Low frequency chronic electrical stimulation of normal and dystrophic chicken muscle

Modeling neuromuscular diseases in zebrafish

Neuromuscular diseases are a diverse group of conditions that affect the motor system and present some overlapping as well as distinct clinical manifestations. Although individually rare, the combined prevalence of NMDs is similar to Parkinson's. Over the past decade, new genetic mutations have been discovered through whole exome/genome sequencing, but the pathogenesis of most NMDs remains largely unexplored. Little information on the molecular mechanism governing the progression and development of NMDs accounts for the continual failure of therapies in clinical trials. Different aspects of the diseases are typically investigated using different models from cells to animals. Zebrafish emerges as an excellent model for studying genetics and pathogenesis and for developing therapeutic interventions for most NMDs. In this review, we describe the generation of different zebrafish genetic models mimicking NMDs and how they are used for drug discovery and therapy development.

Beneficial impacts of neuromuscular electrical stimulation on muscle structure and function in the zebrafish model of Duchenne muscular dystrophy

Neuromuscular electrical stimulation (NMES) allows activation of muscle fibers in the absence of voluntary force generation. NMES could have the potential to promote muscle homeostasis in the context of muscle disease, but the impacts of NMES on diseased muscle are not well understood. We used the zebrafish Duchenne muscular dystrophy (dmd) mutant and a longitudinal design to elucidate the consequences of NMES on muscle health. We designed four neuromuscular stimulation paradigms loosely based on weightlifting regimens. Each paradigm differentially affected neuromuscular structure, function, and survival. Only endurance neuromuscular stimulation (eNMES) improved all outcome measures. We found that eNMES improves muscle and neuromuscular junction morphology, swimming, and survival. Heme oxygenase and integrin alpha7 are required for eNMES-mediated improvement. Our data indicate that neuromuscular stimulation can be beneficial, suggesting that the right type of activity may benefit patients with muscle disease.

Chronic electrical stimulation reduces reliance on anaerobic metabolism in locust jumping muscle

Chronic electrical stimulation (CES) is a well-documented method for changing mammalian muscle from more fast-twitch to slow-twitch metabolic and contractile profiles. Although both mammalian and insect muscles have many similar anatomical and physiological properties, it is unknown if CES produces similar muscle plasticity changes in insects. To test this idea, we separated Schistocerca americana grasshoppers into two groups (n = 37 to 47): one that was subjected to CES for 180 min each day for five consecutive days and one group that was not. Each group was then electrically stimulated for a single time period (0, 5, 30, 60, or 180 min) before measuring jumping muscle lactate, a characteristic of fast-twitch type fibers. At each time point, CES led to a significantly reduced jumping muscle lactate concentration. Based on similar short-term CES mammalian studies, the reduction in lactate production was most likely due to a reduced reliance on anaerobic metabolism. Thus, longer stimulation periods should result in greater aerobic enzymatic activities, altered myosin ATPase, and shift fiber types. This is the first study to use electrical stimulation to explore insect muscle plasticity and our results show that grasshopper jumping muscle responds similarly to mammalian muscle.

Electrically induced muscle cramps induce hypertrophy of calf muscles in healthy adults

OBJECTIVES

Skeletal muscles usually cramp at short lengths, where the tension that can be exerted by muscle fibers is low. Since high tension is an important anabolic stimulus, it is questionable if cramps can induce hypertrophy and strength gains. In the present study we investigated if electrically induced cramps (EIMCs) can elicit these adaptations.

METHODS

15 healthy male adults were randomly assigned to an intervention (IG; n=10) and a control group (CG; n=5). The cramp protocol (CP) applied twice a week to one leg of the IG, consisted of 3x6 EIMCs, of 5 s each. Calf muscles of the opposite leg were stimulated equally, but were hindered from cramping by fixating the ankle at 0° plantar flexion (nCP).

RESULTS

After six weeks, the cross sectional area of the triceps surae was similarly increased in both the CP (+9.0±3.4%) and the nCP (+6.8±3.7%). By contrast, force of maximal voluntary contractions, measured at 0° and 30° plantar flexion, increased significantly only in nCP (0°: +8.5±8.8%; 30°: 11.7±13.7%).

CONCLUSION

The present data indicate that muscle cramps can induce hypertrophy in calf muscles, though lacking high tension as an important anabolic stimulus.

Adaptive change in electrically stimulated muscle: a framework for the design of clinical protocols

Adult mammalian skeletal muscles have a remarkable capacity for adapting to increased use. Although this behavior is familiar from the changes brought about by endurance exercise, it is seen to a much greater extent in the response to long-term neuromuscular stimulation. The associated phenomena include a markedly increased resistance to fatigue, and this is the key to several clinical applications. However, a more rational basis is needed for designing regimes of stimulation that are conducive to an optimal outcome. In this review I examine relevant factors, such as the amount, frequency, and duty cycle of stimulation, the influence of force generation, and the animal model. From these considerations a framework emerges for the design of protocols that yield an overall functional profile appropriate to the application. Three contrasting examples illustrate the issues that need to be addressed clinically.

