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Nishibe T, Dardik A, Akiyama S, Kano M, Fukuda S, Koizumi J, Nishibe M. Reduced Muscle Mass and Muscle Quality in Patients with Intermittent Claudication due to Peripheral Artery Disease. Ann Vasc Surg 2024; 105:275-281. [PMID: 38570014 DOI: 10.1016/j.avsg.2023.12.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 04/05/2024]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is associated with reduced muscle mass and quality, but the effects of leg ischemia caused by PAD on muscle quality remain poorly understood. The purpose of this study was to evaluate leg muscle mass and muscle quality in patients with intermittent claudication due to PAD using bioelectrical impedance analysis (BIA). METHODS One hundred forty-one patients with intermittent claudication due to PAD who visited Tokyo Medical University Hospital from April 2019 to April 2020 were retrospectively analyzed. Leg ischemia was assessed using ankle-brachial pressure index (ABI). The skeletal muscle mass (SMM) assessed leg muscle mass, while the phase angle (PhA) assessed leg muscle quality using BIA. RESULTS A total of 282 legs in 141 patients were included in the analysis. Leg PhA and SMM showed a decreasing trend according to the severity of leg ischemia (borderline/no ischemia: 2.80 ± 0.50 kg/m2, 4.38 ± 0.94°; mild ischemia: 2.83 ± 0.49 kg/m2, 4.33 ± 1.03°; moderate/severe ischemia: 2.50 ± 0.40 kg/m2, 3.89 ± 0. 88°; P < 0.001 and P = 0.020, respectively). The ABI was moderately correlated with leg SMM (B = 0.347, β = 0.134, P < 0.001) and leg PhA (B = 0.577, β = 0.111, P = 0.013) after adjustment for all significant covariates. Leg PhA was moderately correlated with leg SMM (r = 0.318, P < 0.001). CONCLUSIONS Leg ischemia, especially when moderate or severe, has an adverse effect on both muscle mass and quality in the lower extremities and is associated with skeletal muscle myopathy.
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Affiliation(s)
- Toshiya Nishibe
- Faculty of Medical Informatics, Hokkaido Information University, Ebetsu, Hokkaido, Japan; Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Shinobu Akiyama
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shoji Fukuda
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Jun Koizumi
- Department of Radiology, Chiba University School of Medicine, Chiba, Japan
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Fletcher E, Miserlis D, Sorokolet K, Wilburn D, Bradley C, Papoutsi E, Wilkinson T, Ring A, Ferrer L, Haynatzki G, Smith RS, Bohannon WT, Koutakis P. Diet-induced obesity augments ischemic myopathy and functional decline in a murine model of peripheral artery disease. Transl Res 2023; 260:17-31. [PMID: 37220835 DOI: 10.1016/j.trsl.2023.05.002] [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] [Received: 04/17/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
Peripheral artery disease (PAD) causes an ischemic myopathy contributing to patient disability and mortality. Most preclinical models to date use young, healthy rodents with limited translatability to human disease. Although PAD incidence increases with age, and obesity is a common comorbidity, the pathophysiologic association between these risk factors and PAD myopathy is unknown. Using our murine model of PAD, we sought to elucidate the combined effect of age, diet-induced obesity and chronic hindlimb ischemia (HLI) on (1) mobility, (2) muscle contractility, and markers of muscle (3) mitochondrial content and function, (4) oxidative stress and inflammation, (5) proteolysis, and (6) cytoskeletal damage and fibrosis. Following 16-weeks of high-fat, high-sucrose, or low-fat, low-sucrose feeding, HLI was induced in 18-month-old C57BL/6J mice via the surgical ligation of the left femoral artery at 2 locations. Animals were euthanized 4-weeks post-ligation. Results indicate mice with and without obesity shared certain myopathic changes in response to chronic HLI, including impaired muscle contractility, altered mitochondrial electron transport chain complex content and function, and compromised antioxidant defense mechanisms. However, the extent of mitochondrial dysfunction and oxidative stress was significantly greater in obese ischemic muscle compared to non-obese ischemic muscle. Moreover, functional impediments, such as delayed post-surgical recovery of limb function and reduced 6-minute walking distance, as well as accelerated intramuscular protein breakdown, inflammation, cytoskeletal damage, and fibrosis were only evident in mice with obesity. As these features are consistent with human PAD myopathy, our model could be a valuable tool to test new therapeutics.
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Affiliation(s)
- Emma Fletcher
- Department of Biology, Baylor University, Waco, Texas
| | - Dimitrios Miserlis
- Department of Surgery, University of Texas at Austin Dell Medical School, Austin, Texas
| | | | - Dylan Wilburn
- Department of Health, Human Performance and Recreation, Baylor University, Waco, Texas
| | | | | | | | - Andrew Ring
- Department of Biology, Baylor University, Waco, Texas
| | - Lucas Ferrer
- Department of Surgery, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Gleb Haynatzki
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert S Smith
- Department of Surgery, Baylor Scott & White Medical Center, Temple, Texas
| | - William T Bohannon
- Department of Surgery, Baylor Scott & White Medical Center, Temple, Texas
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3
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Bellomo TR, Tsao NL, Johnston-Cox H, Borkowski K, Shakt G, Judy R, Moore J, Ractcliffe SJ, Fiehn O, Floyd TF, Wehrli FW, Mohler E, Newman JW, Damrauer SM. Metabolite patterns associated with individual response to supervised exercise therapy in patients with intermittent claudication. JVS Vasc Sci 2022; 3:379-388. [PMID: 36568282 PMCID: PMC9772856 DOI: 10.1016/j.jvssci.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Supervised exercise therapy (SET) is the first line treatment for intermittent claudication owing to peripheral arterial disease. Despite multiple randomized controlled trials proving the efficacy of SET, there are large differences in individual patient's responses. We used plasma metabolomics to identify potential metabolic influences on the individual response to SET. Methods Primary metabolites, complex lipids, and lipid mediators were measured on plasma samples taken at before and after Gardner graded treadmill walking tests that were administered before and after 12 weeks of SET. We used an ensemble modeling approach to identify metabolites or changes in metabolites at specific time points that associated with interindividual variability in the functional response to SET. Specific time points analyzed included baseline metabolite levels before SET, dynamic metabolomics changes before SET, the difference in pre- and post-SET baseline metabolomics, and the difference (pre- and post-SET) of the dynamic (pre- and post-treadmill). Results High levels of baseline anandamide levels pre- and post-SET were associated with a worse response to SET. Increased arachidonic acid (AA) and decreased levels of the AA precursor dihomo-γ-linolenic acid across SET were associated with a worse response to SET. Participants who were able to tolerate large increases in AA during acute exercise had longer, or better, walking times both before and after SET. Conclusions We identified two pathways of relevance to individual response to SET that warrant further study: anandamide synthesis may activate endocannabinoid receptors, resulting in worse treadmill test performance. SET may train patients to withstand higher levels of AA, and inflammatory signaling, resulting in longer walking times. Clinical Relevance This manuscript describes the use of metabolomic techniques to measure the interindividual effects of SET in patients with peripheral artery disease (PAD). We identified high levels of AEA are linked to CB1 signaling and activation of inflammatory pathways. This alters energy expenditure in myoblasts by decreasing glucose uptake and may induce an acquired skeletal muscle myopathy. SET may also help participants tolerate increased levels of AA and inflammation produced during exercise, resulting in longer walking times. This data will enhance understanding of the pathophysiology of PAD and the mechanism by which SET improves walking intolerance.
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Affiliation(s)
- Tiffany R. Bellomo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Noah L. Tsao
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Hillary Johnston-Cox
- Division of Cardiovascular Medicine, Department of Medicine, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamil Borkowski
- West Coast Metabolomics Center, University of California Davis, Davis, CA
| | - Gabrielle Shakt
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Renae Judy
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Jonni Moore
- Department of Pathology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Oliver Fiehn
- West Coast Metabolomics Center, University of California Davis, Davis, CA
| | - Thomas F. Floyd
- Departments of Anesthesiology and Pain Management, Cardiovascular Surgery, and Radiology, University of Texas Southwestern, Dallas, TX
| | - Felix W. Wehrli
- Department of Radiology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emile Mohler
- Division of Cardiovascular Medicine, Department of Medicine, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John W. Newman
- West Coast Metabolomics Center, University of California Davis, Davis, CA,Department of Nutrition, University of California, Davis, CA,Obesity and Metabolism Research Unit, USDA-ARS-Western Human Nutrition Research Center, Davis, CA
| | - Scott M. Damrauer
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA,Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Correspondence: Scott M. Damrauer, MD, Division of Vascular Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, 4 Silverstein, Philadelphia, PA 19104
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BAG3 Attenuates Ischemia-Induced Skeletal Muscle Necroptosis in Diabetic Experimental Peripheral Artery Disease. Int J Mol Sci 2022; 23:ijms231810715. [PMID: 36142618 PMCID: PMC9502689 DOI: 10.3390/ijms231810715] [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: 08/19/2022] [Revised: 09/05/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
Peripheral artery disease (PAD) is characterized by impaired blood flow to the lower extremities, resulting in ischemic limb injuries. Individuals with diabetes and PAD typically have more severe ischemic limb injuries and limb amputations, but the mechanisms involved are poorly understood. Previously, we identified BAG3 as a gene within a mouse genetic locus termed limb salvage QTL1 on mouse chromosome 7 that determined the extent of limb necrosis following ischemic injury in C57Bl/6 mice. Whether BAG3 deficiency plays a role in the severe ischemic injury observed in diabetic PAD is not known. In vitro, we found simulated ischemia enhanced BAG3 expression in primary human skeletal muscle cells, whereas BAG3 knockdown increased necroptosis markers and decreased cell viability. In vivo, ischemic skeletal muscles from hind limbs of high-fat diet (HFD)-fed mice showed poor BAG3 expression compared to normal chow diet (NCD)-fed mice, and this was associated with increased limb amputations. BAG3 overexpression in ischemic skeletal muscles from hind limbs of HFD mice rescued limb amputation and improved autophagy, necroptosis, skeletal muscle function and regeneration. Therefore, BAG3 deficiency in ischemic skeletal muscles contributes to the severity of ischemic limb injury in diabetic PAD, likely through autophagy and necroptosis pathways.
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The Role of Fatty Acid Binding Protein 3 in Cardiovascular Diseases. Biomedicines 2022; 10:biomedicines10092283. [PMID: 36140383 PMCID: PMC9496114 DOI: 10.3390/biomedicines10092283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Fatty acid binding proteins (FABPs) are proteins found in the cytosol that contribute to disorders related to the cardiovascular system, including atherosclerosis and metabolic syndrome. Functionally, FABPs serve as intracellular lipid chaperones, interacting with hydrophobic ligands and mediating their transportation to sites of lipid metabolism. To date, nine unique members of the FABP family (FABP 1–9) have been identified and classified according to the tissue in which they are most highly expressed. In the literature, FABP3 has been shown to be a promising clinical biomarker for coronary and peripheral artery disease. Given the rising incidence of cardiovascular disease and its associated morbidity/mortality, identifying biomarkers for early diagnosis and treatment is critical. In this review, we highlight key discoveries and recent studies on the role of FABP3 in cardiovascular disorders, with a particular focus on its clinical relevance as a biomarker for peripheral artery disease.
