for monomethyl-lysine. Non-invasive measurement of methylation and glycation products of arginine, lysine and cysteine residues in proteins in urine of L-ZSF1 and O-ZSF1 rats may be useful in studying pathophysiology and pharmacology of HFpEF.
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Affiliation(s)
- Svetlana Baskal
- Institute of Toxicology, Hannover Medical School, Core Unit Proteomics, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Petra Büttner
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Sarah Werner
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Dimitrios Tsikas
- Institute of Toxicology, Hannover Medical School, Core Unit Proteomics, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany.
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10
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Jaconiano E, Moreira-Gonçalves D. Unveiling the role of exercise training in targeting the inflammatory paradigm of heart failure with preserved ejection fraction: a narrative review. Heart Fail Rev 2021; 27:163-190. [PMID: 34244870 DOI: 10.1007/s10741-021-10138-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 12/30/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is currently lacking an effective pharmacological treatment with impact on major outcomes such as hospitalization and mortality. Exercise training (EXT) is recognized as an important nonpharmacological tool, capable of improving exercise capacity and quality of life, and has even been associated with a reduction in hospitalization and cardiovascular mortality risk. However, this positive impact largely lacks a physiological explanation. The aim of this narrative review was to provide an overview of the available data supporting the hypothesis that the beneficial role of EXT in HFpEF might be due to its effects on targeting the inflammatory paradigm described for this disease. A comprehensive literature search was conducted using the PubMed-NCBI database. We reviewed the effects of EXT throughout each step of the pathophysiological pathway leading to HFpEF and found clinical and/or preclinical evidence supporting the reduction of systemic inflammation, endothelial dysfunction, microvascular rarefaction, and myocardial stiffness. We also highlighted some gaps in the knowledge or topics that deserve further clarification in future studies. In conclusion, despite the scarcity of clinical studies in this population, there is compelling evidence suggesting that EXT modulates crucial aspects of the inflammatory pathway described for HFpEF and future investigation on cellular and molecular mechanisms are encouraged.
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Affiliation(s)
- Eliane Jaconiano
- Cardiovascular R&D Center (UnIC) and Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Daniel Moreira-Gonçalves
- Centre of Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
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11
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Wołyniec W, Kasprowicz K, Giebułtowicz J, Korytowska N, Zorena K, Bartoszewicz M, Rita-Tkachenko P, Renke M, Ratkowski W. Changes in Water Soluble Uremic Toxins and Urinary Acute Kidney Injury Biomarkers After 10- and 100-km Runs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214153. [PMID: 31661892 PMCID: PMC6862582 DOI: 10.3390/ijerph16214153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022]
Abstract
Acute kidney injury (AKI) is described as a relatively common complication of exercise. In clinical practice the diagnosis of AKI is based on serum creatinine, the level of which is dependent not only on glomerular filtration rate but also on muscle mass and injury. Therefore, the diagnosis of AKI is overestimated after physical exercise. The aim of this study was to determine changes in uremic toxins: creatinine, urea, uric acid, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), trimethylamine N-oxide (TMAO) and urinary makers of AKI: albumin, neutrophil gelatinase-associated lipocalin (uNGAL), kidney injury molecule-1 and cystatin-C (uCyst-C) after long runs. Sixteen runners, mean age 36.7 ± 8.2 years, (2 women, 14 men) participating in 10- and 100-km races were studied. Blood and urine were taken before and after the races to assess markers of AKI. A statistically significant increase in creatinine, urea, uric acid, SDMA and all studied urinary AKI markers was observed. TMAO and ADMA levels did not change. The changes in studied markers seem to be a physiological reaction, because they were observed almost in every runner. The diagnosis of kidney failure after exercise is challenging. The most valuable novel markers which can help in post-exercise AKI diagnosis are uCyst-C and uNGAL.
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Affiliation(s)
- Wojciech Wołyniec
- Department of Occupational, Metabolic and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | - Katarzyna Kasprowicz
- Department of Biology, Ecology and Sports Medicine, Gdańsk University of Physical Education and Sport, 80-336 Gdańsk, Poland.
| | - Joanna Giebułtowicz
- Department of Bioanalysis and Drug Analysis, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Natalia Korytowska
- Department of Bioanalysis and Drug Analysis, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Katarzyna Zorena
- Department of Biology Ecology and Sport Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | - Maria Bartoszewicz
- Department of Biology Ecology and Sport Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | | | - Marcin Renke
- Department of Occupational, Metabolic and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland.
| | - Wojciech Ratkowski
- Department of Athletics, Department of Athletics, Gdańsk University of Physical Education and Sport, 80-336 Gdańsk, Poland.
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