Application of Animal Models: Chronic Electrical Stimulation-Induced Contractile Activity

Unilateral, chronic low-frequency electrical stimulation (CLFS) is an experimental model that evokes numerous biochemical and physiological adaptations in skeletal muscle. These occur within a short time frame and are restricted to the stimulated muscle. The humoral effects of whole body exercise are eliminated and the nonstimulated contralaterai limb can often be used as a control muscle, if possible effects on the contralateral side are considered. CLFS induces a fast-to-slow transformation of muscle because of alterations in calcium dynamics and myofibrillar proteins, and a white-to-red transformation because of changes in mitochondrial enzymes, myoglobin, and the induction of angiogenesis. These adaptations occur in a coordinated time-dependent manner and result from altered gene expression, including transcriptional and posttranscriptional processes. CLFS techniques have also been applied to myocytes in cell culture, which provide a greater opportunity for the delivery of pharmacological agents or for the application of gene transfer methodologies. Clinical applications of the CLFS technique have been limited, but they have shown potential therapeutic value in patients in whom voluntary muscle contraction is not possible due to debilitating disease and/or injury. Thus the CLFS technique has great value for studying various aspects of muscle adaptation, and its wider scientific application to a variety of neuromuscular-based disorders in humans appears to be warranted. Key words: skeletal muscle, muscle plasticity, endurance training, mitochondrial biogenesis, fiber types

The dose-related response of rabbit fast muscle to long-term low-frequency stimulation

Rabbit tibialis anterior muscles were stimulated continuously at 2.5 Hz, 5 Hz, or 10 Hz for 10 months. The resulting adaptive transformation was dose-related for contractile speed, myosin isoform composition, and enzyme activities. The "fast-oxidative" state produced by stimulation at 2.5 Hz was stable: even after 10 months, 84% of the fibers were of type 2A. Absence of a secondary decline in oxidative activity in these muscles provided strong evidence of a causal link between myosin transitions and metabolic adaptation. Significant fiber loss occurred only after prolonged stimulation at 10 Hz. The myosin isoform composition of individual muscles stimulated at 5 Hz resembled that of muscles stimulated at either the lower or the higher frequency, behavior consistent with a threshold for fiber type change. In clinical applications such as cardiomyoplasty, muscles could be used more effectively by engineering their properties to combine speed and power of contraction with the necessary resistance to fatigue.

The input-output relations of skeletal muscle

We used three approaches to determine the stimulation patterns that maximize the isometric force-time integral per impulse (FTIpP) available from tibialis anterior muscles of the rabbit. Initially the interval between two pulses was fixed at the value that gave the maximum force-time integral, and successive pulses were added at intervals that maximized the FTIpP. We checked this iterative approach by a second method, in which a computer-generated protocol was used to deliver randomized bursts to the muscles. These experiments confirmed that optimal stimulation patterns for fast muscles consisted of an initial high-frequency portion followed by a train of impulses at a lower frequency. However, for muscles that had been stimulated chronically at a constant low frequency, an initial high-frequency portion conferred no advantage. In a third set of experiments we used constant-frequency bursts to generate contour surfaces that represented the dependence of FTIpP on the frequency and number of impulses. The results agreed with those from the earlier methods. We conclude that optimized patterns have potential for clinical use, but their value will depend strongly on the activation characteristics of the stimulated muscle.

Power production and working capacity of rabbit tibialis anterior muscles after chronic electrical stimulation at 10 Hz

1. The muscles of the distal anterior compartment of the left hindlimb of rabbits were subjected to continuous indirect electrical stimulation at 10 Hz for periods of up to 12 weeks by means of an implantable stimulator. 2. The maximum shortening velocity (Vmax) and the velocity for maximum power production in single contractions (Vopt) were reduced to 42% and 32% of control values respectively after 12 weeks of stimulation. The rate of change of these parameters was greatest between the second and sixth week of stimulation. These changes, it is suggested, reflect the documented time course of the replacement of fast with slow isoforms of myosin. 3. The reductions in force production and speed of the stimulated muscles combined to produce a marked, progressive decline in the maximum power produced in single contractions. After 8 weeks of stimulation, the maximum power output had fallen to less than 10% of the control value. 4. The fatigue resistance of the stimulated and control muscles was tested over several hours of cyclical shortening contractions designed to elicit an initial power output of 10 W kg-1 with the muscles set to contract at Vopt. This level of work output represented about 1.6% (control) and 25% (12-week-stimulated) of the absolute maximum power output achieved during single contractions. 5. Despite the large reduction in the maximum power output of single contractions, the stimulated muscles showed less than 10% reduction in their power output during the fatigue tests over periods of up to 7 h. The control muscles showed a 70% reduction over the same period. There was no difference in the fatigue resistance under this protocol between muscles stimulated for 2 weeks and those stimulated for longer periods. Transformation of myosin isoforms, which is known to occur later than 2 weeks after the start of stimulation, is not necessary for the induction of this degree of fatigue resistance.