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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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7
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Ismaeel A, Lavado R, Koutakis P. Metabolomics of peripheral artery disease. Adv Clin Chem 2022; 106:67-89. [PMID: 35152975 DOI: 10.1016/bs.acc.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The science of metabolomics has emerged as a novel tool for studying changes in metabolism that accompany different disease states. Several studies have applied this evolving field to the study of various cardiovascular disease states, which has led to improved understanding of metabolic changes that underlie heart failure and ischemic heart disease. A significant amount of progress has also been made in the identification of novel biomarkers of cardiovascular disease. Another common atherosclerotic disease, peripheral artery disease (PAD) affects arteries of the lower extremities. Although certain aspects of the disease pathophysiology overlap with other cardiovascular diseases in general, PAD patients suffer unique manifestations that lead to significant morbidity and mortality as well as severe functional limitations. Furthermore, because over half of PAD patients are asymptomatic, there is a need for improved diagnostic and screening methods. Identification of metabolites associated with the disease may thus be a promising approach for PAD. However, PAD remains highly understudied. In this chapter, we discuss the application of metabolomics to the study of PAD.
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Affiliation(s)
- Ahmed Ismaeel
- Department of Biology, Baylor University, Waco, TX, United States
| | - Ramon Lavado
- Department of Environmental Science, Baylor University, Waco, TX, United States
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8
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Syed MH, Zamzam A, Khan H, Singh K, Forbes TL, Rotstein O, Abdin R, Eikelboom J, Qadura M. Fatty acid binding protein 3 is associated with peripheral arterial disease. JVS Vasc Sci 2021; 1:168-175. [PMID: 34617045 PMCID: PMC8489205 DOI: 10.1016/j.jvssci.2020.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/17/2020] [Indexed: 12/30/2022] Open
Abstract
Background Peripheral arterial disease (PAD) affects more than 150 million people worldwide and is associated with high rates of lower extremity amputation, myocardial infarction, stroke and death. Fatty acid binding protein 3 (FABP3) is released into circulation in patients with skeletal muscle injury. In this pilot study, we investigated a possible association between PAD and blood levels of FABP3. Methods Blood samples were collected from patients with clinical symptoms and diagnostic findings indicative of PAD (PAD group; ankle-brachial index [ABI] <0.9; n = 75) and in those without clinical or diagnostic features of PAD (non-PAD group; ABI >0.9; n = 75) presenting to vascular surgery ambulatory clinics at St. Michael's Hospital. Plasma samples were analyzed by protein multiplex to quantify FABP3 levels. Results PAD patients were found to have higher blood levels of FABP3 compared to patients without PAD (mean 3.90 ± 1.69 vs 2.03 ± 0.78; P < .001). A subgroup analysis demonstrated that the FABP3 levels were increased by almost two-fold in patients with PAD, independent of coronary artery disease (P < .001) or diabetes mellitus status (P < .001). Moreover, a significant negative correlation between FABP3 and the ABI was observed in PAD and patients without PAD matched groups (r = –0.51; P = .001). Last, immunohistochemistry demonstrated elevated expressions of FABP3 within skeletal muscle obtained from patients with the most severe form of PAD, chronic limb-threatening ischemia, when compared with patients without PAD. Conclusions Patients with PAD have elevated plasma levels of FABP3. An increasing severity of PAD is associated with higher FABP3 levels. There is a pressing need for a simple, readily accessible, blood-based biomarker for PAD. In this study, we found elevated levels of FABP3 in patients with PAD. This increase in FABP3 was irrespective of history of coronary artery disease or diabetes. Furthermore, our data suggest that an increasing severity of PAD is associated with higher FABP3 levels. Subsequently, FABP3 may be a potential diagnostic biomarker for PAD. However, further studies are needed to confirm the capability of FABP3 to serve as a valid and reliable biomarker for PAD.
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Affiliation(s)
- Muzammil H Syed
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hamzah Khan
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Krishna Singh
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ori Rotstein
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rawand Abdin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John Eikelboom
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
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9
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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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10
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Gratl A, Pesta D, Gruber L, Speichinger F, Raude B, Omran S, Greiner A, Frese JP. The effect of revascularization on recovery of mitochondrial respiration in peripheral artery disease: a case control study. J Transl Med 2021; 19:244. [PMID: 34088309 PMCID: PMC8178834 DOI: 10.1186/s12967-021-02908-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/24/2021] [Indexed: 12/24/2022] Open
Abstract
Background Peripheral arterial disease (PAD) is accompanied by myopathy characterized by mitochondrial dysfunction. The aim of this experimental study was to investigate the effect of revascularization procedures on mitochondrial function in ischemic and non-ischemic muscle. Methods Muscle biopsies from patients with symptomatic stage IIB/III PAD caused by isolated pathologies of the superficial femoral artery were obtained from muscle regions within the chronic ischemic muscle (gastrocnemius) and from non-ischemic muscle (vastus lateralis) before and 6 weeks after invasive revascularization. High-resolution respirometry was used to investigate mitochondrial function and results were normalized to citrate synthase activity (CSA). Results are given in absolute values and fold over basal (FOB). Results Respiratory states (OXPHOS (P) and electron transfer (E) capacity) normalized to CSA decreased while CSA was increased in chronic ischemic muscle after revascularization. There were no changes in in non-ischemic muscle. The FOB of chronic ischemic muscle was significantly higher for CSA (chronic ischemic 1.37 (IQR 1.10–1.64) vs. non-ischemic 0.93 (IQR 0.69–1.16) p = 0.020) and significantly lower for respiratory states normalized to CSA when compared to the non-ischemic muscle (P per CSA chronic ischemic 0.64 (IQR 0.46–0.82) vs non-ischemic 1.16 (IQR 0.77–1.54) p = 0.011; E per CSA chronic ischemic 0.61 (IQR 0.47–0.76) vs. non-ischemic 1.02 (IQR 0.64–1.40) p = 0.010). Conclusions Regeneration of mitochondrial content and function following revascularization procedures only occur in muscle regions affected by malperfusion. This indicates that the restoration of blood and oxygen supply are important mediators aiding mitochondrial recovery. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-02908-0.
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Affiliation(s)
- Alexandra Gratl
- Department of Vascular Surgery, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany.,Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik Pesta
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Department of Sports Science, Medical Section, Innsbruck, Austria.,German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fiona Speichinger
- Department of Vascular Surgery, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Ben Raude
- Department of Vascular Surgery, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Safwan Omran
- Department of Vascular Surgery, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Andreas Greiner
- Department of Vascular Surgery, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Jan Paul Frese
- Department of Vascular Surgery, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany.
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Shimotsu R, Hotta K, Ikegami R, Asamura T, Tabuchi A, Masamoto K, Yagishita K, Poole DC, Kano Y. Vascular permeability of skeletal muscle microvessels in rat arterial ligation model: in vivo analysis using two-photon laser scanning microscopy. Am J Physiol Regul Integr Comp Physiol 2021; 320:R972-R983. [PMID: 33949210 DOI: 10.1152/ajpregu.00135.2020] [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: 05/22/2020] [Accepted: 04/23/2021] [Indexed: 11/22/2022]
Abstract
Peripheral artery disease (PAD) in the lower limb compromises oxygen supply due to arterial occlusion. Ischemic skeletal muscle is accompanied by capillary structural deformation. Therefore, using novel microscopy techniques, we tested the hypothesis that endothelial cell swelling temporally and quantitatively corresponds to enhanced microvascular permeability. Hindlimb ischemia was created in male Wistar rat's by iliac artery ligation (AL). The tibialis anterior (TA) muscle microcirculation was imaged using intravenously infused rhodamine B isothiocyanate dextran fluorescent dye via two-photon laser scanning microscopy (TPLSM) and dye extravasation at 3 and 7 days post-AL quantified to assess microvascular permeability. The TA microvascular endothelial ultrastructure was analyzed by transmission electron microscopy (TEM). Compared with control (0.40 ± 0.15 μm3 × 106), using TPLSM, the volumetrically determined interstitial leakage of fluorescent dye measured at 3 (3.0 ± 0.40 μm3 × 106) and 7 (2.5 ± 0.8 μm3 × 106) days was increased (both P < 0.05). Capillary wall thickness was also elevated at 3 (0.21 ± 0.06 μm) and 7 (0.21 ± 0.08 μm) days versus control (0.11 ± 0.03 μm, both P < 0.05). Capillary endothelial cell swelling was temporally and quantitatively associated with elevated vascular permeability in the AL model of PAD but these changes occurred in the absence of elevations in protein levels of vascular endothelial growth factor (VEGF) its receptor (VEGFR2 which decreased by AL-7 day) or matrix metalloproteinase. The temporal coherence of endothelial cell swelling and increased vascular permeability supports a common upstream mediator. TPLSM, in combination with TEM, provides a sensitive and spatially discrete technique to assess the mechanistic bases for, and efficacy of, therapeutic countermeasures to the pernicious sequelae of compromised peripheral arterial function.
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Affiliation(s)
- Rie Shimotsu
- Department of Engineering Science, University of Electro-Communications, Chofu, Japan
| | - Kzuki Hotta
- Department of Engineering Science, University of Electro-Communications, Chofu, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Ikegami
- Department of Engineering Science, University of Electro-Communications, Chofu, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
- Department of Health Science, Health Science University, Yamanashi, Japan
| | - Tomoyo Asamura
- Department of Engineering Science, University of Electro-Communications, Chofu, Japan
| | - Ayaka Tabuchi
- Department of Engineering Science, University of Electro-Communications, Chofu, Japan
| | - Kazuto Masamoto
- Faculty of Informatics and Engineering, University of Electro-Communications, Chofu, Japan
- Center for Neuroscience and Biomedical Engineering (CNBE), University of Electro-Communications, Chofu, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Hyperbaric Medical Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - David C Poole
- Department of Anatomy and Physiology, Kansas State University, Manhattan, Kansas
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - Yutaka Kano
- Department of Engineering Science, University of Electro-Communications, Chofu, Japan
- Center for Neuroscience and Biomedical Engineering (CNBE), University of Electro-Communications, Chofu, Japan
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12
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Gait variability is affected more by peripheral artery disease than by vascular occlusion. PLoS One 2021; 16:e0241727. [PMID: 33788839 PMCID: PMC8011739 DOI: 10.1371/journal.pone.0241727] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Patients with peripheral artery disease with intermittent claudication (PAD-IC) have altered gait variability from the first step they take, well before the onset of claudication pain. The mechanisms underlying these gait alterations are poorly understood. Aims To determine the effect of reduced blood flow on gait variability by comparing healthy older controls and patients with PAD-IC. We also determined the diagnostic value of gait variability parameters to identify the presence of PAD. Methods A cross-sectional cohort design was used. Thirty healthy older controls and thirty patients with PAD-IC walked on a treadmill at their self-selected speed in pain free walking (normal walking for healthy older controls; prior to claudication onset for PAD) and reduced blood flow (post vascular occlusion with thigh tourniquet for healthy older controls; pain for PAD) conditions. Gait variability was assessed using the largest Lyapunov exponent, approximate entropy, standard deviation, and coefficient of variation of ankle, knee, and hip joints range of motion. Receiver operating characteristics curve analyses of the pain free walking condition were performed to determine the optimal cut-off values for separating individuals with PAD-IC from those without PAD-IC. Results and discussion Patients with PAD-IC have increased amount of variability for knee and hip ranges of motion compared with the healthy older control group. Regarding the main effect of condition, reduced blood flow demonstrated increased amount of variability compared with pain free walking. Significant interactions between group and condition at the ankle show increased values for temporal structure of variability, but a similar amount of variability in the reduced blood flow condition. This demonstrates subtle interactions in the movement patterns remain distinct between PAD-IC versus healthy older controls during the reduced blood flow condition. A combination of gait variability parameters correctly identifies PAD-IC disease 70% of the time or more. Conclusions Gait variability is affected both by PAD and by the mechanical induction of reduced blood flow. Gait variability parameters have potential diagnostic ability, as some measures had 90.0% probability of correctly identifying patients with PAD-IC.
