Changes in intercellular electrical coupling of smooth muscle accompanying atrophy and hypertrophy

Effect of Body Mass Index on the sensitivity of Magnetogastrogram and Electrogastrogram

AIM

Gastric disorders affect the gastric slow wave. The cutaneous electrogastrogram (EGG) evaluates the electrical potential of the slow wave but is limited by the volume conduction properties of the abdominal wall. The magnetogastrogram (MGG) evaluates the gastric magnetic field activity and is not affected as much by the volume conductor properties of the abdominal wall. We hypothesized that MGG would not be as sensitive to body mass index as EGG.

METHODS

We simultaneously recorded gastric slow wave signals with mucosal electrodes, a Superconducting Quantum Interference Device magnetometer (SQUID) and cutaneous electrodes before and after a test meal. Data were recorded from representative pools of human volunteers. The sensitivity of EGG and MGG was compared to the body mass index and waist circumference of volunteers.

RESULTS

The study population had good linear regression of their Waist circumference (Wc) and Body Mass Index (BMI) (regression coefficient, R=0.9). The mean BMI of the study population was 29.2 ±1.8 kgm^-2 and mean Wc 35.7±1.4 inch. We found that while subjects with BMI≥25 showed significant reduction in post-prandial EGG sensitivity, only subjects with BMI≥30 showed similar reduction in post-prandial MGG sensitivity. Sensitivity of SOBI "EGG and MGG" was not affected by the anthropometric measurements.

CONCLUSIONS

Compared to electrogastrogram, the sensitivity of the magnetogastrogram is less affected by changes in body mass index and waist circumference. The use of Second Order Blind Identification (SOBI) increased the sensitivity of EGG and MGG recordings and was not affected by BMI or waist circumference.

Advances in brain targeting and drug delivery of anti-HIV therapeutic agents

INTRODUCTION

Human immunodeficiency virus (HIV) is a neurotropic virus that enters the central nervous system (CNS) early in the course of infection. Although antiretroviral drugs are able to eliminate the majority of the HIV virus in the bloodstream, however, no specific treatment currently exist for CNS infections related to HIV. This is mainly attributed to the poor penetrability of antiretroviral therapy across the blood-brain barrier (BBB), and the protective nature of the BBB. Therefore, in order to increase the efficacy of anti-HIV drugs, novel drug delivery methodologies that can exhibit activity in the CNS are most needed and warranted.

AREAS COVERED

In this review article, the authors discussed the challenges with delivering drugs to the brain especially under HIV infection pathophysiology status. Also, they discussed the approaches currently being investigated to enhance brain targeting of anti-HIV drugs. A literature search was performed to cover advances in major approaches used to enhance drug delivery to the brain.

EXPERT OPINION

If drugs could reach the CNS in sufficient quantity by the methodologies discussed, mainly through intranasal administration and the utilization of nanotechnology, this could generate interest in previously abandoned therapeutic agents and enable an entirely novel approach to CNS drug delivery.

Functional assessment of the bladder

The urinary bladder has two functions: to store and to empty. A frequency-volume chart completed by the patient provides useful information about voiding intervals, possible factors provocative for incontinence, functional bladder capacity and daily urine volume. Filling cystometry is used primarily to evaluate reflex function in the storage phase, giving information about the presence or absence of detrusor instability and (in combination with urethral EMG) about detrusor-sphincter coordination. Information is also obtained about bladder sensation, bladder capacity and bladder compliance. Detrusor function during emptying is closely related to outflow conditions and therefore demands simultaneous registration of detrusor pressure and urinary flow rate. An inverse relation exists between detrusor pressure and flow rate, which means that reduced flow rate causes increased detrusor pressure for the same detrusor power. Underactive detrusor function will result in low detrusor pressure and low flow rate. The finding of a non-contractile detrusor may indicate psychogenic inhibition or a neurogenic lesion. Sacral evoked potentials and denervation supersensitivity tests may help to distinguish between these conditions.

Magnetogastrographic detection of gastric electrical response activity in humans

The detection and characterization of gastric electrical activity has important clinical applications, including the early diagnosis of gastric diseases in humans. In mammals, this phenomenon has two important features: an electrical control activity (ECA) that manifests itself as an electric slow wave (with a frequency of 3 cycles per minute in humans) and an electrical response activity (ERA) that is characterized by spiking potentials during the plateau phase of the ECA. Whereas the ECA has been recorded in humans both invasively and non-invasively (magnetogastrography-MGG), the ERA has never been detected non-invasively in humans before. In this paper, we report on our progress towards the non-invasive detection of ERA from the human stomach using a procedure that involves the application of principal component analysis to MGG recordings, which were acquired in our case from ten normal human patients using a Superconducting QUantum Interference Device (SQUID) magnetometer. Both pre- and post-prandial recordings were acquired for each patient and 20 min of recordings (10 min of pre-prandial and 10 min of post-prandial data) were analysed for each patient. The mean percentage of ECA slow waves that were found to exhibit spikes of suspected ERA origin was 41% and 61% for pre- and post-prandial recordings, respectively, implying a 47% ERA increase post-prandially (P < 0.0001 at a 95% confidence level). The detection of ERA in humans is highly encouraging and points to the possible use of non-invasive ERA recordings as a valuable tool for the study of human gastric disorders.