Basic studies on skeletal muscle for cardiac assistance

It is well recognized that skeletal muscle is incapable of maintaining the continuous power output needed for significant circulatory assistance unless it is rendered fatigue resistant by electrical stimulation. Most studies using conditioning patterns related to the pumping rate of the natural heart have suggested that such patterns can produce complete transformation to a slow phenotype. Such a transformation has two undesirable accompaniments: a reduction in the contractile speed of the muscle and an extreme reduction in its power-generating capacity. We have investigated the chronic effect on rabbit muscle of intermittent high frequency contractions either alone or overlaid on a continuous background of 10 Hz. If the amount of stimulation were the overriding stimulus for transformation, then the rate and/or extent of transformation should, if anything, be greater with the additional activation. If, on the other hand, components of the transformation could be modulated independently by the pattern of impulses, then the reduction in power output might be avoided to some extent by a pattern somewhat analogous to a strength-training exercise regime. Our results suggest that high force contractions may indeed preserve power output without compromising the acquisition of fatigue resistance.

Effects of electrically induced contractile activity on cultured embryonic chick breast muscle cells

Development of chicken breast muscle is characterized by the sequential appearance of six electrophoretically distinct myosin heavy chain (HC) isoforms. Cultured secondary myotubes, derived from 12-day embryonic chick breast muscle, mainly express the early embryonic HC isoform HCemb/e, normally present in 8-day embryonic breast muscle, and the two fast light chain isoforms LC1f and LC2f. Direct low-frequency (2.5 Hz) stimulation of these myotubes via platinum electrodes leads to a shift in myosin HC expression with increases in the late embryonic HC isoform HCemb/l amounting to 35% of total HC in 19-day-stimulated cultures. Measurements of 35S-methionine incorporation and immunohistochemical analyses demonstrate increases in LC3f. This increase is also seen at the mRNA level. These results indicate that induced contractile activity promotes myotube maturation in vitro. The observation that chronic stimulation enhances the expression of the slow isoform LC2s at the RNA, as well as the protein level, suggests an additional effect consisting of a fast-to-slow change in phenotype expression. In view of the fact that muscle maturation and phenotype expression is under neural control during development in vivo, our results on directly stimulated, aneural myotubes indicate that neurally transmitted contractile activity may be an important factor in modulating phenotype expression of secondary myotubes.

Treadmill exercise training increases the oxidative capacity of chicken iliotibialis muscle

The number of fibers staining for the oxidative enzyme succinic dehydrogenase (SDH) was measured in the iliotibialis lateralis caudalis muscle of the domestic fowl before treadmill training and after 6 wk and 15 wk of training, respectively. This leg muscle contains exclusively fast-twitch or type II fibers, and before exercise training approximately 40% of these stained intensely for SDH. After 6 and 15 wk training this proportion rose to approximately 50 and 60%, respectively. Most of these highly oxidative fibers also stained weakly for the glycolytic enzyme alpha-glycerophosphate dehydrogenase (alpha-GPDH) and belonged to the fast-twitch oxidative category. Most of the poorly oxidative fibers stained strongly for alpha-GPDH and therefore belonged to the fast-twitch glycolytic category. It is concluded that exercise training in birds can bring about adaptive changes in the oxidative capacity of skeletal muscle similar to those that have been observed in man and other mammals.

Oxidative stress and muscular dystrophy

Oxidative stress may be the fundamental basis of many of the structural, functional and biochemical changes characteristic of the inherited muscular dystrophies in animals and humans. The presence of by-products of oxidative damage, and the compensatory increases in cellular antioxidants, both indicate oxidative stress may be occurring in dystrophic muscle. Changes in the proportions and metabolism of cellular lipids, abnormal functions of cellular membranes, altered activity of membrane-bound enzymes such as the SR Ca2+-ATPase, disturbances in cellular protein turnover and energy production and a variety of other changes all indicate that these inherited muscular dystrophies appear more like the results of oxidative stress to muscle than any other type of underlying muscle disturbance. Particular details of these altered characteristics of dystrophic muscle, in combination with current knowledge on the processes of oxidative damage to cells, may provide some insight into the underlying biochemical defect responsible for the disease, as well as direct research towards the ultimate goal of an effective treatment.