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13
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Terwilliger ZS, Ryan TE, Goldberg EJ, Schmidt CA, Yamaguchi DJ, Karnekar R, Brophy P, Green TD, Zeczycki TN, Mac Gabhann F, Annex BH, McClung JM. Racial differences in the limb skeletal muscle transcriptional programs of patients with critical limb ischemia. Vasc Med 2021; 26:247-258. [PMID: 33685287 DOI: 10.1177/1358863x20983918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Critical limb ischemia (CLI) is the most severe manifestation of peripheral artery disease (PAD) and is characterized by high rates of morbidity and mortality. As with most severe cardiovascular disease manifestations, Black individuals disproportionately present with CLI. Accordingly, there remains a clear need to better understand the reasons for this discrepancy and to facilitate personalized therapeutic options specific for this population. Gastrocnemius muscle was obtained from White and Black healthy adult volunteers and patients with CLI for whole transcriptome shotgun sequencing (WTSS) and enrichment analysis was performed to identify alterations in specific Reactome pathways. When compared to their race-matched healthy controls, both White and Black patients with CLI demonstrated similar reductions in nuclear and mitochondrial encoded genes and mitochondrial oxygen consumption across multiple substrates, indicating a common bioenergetic paradigm associated with amputation outcomes regardless of race. Direct comparisons between tissues of White and Black patients with CLI revealed hemostasis, extracellular matrix organization, platelet regulation, and vascular wall interactions to be uniquely altered in limb muscles of Black individuals. Among traditional vascular growth factor signaling targets, WTSS revealed only Tie1 to be significantly altered from White levels in Black limb muscle tissues. Quantitative reverse transcription polymerase chain reaction validation of select identified targets verified WTSS directional changes and supports reductions in MMP9 and increases in NUDT4P1 and GRIK2 as unique to limb muscles of Black patients with CLI. This represents a critical first step in better understanding the transcriptional program similarities and differences between Black and White patients in the setting of amputations related to CLI and provides a promising start for therapeutic development in this population.
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Affiliation(s)
- Zoe S Terwilliger
- Diabetes and Obesity Institute, East Carolina University, Brody Medical Center, Greenville, NC, USA.,Department of Physiology, East Carolina University, Brody Medical Center, Greenville, NC, USA
| | - Terence E Ryan
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Emma J Goldberg
- Diabetes and Obesity Institute, East Carolina University, Brody Medical Center, Greenville, NC, USA.,Department of Physiology, East Carolina University, Brody Medical Center, Greenville, NC, USA
| | - Cameron A Schmidt
- Diabetes and Obesity Institute, East Carolina University, Brody Medical Center, Greenville, NC, USA.,Department of Physiology, East Carolina University, Brody Medical Center, Greenville, NC, USA
| | - Dean J Yamaguchi
- Department of Cardiovascular Sciences, East Carolina University, Brody Medical Center, Greenville, NC, USA.,Division of Surgery, East Carolina University, Brody Medical Center, Greenville, NC, USA
| | - Reema Karnekar
- Diabetes and Obesity Institute, East Carolina University, Brody Medical Center, Greenville, NC, USA.,Department of Physiology, East Carolina University, Brody Medical Center, Greenville, NC, USA
| | - Patricia Brophy
- Diabetes and Obesity Institute, East Carolina University, Brody Medical Center, Greenville, NC, USA
| | - Thomas D Green
- Diabetes and Obesity Institute, East Carolina University, Brody Medical Center, Greenville, NC, USA.,Department of Physiology, East Carolina University, Brody Medical Center, Greenville, NC, USA
| | - Tonya N Zeczycki
- Diabetes and Obesity Institute, East Carolina University, Brody Medical Center, Greenville, NC, USA.,Department of Biochemistry, East Carolina University, Brody Medical Center, Greenville, NC, USA
| | - Feilim Mac Gabhann
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Brian H Annex
- Department of Medicine, Medical College of Georgia, Augusta, GA, USA.,Vascular Biology Center, Medical College of Georgia, Augusta, GA, USA
| | - Joseph M McClung
- Diabetes and Obesity Institute, East Carolina University, Brody Medical Center, Greenville, NC, USA.,Department of Physiology, East Carolina University, Brody Medical Center, Greenville, NC, USA.,Department of Cardiovascular Sciences, East Carolina University, Brody Medical Center, Greenville, NC, USA
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14
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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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15
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Casale GP, Thompson JR, Carpenter LC, Kim J, Lackner TJ, Mietus CJ, Ha DM, Myers SA, Brunette KE, Li S, Shields C, Willcockson G, Pipinos II. Cytokine signature of inflammation mediated by autoreactive Th-cells, in calf muscle of claudicating patients with Fontaine stage II peripheral artery disease. Transl Res 2021; 228:94-108. [PMID: 32835907 PMCID: PMC7779738 DOI: 10.1016/j.trsl.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/21/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Abstract
Peripheral artery disease (PAD), a severe atherosclerotic condition primarily of the elderly, afflicts 200 million individuals, worldwide, and is associated with lower extremity myopathy. Circulating markers of inflammation have been linked to risk and severity of PAD but the contribution of local inflammation to myopathy remains unknown. We evaluated, by ELISA, calf muscle of PAD patients (N = 23) and control subjects (N = 18) for local expression of inflammatory cytokines including Granulocyte/Monocyte Colony-Stimulating Factor (GM-CSF), Interleukin 17A (IL-17A), Interferon ϒ (IFN-ϒ), tumor necrosis factor α (TNF-α), and Interleukin 6 (IL-6). One or more of these cytokines were expressed in nineteen patients and 2 controls and coordinated expression of GM-CSF, IL-17A, IFN-ϒ, and TNF-α, a signature of activated, MHC Class II dependent autoreactive Th-cells, was unique to 11 patients. GM-CSF is the central driver of tissue-damaging myeloid macrophages. Patients with this cytokine signature had a shorter (P= 0.017) Claudication Onset Distance (17 m) compared with patients lacking the signature (102 m). Transforming Growth Factor β1 (TGFβ1) and Chemokine Ligand 5 (CCL5) were expressed coordinately in all PAD and control muscles, independently of GM-CSF, IL-17A, IFN-ϒ, TNF-α, or IL-6. TGFβ1 and CCL5 and their gene transcripts were increased in PAD muscle, consistent with increased age-associated inflammation in these patients. Serum cytokines were not informative of muscle cytokine expression. We have identified a cytokine profile of autoimmune inflammation in calf muscles of a significant proportion of claudicating PAD patients, in association with decreased limb function, and a second independent profile consistent with increased "inflammaging" in all PAD patients.
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Affiliation(s)
- George P Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
| | - Jonathan R Thompson
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Lauren C Carpenter
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Julian Kim
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Timothy J Lackner
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Constance J Mietus
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Duy M Ha
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska
| | | | - Shuai Li
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Christina Shields
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gregory Willcockson
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
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16
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Miyakuni T, Komiyama H, Takano M, Ikeda T, Matsushita M, Kobayashi N, Otsuka T, Miyauchi Y, Asai K, Seino Y, Shimizu W. A preliminary pilot study investigating the impact of endovascular treatment on leg muscle volume in peripheral artery disease and its relation to baseline glycemic control. Nutr Metab Cardiovasc Dis 2021; 31:269-276. [PMID: 33092977 DOI: 10.1016/j.numecd.2020.09.003] [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] [Received: 05/29/2020] [Revised: 08/19/2020] [Accepted: 09/01/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Peripheral artery disease (PAD), intermittent claudication, and impaired mobility contribute to the loss of skeletal muscle. This study investigated the impact of endovascular treatment (EVT) in patients suffering from PAD above the knee and its relation to baseline glycemic control. METHODS AND RESULTS Mid-thigh muscle volume was measured before EVT, 3 months after EVT and 6 months after EVT. Mid-thigh muscle volumes of ipsilateral PAD patients with ischemic and non-ischemic legs were compared. Correlations between total thigh muscle volume and clinical characteristics were analyzed using univariable and multivariable analysis. Overall, thigh muscle volume increased after EVT. The mid-thigh muscle volume was significantly lower in patients with ipsilateral lesions and in those with ischemic lower limbs. The thigh muscle volume of those with ischemic lower limbs increased after EVT. Baseline glycated hemoglobin was the only factor that was negatively correlated with changes in the muscle volume after EVT. Muscle volume significantly increased in normoglycemic HbA1c<6.5% (47 mmol/mol) patients. There was no significant alteration in the muscle volume of hyperglycemic HbA1c ≥ 6.5% patients. CONCLUSION Ischemic muscle atrophy was ameliorated after EVT in normoglycemic patients. There is a need for a large-scale trial to investigate whether EVT can protect or delay skeletal muscle loss.
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Affiliation(s)
- Tomoyo Miyakuni
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, 270-1613, Japan
| | - Hidenori Komiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan.
| | - Masamichi Takano
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, 270-1613, Japan
| | - Takeshi Ikeda
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, 270-1613, Japan
| | - Masato Matsushita
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, 270-1613, Japan
| | - Nobuaki Kobayashi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, 270-1613, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, 113-8602, Japan
| | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, 270-1613, Japan
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, 270-1613, Japan.
| | - Yoshihiko Seino
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, 270-1613, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
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17
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The Nitric Oxide System in Peripheral Artery Disease: Connection with Oxidative Stress and Biopterins. Antioxidants (Basel) 2020; 9:antiox9070590. [PMID: 32640613 PMCID: PMC7402092 DOI: 10.3390/antiox9070590] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
Peripheral artery disease (PAD) pathophysiology extends beyond hemodynamics to include other operating mechanisms, including endothelial dysfunction. Oxidative stress may be linked to endothelial dysfunction by reducing nitric oxide (NO) bioavailability. We aimed to investigate whether the NO system and its regulators are altered in the setting of PAD and to assess the relationship between NO bioavailability and oxidative stress. Sera from 35 patients with intermittent claudication (IC), 26 patients with critical limb ischemia (CLI), and 35 non-PAD controls were analyzed to determine levels of tetrahydrobiopterin (BH4), dihydrobiopterin (BH2), nitrate/nitrite (nitric oxides, or NOx), arginine, citrulline, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and the oxidative stress markers 8-Oxo-2′-deoxyguanosine (8-OHdG), 4-hydroxynonenal (4-HNE), advanced glycation end products (AGEs), and protein carbonyls. NOx was significantly lower in IC and CLI patients compared to controls in association with elevated oxidative stress, with the greatest NOx reductions observed in CLI. Compared with controls, IC and CLI patients had reduced BH4, elevated BH2, and a reduced BH4/BH2 ratio. SDMA, the arginine/SDMA ratio, and the arginine/ADMA ratio were significantly higher in CLI patients. The NO system and its regulators are significantly compromised in PAD. This dysregulation appears to be driven by increased oxidative stress and worsens as the disease progresses from claudication to CLI.
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18
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Signorelli SS, Vanella L, Abraham NG, Scuto S, Marino E, Rocic P. Pathophysiology of chronic peripheral ischemia: new perspectives. Ther Adv Chronic Dis 2020; 11:2040622319894466. [PMID: 32076496 PMCID: PMC7003198 DOI: 10.1177/2040622319894466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
Peripheral arterial disease (PAD) affects individuals particularly over 65 years old in the more advanced countries. Hemodynamic, inflammatory, and oxidative mechanisms interact in the pathophysiological scenario of this chronic arterial disease. We discuss the hemodynamic, muscle tissue, and oxidative stress (OxS) conditions related to chronic ischemia of the peripheral arteries. This review summarizes the results of evaluating both metabolic and oxidative markers, and also therapy to counteract OxS. In conclusion, we believe different pathways should be highlighted to discover new drugs to treat patients suffering from PAD.