Multiscale modelling of human gastric electric activity: can the electrogastrogram detect functional electrical uncoupling?

During recent years there has been a growing interest in the assessment of gastric electrical health through cutaneous abdominal recordings. The analysis of such recordings is largely limited to an inspection of frequency dynamics, and this has raised doubts as to whether functional gastric electrical uncoupling can be detected using this technique. We describe here a computational approach to the problem in which the equations governing the underlying physics of the problem have been solved over an anatomically detailed human torso geometry. Cellular electrical activity was embedded within a stomach tissue model, and this was coupled to the torso using an equivalent current source approach. Simulations were performed in which normal and functionally uncoupled (through the introduction of an ectopic antral pacemaker) gastric slow wave activity was present, and corresponding cutaneous electrogastrograms were produced. These were subsequently analysed using the currently recommended techniques, and it was found that the functionally uncoupled situation was indistinguishable from normal slow wave activity using this approach.

Artifact reduction in magnetogastrography using fast independent component analysis

The analysis of magnetogastrographic (MGG) signals has been limited to epochs of data with limited interference from extraneous signal components that are often present and may even dominate MGG data. Such artifacts can be of both biological (cardiac, intestinal and muscular activities, motion artifacts, etc) and non-biological (environmental noise) origin. Conventional methods-such as Butterworth and Tchebyshev filters-can be of great use, but there are many disadvantages associated with them as well as with other typical filtering methods because a large amount of useful biological information can be lost, and there are many trade-offs between various filtering methods. Moreover, conventional filtering cannot always fully address the physicality of the signal-processing problem in terms of extracting specific signals due to particular biological sources of interest such as the stomach, heart and bowel. In this paper, we demonstrate the use of fast independent component analysis (FICA) for the removal of both biological and non-biological artifacts from multi-channel MGG recordings acquired using a superconducting quantum intereference device (SQUID) magnetometer. Specifically, we show that the signal of gastric electrical control activity (ECA) can be isolated from SQUID data as an independent component even in the presence of severe motion, cardiac and respiratory artifacts. The accuracy of the method is analyzed by comparing FICA-extracted versus electrode-measured respiratory signals. It is concluded that, with this method, reliable results may be obtained for a wide array of magnetic recording scenarios.

Changes in cell-to-cell electrical coupling associated with left ventricular hypertrophy

The impedance to current flow in the intracellular compartment of guinea pig left ventricular myocardium was measured at 20 degrees C and 37 degrees C using tissue from hypertrophied hearts subjected to aortic constriction. Alternating current of varying frequency was passed longitudinally along myocardial preparations, which revealed two time constants: one attributed to the surface membrane at the ends of the preparation and a second lying in the intracellular pathway. The longitudinal impedance was quantitatively analyzed in terms of a parallel intracellular and extracellular pathway; the former had two series components, one attributable to the sarcoplasm and the other to the low-resistance junctions between adjacent cells. This interpretation was consistent (1) with control experiments using n-heptanol, which increased the component attributed to intercellular junctions but not sarcoplasmic resistivity, and (2) with suspensions of isolated myocytes, which yielded a similar value for the sarcoplasmic resistivity. Aortic constriction increased the heart weight-to-body weight ratio of experimental animals from a mean value of 3.10 +/- 0.28 to 5.05 +/- 0.83 g/kg after 50 days of constriction and 5.60 +/- 0.95 g/kg after 150 days of constriction. An increase of heart weight-to-body weight ratio at 150 days of constriction was associated with an increased intracellular resistivity, which could be attributed solely to an increase of the junctional resistance between adjacent cells by approximately 44% at 20 degrees C and 140% at 37 degrees C; the sarcoplasmic resistivity was unchanged. The results are discussed in terms of altered conduction in hypertrophied myocardium as a possible basis for arrhythmias in this tissue.