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Affiliation(s)
- Salvatore Santo Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, University Hospital 'G. Rodolico', Catania, 95124, Italy
| | - Luca Vanella
- Department of Drug Science, University of Catania, Catania, Italy
| | - Nader G Abraham
- Departments of Medicine, Pharmacology and Gastroenterology, New York Medical College, Valhalla, NY, USA
| | - Salvatore Scuto
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Elisa Marino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Petra Rocic
- Departments of Medicine, Pharmacology and Gastroenterology, New York Medical College, Valhalla, NY, USA
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19
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Gratl A, Frese J, Speichinger F, Pesta D, Frech A, Omran S, Greiner A. Regeneration of Mitochondrial Function in Gastrocnemius Muscle in Peripheral Arterial Disease After Successful Revascularisation. Eur J Vasc Endovasc Surg 2019; 59:109-115. [PMID: 31786105 DOI: 10.1016/j.ejvs.2019.08.011] [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: 12/02/2018] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Myopathy, characterised by altered mitochondrial function, is a central part of the pathophysiology of peripheral arterial disease and the aim of this study was to investigate the effect of revascularisation on mitochondrial function. METHODS High resolution respirometry was used to investigate mitochondrial respiration and the results were normalised to citrate synthase activity (CSA), a marker of mitochondrial content. Ten patients with symptomatic peripheral arterial disease (study group) and 10 subjects without ischaemia (control group) were included. Ankle brachial index and ultrasound imaging were performed before and after vascular intervention to confirm technically successful revascularisation. Within the study group, muscle biopsies from the gastrocnemius muscle were taken before vascular intervention and six weeks after revascularisation. Within the control group, tissue was harvested once. RESULTS There were no significant group differences regarding anthropometric data. CSA showed a significant increase after successful revascularisation (CSA pre-operative 281.4 (252.4-391.8) nmol/min/mg protein vs. CSA post-operative 438.5 (361.4-471.3) nmol/min/mg protein; p = .01) with post-operative return of values to the range of control subjects (CSA control 396.6 (308.2-435.9)). Mitochondrial respiration normalised to CSA in oxidative phosphorylation (P) as well as in electron transfer (E) capacity were significantly reduced post-operatively when compared with pre-operative values (P pre-operative 0.218 (0.196-0.266) pmol/(sec×mg) per CSA vs. post-operative 0.132 (0.116-0.150) pmol/(sec×mg) per CSA, p = .007; E pre-operative 0.230 (0.195-0.279) pmol/(sec×mg) per CSA vs. post-operative 0.129 (0.120-0.154) pmol/(sec×mg) per CSA, p = .005) meaning a post-operative return of values to within the range of control subjects (P control 0.124 (0.080-0.155) pmol/(sec×mg) per CSA; E control 0.121 (0.079-0.125) pmol/(sec×mg) per CSA). CONCLUSION With these results, it has been shown that the initially impaired mitochondrial function and content can normalise after revascularisation.
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Affiliation(s)
- Alexandra Gratl
- Department of Vascular Surgery, Charité - Medical University of Berlin, Berlin, Germany; Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - Jan Frese
- Department of Vascular Surgery, Charité - Medical University of Berlin, Berlin, Germany
| | - Fiona Speichinger
- Department of Vascular Surgery, Charité - Medical University of Berlin, Berlin, Germany
| | - Dominik Pesta
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Institute for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany; German Centre for Diabetes Research (DZD), München-Neuherberg, Germany; Department of Sports Science, Medical Section, University of Innsbruck, Innsbruck, Austria
| | - Andreas Frech
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Safwan Omran
- Department of Vascular Surgery, Charité - Medical University of Berlin, Berlin, Germany
| | - Andreas Greiner
- Department of Vascular Surgery, Charité - Medical University of Berlin, Berlin, Germany
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20
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Altered Metabolomic Profile in Patients with Peripheral Artery Disease. J Clin Med 2019; 8:jcm8091463. [PMID: 31540015 PMCID: PMC6780416 DOI: 10.3390/jcm8091463] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 12/15/2022] Open
Abstract
Peripheral artery disease (PAD) is a common atherosclerotic disease characterized by narrowed or blocked arteries in the lower extremities. Circulating serum biomarkers can provide significant insight regarding the disease progression. Here, we explore the metabolomics signatures associated with different stages of PAD and investigate potential mechanisms of the disease. We compared the serum metabolites of a cohort of 26 PAD patients presenting with claudication and 26 PAD patients presenting with critical limb ischemia (CLI) to those of 26 non-PAD controls. A difference between the metabolite profiles of PAD patients from non-PAD controls was observed for several amino acids, acylcarnitines, ceramides, and cholesteryl esters. Furthermore, our data demonstrate that patients with CLI possess an altered metabolomic signature different from that of both claudicants and non-PAD controls. These findings provide new insight into the pathophysiology of PAD and may help develop future diagnostic procedures and therapies for PAD patients.
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21
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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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22
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Mujaddadi A, Moiz JA, Singla D, Naqvi IH, Ali MS, Talwar D. Effect of eccentric exercise on markers of muscle damage in patients with chronic obstructive pulmonary disease. Physiother Theory Pract 2019; 37:801-807. [PMID: 31340714 DOI: 10.1080/09593985.2019.1644690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Eccentric exercise may be considered as an attractive alternative to conventional exercise in pulmonary rehabilitation (PR) for patients with chronic obstructive pulmonary disease (COPD). However, due to muscle damage associated with eccentric exercise, there has been reluctance in using this exercise form in PR.Objective: The aim of the present study was to investigate the effect of eccentric exercise on markers of muscle damage in patients with COPD.Methods: We analyzed 14 patients with moderate-severe COPD and 14 age-matched healthy controls. Both groups performed submaximal eccentric exercise of the elbow flexors. Muscle soreness (MS), maximum voluntary isometric contraction (MVC) of the elbow flexors, elbow range of motion (ROM), upper arm circumference (CIR), and biochemical markers such as creatine Kinase (CK) and lactate Dehydrogenase (LDH) were measured at pre-exercise, 24 h, 48 h, and 72 h following submaximal eccentric exercise.Results: There was a significant difference in markers of muscle damage, MS (p = .002), MVC (p < .001), ROM (p = .010), CIR (p < .001), and LDH (p = .001). However, no significant differences were observed in the activity of CK (p = .261) between COPD and control group following eccentric exercise which indicates greater degree of muscle damage in COPD as compared with control.Conclusion: Sub-maximal eccentric exercise causes significantly greater muscle damage in elderly COPD patients than healthy controls. Therefore, initial exercise should be progressed with lower intensities to prevent undue muscle damage in these patients.
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Affiliation(s)
- Aqsa Mujaddadi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Okhla, New Delhi-110025, India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Okhla, New Delhi-110025, India
| | - Deepika Singla
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Okhla, New Delhi-110025, India
| | | | - Mir Shad Ali
- Department of Pulmonary Rehabilitation, Metro Centre for Respiratory Diseases, Metro Hospital and Multispecialty Institute, Noida, Uttar Pradesh- 201301, India
| | - Deepak Talwar
- Department of Pulmonology Allergy Sleep and Critical Care Medicine, Metro Centre for Respiratory Diseases, Metro Hospital and Multispecialty Institute, Noida, Uttar Pradesh- 201301, India
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23
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Goldberg EJ, Schmidt CA, Green TD, Karnekar R, Yamaguchi DJ, Spangenberg EE, McClung JM. Temporal Association Between Ischemic Muscle Perfusion Recovery and the Restoration of Muscle Contractile Function After Hindlimb Ischemia. Front Physiol 2019; 10:804. [PMID: 31316393 PMCID: PMC6611152 DOI: 10.3389/fphys.2019.00804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/06/2019] [Indexed: 12/15/2022] Open
Abstract
During incomplete skeletal muscle recovery from ischemia, such as that occurs with critical limb ischemia, the temporal relationship between recovery of muscle capillary perfusion and contractile function is poorly defined. We examined this relationship in BALB/cJ mice (N = 24) following unilateral hindlimb ischemia (HLI), which pre-clinically mimics the myopathy observed in critical limb ischemia patients. Specifically, we examined this relationship in two phenotypically distinct muscles (i.e., "oxidative" soleus - Sol and "glycolytic" extensor digitorum longus - EDL) 14- or 56-days after HLI. Although overall limb blood flow (LDPI) reached its' recovery peak (48% of control) by HLI d14, the capillary networks in both the Sol and EDL (whole mount confocal imaging) were disrupted and competent muscle capillary perfusion (perfused lectin+μm2/muscle μm2) remained reduced. Interestingly, both Sol and EDL muscles recovered their distinct capillary structures and perfusion (Con Sol; 0.056 ± 0.02 lectin+μm2/muscle μm2, and Con EDL; 0.039 ± 0.005 lectin+μm2/muscle μm2) by HLI d56 (Sol; 0.062 ± 0.011 lectin+μm2/muscle μm2 and EDL; 0.0035 ± 0.005 lectin+μm2/muscle μm2), despite no further improvement in limb blood flow (LDPI). Both muscles suffered severe myopathy, indicated by loss of dystrophin positive immunostaining and the absence of stimulation induced isometric force production at HLI d14. Dystrophin immunofluorescence returned at HLI d56, although neither myofiber CSA (μm2) nor isometric force production (58 and 28% sustained deficits, Sol and EDL, respectively) recovered completely in either muscle. In summary, we reveal that the temporal relationship between the restoration of muscle capillary perfusion and functional ischemic skeletal muscle regeneration favors competent muscle capillary perfusion recovery in BALB/c mice in a phenotypically non-distinct manner.
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Affiliation(s)
- Emma J Goldberg
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States.,East Carolina Diabetes and Obesity Institute, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Cameron A Schmidt
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States.,East Carolina Diabetes and Obesity Institute, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - T D Green
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States.,East Carolina Diabetes and Obesity Institute, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - R Karnekar
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States.,East Carolina Diabetes and Obesity Institute, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - D J Yamaguchi
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, United States.,Division of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - E E Spangenberg
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States.,East Carolina Diabetes and Obesity Institute, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Joseph M McClung
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States.,East Carolina Diabetes and Obesity Institute, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC, United States.,Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, United States
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24
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Kalinin RE, Suchkov IA, Mzhavanadze ND, Pshennikov AS, Ncheĭe AF. [Current aspects of performing treadmill test in patients with peripheral artery disease]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:25-33. [PMID: 31149988 DOI: 10.33529/angio2019209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The protocols of performing treadmill tests (TMT) in patients presenting with peripheral artery disease have over the last decades undergone significant changes, with the alterations concerning not only the speed and time values of the load, but also the parameters measured. Currently, there is no unified generally accepted method of TMT, hence the need for an optimal protocol for carrying out this type of examination, which would help obtain reliable results in assessment of everyday life functional activity of patients and efficacy of various methods of treatment for peripheral atherosclerosis. The choice of an optimal methodology of performing a TMT in patients with intermittent claudication is extremely important because studying the haemodynamic parameters alone not always clearly reflect functional peculiarities of the course of the disease, since they depend not only on the presence of arterial stenoses or occlusions, but also on the activity of oxidative enzymes, endothelial and mitochondrial dysfunction, taking therapeutic agents, concomitant pathology and a series of other factors. The article is a review of the related literature contained in such databases as the Medline, PubMed, Russian Science Citation Index (RSCI) and Scopus and concerning TMT in patients with peripheral artery disease. The authors summarized the information from a total of 63 literature sources over the period from the 1970s to 2018.
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Affiliation(s)
- R E Kalinin
- Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - I A Suchkov
- Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - N D Mzhavanadze
- Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - A S Pshennikov
- Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
| | - A F Ncheĭe
- Ryazan State Medical University of the RF Ministry of Public Health, Ryazan, Russia
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25
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Kim K, Reid BA, Ro B, Casey CA, Song Q, Kuang S, Roseguini BT. Heat therapy improves soleus muscle force in a model of ischemia-induced muscle damage. J Appl Physiol (1985) 2019; 127:215-228. [PMID: 31161885 DOI: 10.1152/japplphysiol.00115.2019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Leg muscle ischemia in patients with peripheral artery disease (PAD) leads to alterations in skeletal muscle morphology and reduced leg strength. We tested the hypothesis that exposure to heat therapy (HT) would improve skeletal muscle function in a mouse model of ischemia-induced muscle damage. Male 42-wk-old C57Bl/6 mice underwent ligation of the femoral artery and were randomly assigned to receive HT (immersion in a water bath at 37°C, 39°C, or 41°C for 30 min) or a control intervention for 3 wk. At the end of the treatment, the animals were anesthetized and the soleus and extensor digitorum longus (EDL) muscles were harvested for the assessment of contractile function and examination of muscle morphology. A subset of animals was used to examine the impact of a single HT session on the expression of genes involved in myogenesis and the regulation of muscle mass. Relative soleus muscle mass was significantly higher in animals exposed to HT at 39°C compared with the control group (control: 0.36 ± 0.01 mg/g versus 39°C: 0.40 ± 0.01 mg/g, P = 0.024). Maximal absolute force of the soleus was also significantly higher in animals treated with HT at 37°C and 39°C (control: 274.7 ± 6.6 mN; 37°C: 300.1 ± 7.7 mN; 39°C: 299.5 ± 10 mN, P < 0.05). In the soleus, but not the EDL muscle, a single session of HT enhanced the mRNA expression of myogenic factors as well as of both positive and negative regulators of muscle mass. These findings suggest that the beneficial effects of HT are muscle specific and dependent on the treatment temperature in a model of PAD. NEW & NOTEWORTHY This is the first study to comprehensively examine the impact of temperature and muscle fiber type composition on the adaptations to repeated heat stress in a model of ischemia-induced muscle damage. Exposure to heat therapy (HT) at 37°C and 39°C, but not at 41°C, improved force development of the isolated soleus muscle. These results suggest that HT may be a practical therapeutic tool to restore muscle mass and strength in patients with peripheral artery disease.
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Affiliation(s)
- Kyoungrae Kim
- Department of Health and Kinesiology, Purdue University , West Lafayette, Indiana
| | - Blake A Reid
- Department of Health and Kinesiology, Purdue University , West Lafayette, Indiana
| | - Bohyun Ro
- Department of Physical Education, Dong-A University , Busan , Korea
| | - Caitlin A Casey
- Department of Health and Kinesiology, Purdue University , West Lafayette, Indiana
| | - Qifan Song
- Department of Statistics, Purdue University , West Lafayette, Indiana
| | - Shihuan Kuang
- Department of Animal Sciences, Purdue University , West Lafayette, Indiana
| | - Bruno T Roseguini
- Department of Health and Kinesiology, Purdue University , West Lafayette, Indiana
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26
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Koutakis P, Ismaeel A, Farmer P, Purcell S, Smith RS, Eidson JL, Bohannon WT. Oxidative stress and antioxidant treatment in patients with peripheral artery disease. Physiol Rep 2019; 6:e13650. [PMID: 29611350 PMCID: PMC5880878 DOI: 10.14814/phy2.13650] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 12/27/2022] Open
Abstract
Peripheral artery disease is an atherosclerotic disease of arterial vessels that mostly affects arteries of lower extremities. Effort induced cycles of ischemia and reperfusion lead to increased reactive oxygen species production by mitochondria. Therefore, the pathophysiology of peripheral artery disease is a consequence of metabolic myopathy, and oxidative stress is the putative major operating mechanism behind the structural and metabolic changes that occur in muscle. In this review, we discuss the evidence for oxidative damage in peripheral artery disease and discuss management strategies related to antioxidant supplementation. We also highlight the major pathways governing oxidative stress in the disease and discuss their implications in disease progression. Potential therapeutic targets and diagnostic methods related to these mechanisms are explored, with an emphasis on the Nrf2 pathway.
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Affiliation(s)
- Panagiotis Koutakis
- Department of Health Human Performance and Recreation, Baylor University, Waco, Texas
| | - Ahmed Ismaeel
- Department of Health Human Performance and Recreation, Baylor University, Waco, Texas
| | - Patrick Farmer
- Department of Chemistry and Biochemistry, Baylor University, Waco, Texas
| | - Seth Purcell
- Department of Surgery, Baylor Scott and White Medical Center, Temple, Texas
| | - Robert S Smith
- Department of Surgery, Baylor Scott and White Medical Center, Temple, Texas
| | - Jack L Eidson
- Department of Surgery, Baylor Scott and White Medical Center, Temple, Texas
| | - William T Bohannon
- Department of Surgery, Baylor Scott and White Medical Center, Temple, Texas
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27
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Ryan TE, Yamaguchi DJ, Schmidt CA, Zeczycki TN, Shaikh SR, Brophy P, Green TD, Tarpey MD, Karnekar R, Goldberg EJ, Sparagna GC, Torres MJ, Annex BH, Neufer PD, Spangenburg EE, McClung JM. Extensive skeletal muscle cell mitochondriopathy distinguishes critical limb ischemia patients from claudicants. JCI Insight 2018; 3:123235. [PMID: 30385731 DOI: 10.1172/jci.insight.123235] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022] Open
Abstract
The most severe manifestation of peripheral arterial disease (PAD) is critical limb ischemia (CLI). CLI patients suffer high rates of amputation and mortality; accordingly, there remains a clear need both to better understand CLI and to develop more effective treatments. Gastrocnemius muscle was obtained from 32 older (51-84 years) non-PAD controls, 27 claudicating PAD patients (ankle-brachial index [ABI] 0.65 ± 0.21 SD), and 19 CLI patients (ABI 0.35 ± 0.30 SD) for whole transcriptome sequencing and comprehensive mitochondrial phenotyping. Comparable permeabilized myofiber mitochondrial function was paralleled by both similar mitochondrial content and related mRNA expression profiles in non-PAD control and claudicating patient tissues. Tissues from CLI patients, despite being histologically intact and harboring equivalent mitochondrial content, presented a unique bioenergetic signature. This signature was defined by deficits in permeabilized myofiber mitochondrial function and a unique pattern of both nuclear and mitochondrial encoded gene suppression. Moreover, isolated muscle progenitor cells retained both mitochondrial functional deficits and gene suppression observed in the tissue. These findings indicate that muscle tissues from claudicating patients and non-PAD controls were similar in both their bioenergetics profile and mitochondrial phenotypes. In contrast, CLI patient limb skeletal muscles harbor a unique skeletal muscle mitochondriopathy that represents a potentially novel therapeutic site for intervention.
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Affiliation(s)
- Terence E Ryan
- Department of Physiology.,East Carolina Diabetes and Obesity Institute
| | | | - Cameron A Schmidt
- Department of Physiology.,East Carolina Diabetes and Obesity Institute
| | - Tonya N Zeczycki
- East Carolina Diabetes and Obesity Institute.,Department of Biochemistry and Molecular Biology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Saame Raza Shaikh
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Thomas D Green
- Department of Physiology.,East Carolina Diabetes and Obesity Institute
| | - Michael D Tarpey
- Department of Physiology.,East Carolina Diabetes and Obesity Institute
| | - Reema Karnekar
- Department of Physiology.,East Carolina Diabetes and Obesity Institute
| | - Emma J Goldberg
- Department of Physiology.,East Carolina Diabetes and Obesity Institute
| | | | | | - Brian H Annex
- Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - P Darrell Neufer
- Department of Physiology.,East Carolina Diabetes and Obesity Institute
| | | | - Joseph M McClung
- Department of Physiology.,East Carolina Diabetes and Obesity Institute.,Department of Cardiovascular Sciences
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28
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Hernandez H, Myers SA, Schieber M, Ha DM, Baker S, Koutakis P, Kim KS, Mietus C, Casale GP, Pipinos II. Quantification of Daily Physical Activity and Sedentary Behavior of Claudicating Patients. Ann Vasc Surg 2018; 55:112-121. [PMID: 30114505 DOI: 10.1016/j.avsg.2018.06.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 05/01/2018] [Accepted: 06/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Claudication is the most common manifestation of peripheral artery disease (PAD), producing significant ambulatory compromise. Limited information exists on the routine physical activity of claudicating patients. Our objective was to record the intensity/time profiles of physical activity and the timing and duration of sedentary behavior of a sample of community-dwelling claudicating patients. METHODS Forty-four claudicating patients referred to our vascular clinic were recruited. Physical activity was recorded using the ActiGraph GT1M activity monitor. The Actigraph monitor is a lightweight instrument designed to measure human movement through changes in acceleration, measured as counts over 1-minute time periods. Data from 7 consecutive days were used for the calculations. We processed the data using the ActiLife software program. RESULTS The average daily activity of the claudicating patients shows a steady increase beginning approximately 05:30 AM until a peak plateau from approximately 10:00 AM to 01:30 PM followed by a steady decrease until approximately 09:30 PM, when a sustained period of inactivity begins. The average claudicating patient takes 3586 steps per day at an average intensity of 1.77 metabolic equivalents of task (METs, a physiological measure expressing the energy cost of physical activities). Average physical activity intensity and peak intensity fluctuate very little during the day, and they rarely exceed the level of light activity (light = <3 METs maximum effort, such as casual walking or light housework). During awake time, approximately 7 hours are spent in sedentary behaviors (<1.5 METs), and sedentary time is spread throughout the day mostly in short intervals between periods of low-energy activity. CONCLUSIONS Our study objectively demonstrates the reduced physical activity of claudicating patients and documents physical activity/duration profiles throughout the day. The intensity of the physical activity of the average claudicating patient fluctuates very little during the day and rarely exceeds a light intensity level. Claudicating patients spend approximately half of their awake time in sedentary behavior and when they walk they do it in short bursts followed by several minutes of rest. We anticipate that changes in routine physical activity/duration profiles of patients with PAD will provide relevant, sensitive, and direct measures of the effectiveness of therapeutic interventions.
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Affiliation(s)
- Hernan Hernandez
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Sara A Myers
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE
| | - Molly Schieber
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE
| | - Duy M Ha
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Sarah Baker
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE
| | - Panagiotis Koutakis
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE; Department of Health, Human Performance and Recreation, Baylor University, Waco, TX
| | - Kyung-Soo Kim
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Constance Mietus
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - George P Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE.
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29
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NEMCOVA A, JIRKOVSKA A, DUBSKY M, BEM R, FEJFAROVA V, WOSKOVA V, PYSNA A, BUNCOVA M. Perfusion Scintigraphy in the Assessment of Autologous Cell Therapy in Diabetic Patients With Critical Limb Ischemia. Physiol Res 2018; 67:583-589. [DOI: 10.33549/physiolres.933868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Perfusion scintigraphy with technetium-99-methoxy-isobutyl-isonitrile (99mTc-MIBI) is often used for assessing myocardial function but the number of studies concerning lower limb perfusion is limited. The aim of our study was to assess whether 99mTc-MIBI was an eligible method for evaluation of the effect of cell therapy on critical limb ischemia (CLI) in diabetic patients. 99mTc-MIBI of calf muscles was performed before and 3 months after autologous cell therapy (ACT) in 24 diabetic patients with CLI. Scintigraphic parameters such as rest count and exercising count after a stress test were defined. These parameters and their ratios were compared between treated and untreated (control) limbs and with changes in transcutaneous oxygen pressure (TcPO2) that served as a reference method. The effect of ACT was confirmed by a significant increase in TcPO2 values (p˂0.001) at 3 months after ACT. We did not observe any significant changes of scintigraphic parameters both at rest and after stress 3 months after ACT, there were no differences between treated and control limbs and no association with TcPO2 changes. Results of our study showed no significant contribution of 99mTc-MIBI of calf muscles to the assessment of ACT in diabetic patients with CLI over a 3-month follow-up period.