Smooth muscle adaptation after intestinal transection and resection

Changes in motor function occur in the intestinal remnant after intestinal resection. Smooth muscle adaptation also occurs, particularly after extensive resection. The time course of these changes and their interrelationship are unclear. Our aim was to evaluate changes in canine smooth muscle structure and function during intestinal adaptation after transection and resection. Twenty-five dogs underwent either transection (N = 10), 50% distal resection (N = 10), or 50% proximal resection (N = 5). Thickness and length of the circular (CM) and longitudinal (LM) muscle layers were measured four and 12 weeks after resection. In vitro length-tension properties and response to a cholinergic agonist were studied in mid-jejunum and mid-ileum. Transection alone caused increased CM length in the jejunum proximal to the transection but did not affect LM length or muscle thickness. A 50% resection resulted in increased length of CM throughout the intestine and thickening of CM and LM near the anastomosis. Active tension of jejunal CM increased transiently four weeks after resection. Active tension in jejunal LM was decreased 12 weeks after transection and resection. Sensitivity of CM to carbachol was similar after transection and resection. It is concluded that: (1) Structural adaptation of both circular and longitudinal muscle occurs after intestinal resection. (2) This process is influenced by the site of the intestinal remnant. (3) Only minor and transient changes occur in smooth muscle function after resection. (4) Factors other than muscle adaptation are likely involved in the changes in motor function seen following massive bowel resection.

Branched-chain 2-oxo acid dehydrogenase complex activation by tetanic contractions in rat skeletal muscle

Branched-chain 2-oxo acid dehydrogenase complex in rat skeletal muscle was activated by muscle contractions elicited by electrical stimulation. This activation was attributed to dephosphorylation of the phosphorylated enzyme complex, and the total enzyme activity was not altered by muscle contractions. The activation of the enzyme complex occurred in the muscle of the electrically stimulated leg, but not in the muscle of the non-stimulated (control) leg, indicating that blood components are not involved in the mechanism of the enzyme activation in the muscle. Adenine nucleotides, branched-chain amino and 2-oxo acids and lactate in the muscle were determined as possible factors modulating the enzyme complex activity through inhibition of branched-chain 2-oxo acid dehydrogenase kinase activity. The profile of enzyme activation induced by muscle contractions was different from the alteration of the adenine nucleotide concentrations but was similar to the alteration of the concentrations of branched-chain amino and 2-oxo acids in the muscle. The lactate concentration in the stimulated muscle was elevated 3-5-fold during the contractions, indicating intracellular acidification. Previous studies have shown that the 2-oxo acid derived from leucine is a potent inhibitor of the kinase. These results suggest that intracellular branched-chain 2-oxo acids increased by muscle contractions accumulate in the mitochondria due to exercise-induced acidification of the muscle cell, resulting in activation of branched-chain 2-oxo acid dehydrogenase complex by inhibition of the kinase.

Hypertrophy of visceral smooth muscle

Smooth muscles of viscera undergo a large increase in volume when there is a chronic, partial obstruction impairing the flow of lumenal contents. Hypertrophy of smooth muscle occurs in various medical conditions and several methods are available for inducing it experimentally in laboratory animals, especially in urinary bladder, small intestine and ureter. The hypertrophic response differs somewhat with the type of organ, the animal species, the age of the subject, and the experimental procedure. Ten- to fifteen-fold increases in muscle volume develop within a few weeks in the urinary bladder or the ileum of adult animals, a growth that would not have occurred in the lifespan of the animal without the experimental intervention. The general architecture of the muscle and the boundaries with adjacent tissues are well preserved. In intestinal hypertrophy, muscle cells increase in number: mitoses are found in mature, fully differentiated muscle cells. Cell division by full longitudinal splitting of muscle cells may also occur. Enlargement of muscle cells accounts for most of the muscle hypertrophy. The hypertrophic muscle cell has an irregular profile with deep indentations of the cell membrane, bearing caveolae and dense bands; however, the cell surface grows less than the cell volume (reduction of surface-to-volume ratio). The nucleus is crenated and is much less enlarged than the cell (reduction of the nucleo-plasmatic ratio). Mitochondria grow in number but in some muscles their spatial density decreases; intermediate filaments increase more than myofilaments. The spatial density of sarcoplasmic reticulum is generally increased. In the hypertrophic intestine, gap junctions increase in number and size; in the bladder, gap junctions are absent both in control and in hypertrophy. Thus the hypertrophic muscle cell is not only larger than a control cell, but has a different pattern of its structural components. Extensive neo-angiogenesis maintains a good blood supply to the hypertrophic muscle. The density of innervation is much decreased in the hypertrophic intestine, whereas it appears well maintained in the bladder. Neuronal enlargement is found in the intramural ganglia of the intestine and in the pelvic ganglion. The mechanisms involved in hypertrophic growth are unknown. Three possible factors, mechanical factors, especially stretch, altered nerve discharge, and trophic factors are discussed.