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Affiliation(s)
- A. NEMCOVA
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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30
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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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Hart CR, Layec G, Trinity JD, Kwon OS, Zhao J, Reese VR, Gifford JR, Richardson RS. Increased skeletal muscle mitochondrial free radical production in peripheral arterial disease despite preserved mitochondrial respiratory capacity. Exp Physiol 2018; 103:838-850. [PMID: 29604234 DOI: 10.1113/ep086905] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/23/2018] [Indexed: 12/17/2022]
Abstract
NEW FINDINGS What is the central question of this study? What is the degree to which skeletal muscle mitochondria-derived reactive oxygen species (ROS) production is linked to impaired skeletal muscle function in patients with early-stage peripheral arterial disease (PAD) and what is the impact on mitochondrial respiratory capacity? What is the main finding and its importance? This is the first study to document increased mitochondria-derived reactive oxygen species production associated with elevated intramuscular oxidative stress, despite preserved mitochondrial respiratory function, in patients with PAD. Furthermore, systemic inflammation, mitochondria-derived ROS production and skeletal muscle oxidative stress were strongly correlated to disease severity, as indicated by ankle-brachial index, in patients with PAD. ABSTRACT Skeletal muscle mitochondrial dysfunction, which is not fully explained by disease-related arterial occlusion, has been implicated in the pathophysiology of peripheral arterial disease (PAD). Therefore, this study comprehensively assessed mitochondrial respiratory function in biopsies from the gastrocnemius of 10 patients with PAD (Fontaine Stage II) and 12 healthy controls (HC). Intramuscular and systemic inflammation, mitochondria-derived reactive oxygen species (ROS) production, and oxidative stress were also assessed to better understand the mechanisms responsible for the proposed PAD-induced mitochondrial dysfunction. Interestingly, mitochondrial respiratory capacity, assessed as complex I (CI) and complex II (CII)-driven State 3 respiration, measured separately and in combination (State 3 CI+II), revealed no difference between the patients with PAD and the HC. However, mitochondria-derived ROS production was significantly elevated in PAD (HC: 1.0 ± 0.9; PAD: 4.3 ± 1.0 AU (mg tissue)-1 ). Furthermore, patients with PAD exhibited significantly greater concentrations of the pro-inflammatory markers tumour necrosis factor α in plasma (HC: 0.9 ± 0.4; PAD: 2.0 ± 0.3 pg ml-1 ) and interleukin 6 in both plasma (HC: 2.3 ± 0.4; PAD: 4.3 ± 0.5 pg ml-1 ) and muscle (∼75% greater). Intramuscular oxidative stress, assessed by protein carbonyls and 4-hydroxynonenal, was significantly greater in PAD compared to HC. Ankle brachial index was significantly correlated with intramuscular inflammation, oxidative stress and mitochondria-derived ROS production. Thus, elevated intramuscular inflammation, oxidative stress and mitochondria-derived ROS production are likely to contribute to the pathophysiology of the skeletal muscle dysfunction associated with PAD, even in the presence of preserved mitochondrial respiratory function in this population.
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Affiliation(s)
- Corey R Hart
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Exercise and Sport Science, University of Utah, Salt Lake City, UT, USA
| | - Gwenael Layec
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA
| | - Oh Sung Kwon
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA
| | - Jia Zhao
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA
| | - Van R Reese
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA
| | - Jayson R Gifford
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
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McDermott MM, Peterson CA, Sufit R, Ferrucci L, Guralnik JM, Kibbe MR, Polonsky TS, Tian L, Criqui MH, Zhao L, Stein JH, Li L, Leeuwenburgh C. Peripheral artery disease, calf skeletal muscle mitochondrial DNA copy number, and functional performance. Vasc Med 2018; 23:340-348. [PMID: 29734865 DOI: 10.1177/1358863x18765667] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In people without lower extremity peripheral artery disease (PAD), mitochondrial DNA copy number declines with aging, and this decline is associated with declines in mitochondrial activity and functional performance. However, whether lower extremity ischemia is associated with lower mitochondrial DNA copy number and whether mitochondrial DNA copy number is associated with the degree of functional impairment in people with PAD is unknown. In people with and without PAD, age 65 years and older, we studied associations of the ankle-brachial index (ABI) with mitochondrial DNA copy number and associations of mitochondrial DNA copy number with functional impairment. Calf muscle biopsies were obtained from 34 participants with PAD (mean age: 73.5 years (SD 6.4), mean ABI: 0.67 (SD 0.15), mean 6-minute walk distance: 1191 feet (SD 223)) and 10 controls without PAD (mean age: 73.1 years (SD 4.7), mean ABI: 1.14 (SD 0.07), mean 6-minute walk distance: 1387 feet (SD 488)). Adjusting for age and sex, lower ABI values were associated with higher mitochondrial DNA copy number, measured in relative copy number (ABI<0.60: 914, ABI 0.60-0.90: 731, ABI 0.90-1.50: 593; p trend=0.016). The association of mitochondrial DNA copy number with the 6-minute walk distance and 4-meter walking velocity differed significantly between participants with versus without PAD ( p-value for interaction=0.001 and p=0.015, respectively). The correlation coefficient between mitochondrial DNA copy number and the 6-minute walk distance was 0.653 ( p=0.056) among people without PAD and -0.254 ( p=0.154) among people with PAD and ABI < 0.90. In conclusion, lower ABI values are associated with increased mitochondrial DNA copy number. Associations of mitochondrial DNA copy number with the 6-minute walk distance and 4-meter walking velocity significantly differed between people with versus without PAD, with stronger positive associations observed in people without PAD than in people with PAD. The cross-sectional and exploratory nature of the analyses precludes conclusions regarding causal inferences. ClinicalTrials.gov Identifier: NCT02246660.
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Affiliation(s)
- Mary M McDermott
- 1 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,2 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Robert Sufit
- 4 Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Luigi Ferrucci
- 5 National Institute on Aging, Division of Intramural Research, Baltimore, MD, USA
| | - Jack M Guralnik
- 6 Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melina R Kibbe
- 7 Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Tamar S Polonsky
- 8 Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lu Tian
- 9 Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | - Michael H Criqui
- 10 Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Lihui Zhao
- 2 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James H Stein
- 11 Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Lingyu Li
- 1 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Giannopoulos G, Angelidis C, Vogiatzi G, Cleman MW, Deftereos S. Antioxidant treatment in peripheral artery disease: the rationale is there, but what about clinical results? Curr Opin Pharmacol 2018; 39:53-59. [DOI: 10.1016/j.coph.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/21/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
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Schmidt CA, Amorese AJ, Ryan TE, Goldberg EJ, Tarpey MD, Green TD, Karnekar RR, Yamaguchi DJ, Spangenburg EE, McClung JM. Strain-Dependent Variation in Acute Ischemic Muscle Injury. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:1246-1262. [PMID: 29454751 DOI: 10.1016/j.ajpath.2018.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/15/2017] [Accepted: 01/11/2018] [Indexed: 12/19/2022]
Abstract
Limited efficacy of clinical interventions for peripheral arterial disease necessitates a better understanding of the environmental and genetic determinants of tissue pathology. Existing research has largely ignored the early skeletal muscle injury response during hind limb ischemia (HLI). We compared the hind limb muscle response, after 6 hours of ischemia, in two mouse strains that differ dramatically in their postischemic extended recovery: C57BL/6J and BALB/cJ. Perfusion, measured by laser Doppler and normalized to the control limb, differed only slightly between strains after HLI (<12% across all measures). Similar (<10%) effect sizes in lectin-perfused vessel area and no differences in tissue oxygen saturation measured by reflectance spectroscopy were also found. Muscles from both strains were functionally impaired after HLI, but greater muscle necrosis and loss of dystrophin-positive immunostaining were observed in BALB/cJ muscle compared with C57BL/6J. Muscle cell-specific dystrophin loss and reduced viability were also detected in additional models of ischemia that were independent of residual perfusion differences. Our results indicate that factors other than the completeness of ischemia alone (ie, background genetics) influence the magnitude of acute ischemic muscle injury. These findings may have implications for future development of therapeutic interventions for limb ischemia and for understanding the phasic etiology of chronic and acute ischemic muscle pathophysiology.
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Affiliation(s)
- Cameron A Schmidt
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Adam J Amorese
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Terence E Ryan
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Emma J Goldberg
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Michael D Tarpey
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Thomas D Green
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Reema R Karnekar
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Dean J Yamaguchi
- Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina; Division of Vascular Surgery, East Carolina University, Greenville, North Carolina
| | - Espen E Spangenburg
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina
| | - Joseph M McClung
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina; East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, North Carolina; Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina.
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KOTOVSKYI VITALIJ, DZHEZHERYA YURIJ, SNARSKII ANDREI, VIŠNIAKOV NIKOLAJ, ŠEŠOK ANDŽELA. INVESTIGATION OF THE DYNAMICS OF BODY OXYGEN STATUS UPON LIMITED LOADS. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519418500033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper discusses the dynamics of oxygen partial pressure in intercellular fluid upon a limited load and a subsequent post-ischemic hyperemia in healthy individuals and individuals with vascular pathologies of the lower limbs. Within the framework of the phenomenological approach, which takes into consideration the qualitative peculiarities of the gas exchange processes in the body, a formal theory describing the dynamics of oxygen ([Formula: see text]) concentration dependently on the conditions of blood supply to the tissues has been developed. It was shown that certain parameters, for instance the relaxation time upon the conditions of artificial ischemia and the characteristic time of return of spontaneous blood circulation in the post-ischemic period, depend on the degree of pathology of the vascular system and may be used for assessing the functional status of a biological body.
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Affiliation(s)
- VITALIJ KOTOVSKYI
- Department of Applied Physics, National Technical University of Ukraine KPI, Peremogy Avenue 37, 03224 Kiev, Ukraine
| | - YURIJ DZHEZHERYA
- Department of Applied Physics, National Technical University of Ukraine KPI, Peremogy Avenue 37, 03224 Kiev, Ukraine
- Institute of Magnetism, National Academy of Sciences of Ukraine, 36 b Vernadsky Avenue, 03142 Kiev, Ukraine
| | - ANDREI SNARSKII
- Department of Applied Physics, National Technical, University of Ukraine KPI, Peremogy Avenue 37, 03224 Kiev, Ukraine
| | - NIKOLAJ VIŠNIAKOV
- Department of Materials Science and Welding, Vilnius Gediminas Technical University, J. Basanaviciaus Street 28, LT-03221 Vilnius, Lithuania
| | - ANDŽELA ŠEŠOK
- Department of Biomechanics, Vilnius Gediminas Technical University, J. Basanaviciaus Street 28, LT-03221 Vilnius, Lithuania
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Myers SA, Applequist BC, Huisinga JM, Pipinos II, Johanning JM. Gait kinematics and kinetics are affected more by peripheral arterial disease than by age. ACTA ACUST UNITED AC 2018; 53:229-38. [PMID: 27149635 DOI: 10.1682/jrrd.2015.02.0027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 07/01/2015] [Indexed: 01/23/2023]
Abstract
Peripheral arterial disease (PAD) produces abnormal gait and disproportionately affects older individuals. The current study investigated PAD gait biomechanics in younger (<65 yr) and older (>/=65 yr) subjects. The study included 61 patients with PAD (31 younger, age: 57.4 +/- 5.3 yr, and 30 older, age: 71.9 +/- 5.2 yr) and 52 nondisabled age-matched control subjects. Patients with PAD were tested during pain-free walking and compared with control subjects. Joint kinematics and kinetics (torques) were compared using a 2 x 2 analysis of variance (groups: patients with PAD vs control subjects, age: younger vs older). Patients with PAD had significantly increased ankle and decreased hip range of motion during the stance phase as well as decreased ankle dorsiflexor torque compared with control subjects. Gait changes in older individuals are largely constrained to time-distance parameters. Joint kinematics and kinetics are significantly altered in patients with PAD during pain-free walking. Symptomatic PAD produces a consistent ambulatory deficit across ages definable by advanced biomechanical analysis. The most important finding of the current study is that gait, in the absence of PAD and other ambulatory comorbidities, does not decline significantly with age based on advanced biomechanical analysis. Therefore, previous studies must be examined in the context of patients with potential PAD being present in the population, and future ambulatory studies must include PAD as a confounding factor when assessing the gait function of elderly individuals.
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Watanabe A, Poole DC, Kano Y. The effects of RSR13 on microvascular Po2 kinetics and muscle contractile performance in the rat arterial ligation model of peripheral arterial disease. J Appl Physiol (1985) 2017; 123:764-772. [DOI: 10.1152/japplphysiol.00257.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/17/2017] [Accepted: 06/08/2017] [Indexed: 01/12/2023] Open
Abstract
Exercise intolerance and claudication are symptomatic of peripheral arterial disease. There is a close relationship between muscle O2 delivery, microvascular oxygen partial pressure (P mvO2), and contractile performance. We therefore hypothesized that a reduction of hemoglobin-oxygen affinity via RSR13 would maintain a higher P mvO2 and enhance blood-muscle O2 transport and contractile function. In male Wistar rats (12 wk of age), we created hindlimb ischemia via right-side iliac artery ligation (AL). The contralateral (left) muscle served as control (CONT). Seven days after AL, phosphorescence-quenching techniques were used to measure P mvO2 at rest and during contractions (electrical stimulation; 1 Hz, 300 s) in tibialis anterior muscle (TA) under saline ( n = 10) or RSR13 ( n = 10) conditions. RSR13 at rest increased TA P mvO2 in CONT (13.9 ± 1.6 to 19.3 ± 1.9 Torr, P < 0.05) and AL (9.0 ± 0.5 to 9.9 ± 0.7 Torr, P < 0.05). Furthermore, RSR13 extended maintenance of the initial TA force (i.e., improved contractile performance) such that force was not decreased significantly until contraction 240 vs. 150 in CONT and 80 vs. 20 in AL. This improved muscle endurance with RSR13 was accompanied by a greater ΔP mvO2 (P mvO2 decrease from baseline) (CONT, 7.4 ± 1.0 to 11.2 ± 1.3; AL, 6.9 ± 0.5 to 8.6 ± 0.6 Torr, both P < 0.05). Whereas RSR13 did not alter the kinetics profile of P mvO2 (i.e., mean response time) substantially during contractions, muscle force was elevated, and the ratio of muscle force to P mvO2 increased. In conclusion, reduction of hemoglobin-oxygen affinity via RSR13 in AL increased P mvO2 and improved muscle contractile performance most likely via enhanced blood-muscle O2 diffusion. NEW & NOTEWORTHY This is the first investigation to examine the effect of RSR13 (erythrocyte allosteric effector) on skeletal muscle microvascular oxygen partial pressure kinetics and contractile function using an arterial ligation model of peripheral arterial disease in experimental animals. The present results provide strong support for the concept that reducing hemoglobin-O2 affinity via RSR13 improved tibialis anterior muscle contractile performance most likely via enhanced blood-muscle O2 diffusion.
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Affiliation(s)
- Aiko Watanabe
- Department of Engineering Science, University of Electro-Communications, Chofu, Tokyo, Japan; and
| | - David C. Poole
- Departments of Anatomy, Physiology and Kinesiology, Kansas State University, Manhattan, KS
| | - Yutaka Kano
- Department of Engineering Science, University of Electro-Communications, Chofu, Tokyo, Japan; and
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Miller AJ, Luck JC, Kim DJK, Leuenberger UA, Proctor DN, Sinoway LI, Muller MD. Blood pressure and leg deoxygenation are exaggerated during treadmill walking in patients with peripheral artery disease. J Appl Physiol (1985) 2017; 123:1160-1165. [PMID: 28819005 DOI: 10.1152/japplphysiol.00431.2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 01/03/2023] Open
Abstract
The purpose of this study was to investigate blood pressure (BP) and leg skeletal muscle oxygen saturation (Smo2) during treadmill walking in patients with peripheral artery disease (PAD) and healthy subjects. Eight PAD patients (66 ± 8 yr, 1 woman) and eight healthy subjects (65 ± 7 yr, 1 woman) walked on a treadmill at 2 mph (0.89 m/s). The incline increased by 2% every 2 min, from 0 to 15% or until maximal discomfort. BP was measured every 2 min with an auscultatory cuff. Heart rate (HR) was recorded continuously with an ECG. Smo2 in the gastrocnemius muscle was measured on each leg using near-infrared spectroscopy. The change in systolic BP from seated to peak walking time (PWT) was greater in PAD (healthy: 23 ± 9 vs. PAD: 44 ± 19 mmHg, P = 0.007). HR was greater in PAD patients compared with controls at PWT (P = 0.011). The reduction in Smo2 (PWT - seated) was greater in PAD (healthy: 15 ± 12 vs. PAD: 49 ± 5%, P < 0.001) in the most affected leg and in the least affected leg (healthy: 12 ± 11 vs. PAD: 32 ± 18%, P = 0.003). PAD patients have an exaggerated decline in leg Smo2 during walking compared with healthy subjects, which may elicit the exaggerated rise in BP and HR during walking in PAD.NEW & NOTEWORTHY This is the first study to simultaneously measure skeletal muscle oxygen saturation and blood pressure (BP) during treadmill exercise in patients with peripheral arterial disease. We found that BP and leg deoxygenation responses to slow-paced, graded treadmill walking are greater in patients with peripheral arterial disease compared with healthy subjects. These data may help explain the high cardiovascular risk in patients with peripheral arterial disease.
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Affiliation(s)
- Amanda J Miller
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | - J Carter Luck
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | - Danielle Jin-Kwang Kim
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | - Urs A Leuenberger
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | - David N Proctor
- Department of Kinesiology, Noll Laboratory, Penn State University, University Park, Pennsylvania
| | - Lawrence I Sinoway
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
| | - Matthew D Muller
- Heart and Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania; and
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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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van Schaardenburgh M, Wohlwend M, Rognmo Ø, Mattsson EJR. Exercise in claudicants increase or decrease walking ability and the response relates to mitochondrial function. J Transl Med 2017; 15:130. [PMID: 28592294 PMCID: PMC5463401 DOI: 10.1186/s12967-017-1232-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/31/2017] [Indexed: 12/02/2022] Open
Abstract
Background Exercise of patients with intermittent claudication improves walking performance. Exercise does not usually increase blood flow, but seems to increase muscle mitochondrial enzyme activities. Although exercise is beneficial in most patients, it might be harmful in some. The mitochondrial response to exercise might therefore differ between patients. Our hypothesis was that changes in walking performance relate to changes in mitochondrial function after 8 weeks of exercise. At a subgroup level, negative responders decrease and positive responders increase mitochondrial capacity. Methods Two types of exercise were studied, calf raising and walking (n = 28). We wanted to see whether there were negative and positive responders, independent of type of exercise. Measurements of walking performance, peripheral hemodynamics, mitochondrial respiration and content (citrate synthase activity) were obtained on each patient before and after the intervention period. Multiple linear regression was used to test whether changes in peak walking time relate to mitochondrial function. Subgroups of negative (n = 8) and positive responders (n = 8) were defined as those that either decreased or increased peak walking time following exercise. Paired t test and analysis of covariance was used to test changes within and between subgroups. Results Changes in peak walking time were related to changes in mitochondrial respiration supported by electron transferring flavoprotein (ETF + CI)P (p = 0.004), complex I (CI + ETF)P (p = 0.003), complex I + complex II (CI + CII + ETF)P (p = 0.037) and OXPHOS coupling efficiency (p = 0.046) in the whole group. Negative responders had more advanced peripheral arterial disease. Mitochondrial respiration supported by electron transferring flavoprotein (ETF + CI)P (p = 0.0013), complex I (CI + ETF)P (p = 0.0005), complex I + complex II (CI + CII + ETF)P (p = 0.011) and electron transfer system capacity (CI + CII + ETF)E (p = 0.021) and OXPHOS coupling efficiency decreased in negative responders (p = 0.0007) after exercise. Positive responders increased citrate synthase activity (p = 0.010). Conclusions Changes in walking performance seem to relate to changes in mitochondrial function after exercise. Negative responders have more advanced peripheral arterial disease and decrease, while positive responders increase mitochondrial capacity. Trial registration ClinicalTrials.gov ID: NCT023110256
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Affiliation(s)
- Michel van Schaardenburgh
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, PO box 8905, 7491, Trondheim, Norway.
| | - Martin Wohlwend
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, PO box 8905, 7491, Trondheim, Norway
| | - Øivind Rognmo
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, PO box 8905, 7491, Trondheim, Norway
| | - Erney J R Mattsson
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, PO box 8905, 7491, Trondheim, Norway.,Department of Vascular Surgery, St. Olavs Hospital, Trondheim, Norway
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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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Schmidt CA, Ryan TE, Lin CT, Inigo MMR, Green TD, Brault JJ, Spangenburg EE, McClung JM. Diminished force production and mitochondrial respiratory deficits are strain-dependent myopathies of subacute limb ischemia. J Vasc Surg 2016; 65:1504-1514.e11. [PMID: 28024849 DOI: 10.1016/j.jvs.2016.04.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/17/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Reduced skeletal muscle mitochondrial function might be a contributing mechanism to the myopathy and activity based limitations that typically plague patients with peripheral arterial disease (PAD). We hypothesized that mitochondrial dysfunction, myofiber atrophy, and muscle contractile deficits are inherently determined by the genetic background of regenerating ischemic mouse skeletal muscle, similar to how patient genetics affect the distribution of disease severity with clinical PAD. METHODS Genetically ischemia protected (C57BL/6) and susceptible (BALB/c) mice underwent either unilateral subacute hind limb ischemia (SLI) or myotoxic injury (cardiotoxin) for 28 days. Limbs were monitored for blood flow and tissue oxygen saturation and tissue was collected for the assessment of histology, muscle contractile force, gene expression, mitochondrial content, and respiratory function. RESULTS Despite similar tissue O2 saturation and mitochondrial content between strains, BALB/c mice suffered persistent ischemic myofiber atrophy (55.3% of C57BL/6) and muscle contractile deficits (approximately 25% of C57BL/6 across multiple stimulation frequencies). SLI also reduced BALB/c mitochondrial respiratory capacity, assessed in either isolated mitochondria (58.3% of C57BL/6 at SLI on day (d)7, 59.1% of C57BL/6 at SLI d28 across multiple conditions) or permeabilized myofibers (38.9% of C57BL/6 at SLI d7; 76.2% of C57BL/6 at SLI d28 across multiple conditions). SLI also resulted in decreased calcium retention capacity (56.0% of C57BL/6) in BALB/c mitochondria. Nonischemic cardiotoxin injury revealed similar recovery of myofiber area, contractile force, mitochondrial respiratory capacity, and calcium retention between strains. CONCLUSIONS Ischemia-susceptible BALB/c mice suffered persistent muscle atrophy, impaired muscle function, and mitochondrial respiratory deficits during SLI. Interestingly, parental strain susceptibility to myopathy appears specific to regenerative insults including an ischemic component. Our findings indicate that the functional deficits that plague PAD patients could include mitochondrial respiratory deficits genetically inherent to the regenerating muscle myofibers.
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Affiliation(s)
- Cameron A Schmidt
- Department of Physiology, East Carolina University, Greenville, NC; Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Terence E Ryan
- Department of Physiology, East Carolina University, Greenville, NC; Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Chien-Te Lin
- Department of Physiology, East Carolina University, Greenville, NC; Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Melissa M R Inigo
- Department of Physiology, East Carolina University, Greenville, NC; Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Tom D Green
- Department of Physiology, East Carolina University, Greenville, NC; Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Jeffrey J Brault
- Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, NC; Department of Kinesiology, East Carolina University, Greenville, NC
| | - Espen E Spangenburg
- Department of Physiology, East Carolina University, Greenville, NC; Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Joseph M McClung
- Department of Physiology, East Carolina University, Greenville, NC; Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, NC.
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Brass EP, Wang H, Hiatt WR. Multiple skeletal muscle mitochondrial DNA deletions in patients with unilateral peripheral arterial disease. Vasc Med 2016. [DOI: 10.1177/1358836x0000500405] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Peripheral arterial disease (PAD) is associated with metabolic derangements and accumulation of the common 4977 bp mitochondrial DNA (mtDNA) deletion mutation. The current study was undertaken to test the hypothesis that PAD is associated with multiple mtDNA deletions. Gastrocnemius biopsies were obtained from nine patients with unilateral PAD. DNA extracted from the biopsies was analyzed for mtDNA deletions using a primer- shift PCR strategy. Multiple primers and strict, prospective criteria were used to identify deletions. PAD was associated with multiple mtDNA deletions (average of 8.2 distinct deletions in muscle from the hemodynamically affected limb). mtDNA injury was present in both the worse- and less-affected limbs of the unilateral PAD patients, and the estimated degree of mtDNA injury was strongly correlated in the two limbs on an intra-subject basis. The 4977 bp deletion was frequently identified, but was not always the deletion of highest frequency in individual samples. The estimated relative frequency of the 4977 bp deletion was correlated with the overall mtDNA injury in the biopsies. In summary, PAD is associated with mtDNA injury as reflected by multiple deletion mutations. As the mutations are not limited to the ischemic limb in unilateral patients, they are unlikely to contribute to the pathophysiology of claudication.
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Affiliation(s)
- Eric P Brass
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Hong Wang
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - William R Hiatt
- Section of Vascular Medicine, Division of Geriatrics, University of Colorado Health Sciences Center and the Colorado Prevention Center, Denver, CO, USA
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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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Roos S, Fyhr IM, Sunnerhagen KS, Moslemi AR, Oldfors A, Ullman M. Histopathological changes in skeletal muscle associated with chronic ischaemia. APMIS 2016; 124:935-941. [PMID: 27539941 DOI: 10.1111/apm.12586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/02/2016] [Indexed: 11/30/2022]
Abstract
Muscle biopsy is an essential part in the diagnostic workup in patients with suspected neuromuscular disorders. It is therefore important to be aware of morphological alterations that can be caused by systemic factors or natural ageing. Chronic limb ischaemia is frequent in elderly individuals. This study was performed to examine histopathological and mitochondrial changes in muscle in patients with chronic critical limb ischaemia. Muscle biopsy of skeletal muscle of the lower limb of patients with chronic ischaemia leading to amputation was performed and compared with muscle biopsies of healthy, age-matched controls. The histopathological abnormalities included fibrosis, necrosis, atrophy, glycogen depletion, internal nuclei, rimmed vacuoles, fibre type grouping, cytochrome c oxidase deficient fibres, MHC-I upregulation, and signs of microangiopathy. The only alteration found in age-matched controls was a few cytochrome c oxidase deficient fibres. There were also increased levels of multiple mitochondrial DNA deletions in ischaemic muscles compared with controls. Critical limb ischaemia is associated with significant histopathological changes in muscle tissue and also increased levels of mitochondrial DNA deletions. Since the alterations mimic different primary myopathic changes, chronic ischaemia is important to consider as a differential diagnosis in elderly individuals, investigated with muscle biopsy for muscle disease.
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Affiliation(s)
- Sara Roos
- Department of Pathology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Ing-Marie Fyhr
- Department of Pathology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Rehabilitation Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ali-Reza Moslemi
- Department of Pathology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anders Oldfors
- Department of Pathology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Michael Ullman
- Department of Orthopaedics, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Szuba A, Oka RK, Harada R, Cooke JP. Limb hemodynamics are not predictive of functional capacity in patients with PAD. Vasc Med 2016; 11:155-63. [PMID: 17288121 DOI: 10.1177/1358863x06074828] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To the practicing clinician, it seems obvious that limb hemodynamics would be the primary determinant of walking distance. However, other determinants, such as skeletal muscle metabolism, may play a role. Accordingly, in the current study, we examined the relationship between measures of limb hemodynamics and walking capacity in patients with peripheral arterial disease (PAD). We measured toe and ankle pressures for calculation of toe-(TBI) and ankle (ABI)-brachial indices; basal and hyperemic calf blood flow (CBF; by plethysmography); and initial (ICT) and absolute (ACT) claudication time using the Skinner-Gardner protocol. As expected, PAD patients had impaired limb hemodynamics with reduced TBI, ABI and a reduction in ABI post-exercise. However, there was no relationship between any of the hemodynamic variables (including ABI, ABI reduction post-exercise, TBI, baseline or maximal CBF) and walking distance as assessed by ICT or ACT. A subset of PAD patients with an ACT >750 s (n =16; ‘long claudicators’) were compared with a subset of PAD patients with an ACT <260 s (n = 16; ‘short claudicators’). The average ACT in the long claudicants was over fivefold greater than the short claudicators. Surprisingly, there were no differences between the two groups in any of the hemo-dynamic variables. There was also no relationship between the initial ABI, TBI, toe pressure, baseline or hyperemic CBF, and the improvement in ACT over the 3-month course of the study. This study found little relationship between hemodynamic variables and functional capacity in PAD. Accordingly, to assess the response to therapeutic interventions, exercise performance and functional status need to be directly measured, and cannot be predicted from hemodynamic measurements.
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Affiliation(s)
- Andrzej Szuba
- Division of Cardiovascular Medicine, 300 Pasteur Drive, Stanford University School of Medicine, Stanford, CA 94305, USA
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Baum O, Torchetti E, Malik C, Hoier B, Walker M, Walker PJ, Odriozola A, Graber F, Tschanz SA, Bangsbo J, Hoppeler H, Askew CD, Hellsten Y. Capillary ultrastructure and mitochondrial volume density in skeletal muscle in relation to reduced exercise capacity of patients with intermittent claudication. Am J Physiol Regul Integr Comp Physiol 2016; 310:R943-51. [DOI: 10.1152/ajpregu.00480.2015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/17/2016] [Indexed: 01/26/2023]
Abstract
Intermittent claudication (IC) is the most commonly reported symptom of peripheral arterial disease (PAD). Impaired limb blood flow is a major casual factor of lower exercise tolerance in PAD but cannot entirely explain it. We hypothesized that IC is associated with structural changes of the capillary-mitochondria interface that could contribute to the reduction of exercise tolerance in IC patients. Capillary and mitochondrial morphometry were performed after light and transmission electron microscopy using vastus lateralis muscle biopsies of 14 IC patients and 10 age-matched controls, and peak power output (PPO) was determined for all participants using an incremental single-leg knee-extension protocol. Capillary density was lower (411 ± 90 mm−2 vs. 506 ± 95 mm−2; P ≤ 0.05) in the biopsies of the IC patients than in those of the controls. The basement membrane (BM) around capillaries was thicker (543 ± 82 nm vs. 423 ± 97 nm; P ≤ 0.01) and the volume density of mitochondria was lower (3.51 ± 0.56% vs. 4.60 ± 0.74%; P ≤ 0.01) in the IC patients than the controls. In the IC patients, a higher proportion of capillaries appeared with collapsed slit-like lumen and/or swollen endothelium. PPO was lower (18.5 ± 9.9 W vs. 33.5 ± 9.4 W; P ≤ 0.01) in the IC patients than the controls. We suggest that several structural alterations in skeletal muscle, either collectively or separately, contribute to the reduction of exercise tolerance in IC patients.
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Affiliation(s)
- Oliver Baum
- Institute of Physiology, CharitéCrossOver (CCO), Berlin, Germany
- Institute of Anatomy, University of Bern, Switzerland
| | | | - Corinna Malik
- Institute of Anatomy, University of Bern, Switzerland
| | - Birgitte Hoier
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Meegan Walker
- School of Health and Sport Sciences, University of the Sunshine Coast, Australia
| | - Philip J. Walker
- Discipline of Surgery, School of Medicine and Centre for Clinical Research, The University of Queensland, Australia; and
- National Health and Medical Research Council, Centre of Research Excellence for Peripheral Arterial Diseases, Australia
| | | | | | | | - Jens Bangsbo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Hans Hoppeler
- Institute of Anatomy, University of Bern, Switzerland
| | - Christopher D. Askew
- School of Health and Sport Sciences, University of the Sunshine Coast, Australia
- National Health and Medical Research Council, Centre of Research Excellence for Peripheral Arterial Diseases, Australia
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
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Ha DM, Carpenter LC, Koutakis P, Swanson SA, Zhu Z, Hanna M, DeSpiegelaere HK, Pipinos II, Casale GP. Transforming growth factor-beta 1 produced by vascular smooth muscle cells predicts fibrosis in the gastrocnemius of patients with peripheral artery disease. J Transl Med 2016; 14:39. [PMID: 26847457 PMCID: PMC4743093 DOI: 10.1186/s12967-016-0790-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/06/2016] [Indexed: 12/03/2022] Open
Abstract
Background Lower leg ischemia, myopathy, and limb dysfunction are distinguishing features of peripheral artery disease (PAD). The myopathy of PAD is characterized by myofiber degeneration in association with extracellular matrix expansion, and increased expression of transforming growth factor-beta 1 (TGF-β1; a pro-fibrotic cytokine). In this study, we evaluated cellular expression of TGF-β1 in gastrocnemius of control (CTRL) and PAD patients and its relationship to deposited collagen, fibroblast accumulation and limb hemodynamics. Methods Gastrocnemius biopsies were collected from PAD patients with claudication (PAD-II; N = 25) and tissue loss (PAD-IV; N = 20) and from CTRL patients (N = 20). TGF-β1 in slide-mounted specimens was labeled with fluorescent antibodies and analyzed by quantitative wide-field, fluorescence microscopy. We evaluated co-localization of TGF-β1 with vascular smooth muscle cells (SMC) (high molecular weight caldesmon), fibroblasts (TE-7 antigen), macrophages (CD163), T cells (CD3) and endothelial cells (CD31). Collagen was stained with Masson Trichrome and collagen density was determined by quantitative bright-field microscopy with multi-spectral imaging. Results Collagen density increased from CTRL to PAD-II to PAD-IV specimens (all differences p < 0.05) and was prominent around microvessels. TGF-β1 expression increased with advancing disease (all differences p < 0.05), correlated with collagen density across all specimens (r = 0.864; p < 0.001), associated with fibroblast accumulation, and was observed exclusively in SMC. TGF-β1 expression inversely correlated with ankle-brachial index across PAD patients (r = −0.698; p < 0.001). Conclusions Our findings support a progressive fibrosis in the gastrocnemius of PAD patients that is caused by elevated TGF-β1 production in the SMC of microvessels in response to tissue hypoxia. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0790-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duy M Ha
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. .,Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Lauren C Carpenter
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Panagiotis Koutakis
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Stanley A Swanson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Zhen Zhu
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Mina Hanna
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Holly K DeSpiegelaere
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA.
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. .,Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA. .,Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA. .,983280 Nebraska Medical Center, Omaha, NE, 68198-7690, USA.
| | - George P Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. .,987690 Nebraska Medical Center, Omaha, NE, 68198-7690, USA.
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Harwood AE, Cayton T, Sarvanandan R, Lane R, Chetter I. A Review of the Potential Local Mechanisms by Which Exercise Improves Functional Outcomes in Intermittent Claudication. Ann Vasc Surg 2016; 30:312-20. [DOI: 10.1016/j.avsg.2015.05.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/21/2015] [Accepted: 05/25/2015] [Indexed: 12/15/2022]
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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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