1
|
Wilburn D, Miserlis D, Fletcher E, Papoutsi E, Ismaeel A, Bradley C, Ring A, Wilkinson T, Smith RS, Ferrer L, Haynatzki G, Monteleone P, Banerjee S, Brisbois E, Bohannon WT, Koutakis P. Skeletal muscle desmin alterations following revascularization in peripheral artery disease claudicants. Sci Rep 2024; 14:12609. [PMID: 38824194 PMCID: PMC11144188 DOI: 10.1038/s41598-024-63626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/30/2024] [Indexed: 06/03/2024] Open
Abstract
Peripheral artery disease (PAD) is characterized by varying severity of arterial stenosis, exercise induced claudication, malperfused tissue precluding normal healing and skeletal muscle dysfunction. Revascularization interventions improve circulation, but post-reperfusion changes within the skeletal muscle are not well characterized. This study investigates if revascularization enhanced hemodynamics increases walking performance with concurrent improvement of mitochondrial function and reverses abnormal skeletal muscle morphological features that develop with PAD. Fifty-eight patients completed walking performance testing and muscle biopsy before and 6 months after revascularization procedures. Muscle fiber morphology, desmin structure, and mitochondria respiration assessments before and after the revascularization were evaluated. Revascularization improved limb hemodynamics, walking function, and muscle morphology. Qualitatively not all participants recovered normal structural architecture of desmin in the myopathic myofibers after revascularization. Heterogenous responses in the recovery of desmin structure following revascularization may be caused by other underlying factors not reversed with hemodynamic improvements. Revascularization interventions clinically improve patient walking ability and can reverse the multiple subcellular functional and structural abnormalities in muscle cells. Further study is needed to characterize desmin structural remodeling with improvements in skeletal muscle morphology and function.
Collapse
Affiliation(s)
- Dylan Wilburn
- Department of Biology, Baylor University, B.207 Baylor Science Building, One Bear Place #97388, Waco, TX, 76798-7388, USA
| | - Dimitrios Miserlis
- Department of Surgery and Perioperative Care, University of Texas, Austin, TX, USA
- Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Emma Fletcher
- Department of Biology, Baylor University, B.207 Baylor Science Building, One Bear Place #97388, Waco, TX, 76798-7388, USA
| | - Evlampia Papoutsi
- Department of Biology, Baylor University, B.207 Baylor Science Building, One Bear Place #97388, Waco, TX, 76798-7388, USA
| | - Ahmed Ismaeel
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Cassandra Bradley
- Department of Biology, Baylor University, B.207 Baylor Science Building, One Bear Place #97388, Waco, TX, 76798-7388, USA
| | - Andrew Ring
- Department of Biology, Baylor University, B.207 Baylor Science Building, One Bear Place #97388, Waco, TX, 76798-7388, USA
| | - Trevor Wilkinson
- Department of Biology, Baylor University, B.207 Baylor Science Building, One Bear Place #97388, Waco, TX, 76798-7388, USA
| | - Robert S Smith
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX, USA
| | - Lucas Ferrer
- Department of Surgery and Perioperative Care, University of Texas, Austin, TX, USA
| | - Gleb Haynatzki
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Peter Monteleone
- Department of Internal Medicine, University of Texas, Austin, TX, USA
| | - Subhash Banerjee
- Department of Cardiology, Baylor Scott & White Medical Center, Dallas, TX, USA
| | - Elizabeth Brisbois
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - William T Bohannon
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX, USA
| | - Panagiotis Koutakis
- Department of Biology, Baylor University, B.207 Baylor Science Building, One Bear Place #97388, Waco, TX, 76798-7388, USA.
| |
Collapse
|
2
|
Bradley CE, Fletcher E, Wilkinson T, Ring A, Ferrer L, Miserlis D, Pacher P, Koutakis P. Mitochondrial fatty acid beta-oxidation: a possible therapeutic target for skeletal muscle lipotoxicity in peripheral artery disease myopathy. EXCLI JOURNAL 2024; 23:523-533. [PMID: 38741727 PMCID: PMC11089102 DOI: 10.17179/excli2024-7004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024]
Abstract
Peripheral artery disease (PAD) is an atherosclerotic disease impacting over 200 million individuals and the prevalence increases with age. PAD occurs when plaque builds up within the peripheral arteries, leading to reduced blood flow and oxygen supply to the outer extremities. Individuals who experience PAD suffer from ischemia, which is typically accompanied by significant damage to skeletal muscles. Additionally, this tissue damage affects mitochondria, causing them to become dysregulated and dysfunctional, resulting in decreased metabolic rates. As there is no known cure for PAD, researchers are exploring potential therapeutic targets by examining coexisting cardiovascular conditions and metabolic risk factors, such as the aging process. Among these comorbidities, type-two diabetes mellitus and obesity are particularly common in PAD cases. These conditions, along with aging itself, are associated with an elevated accumulation of ectopic lipids within skeletal muscles, similar to what is observed in PAD. Researchers have attempted to reduce excess lipid accumulation by increasing the rate of fatty acid beta oxidation. Manipulating acetyl coenzyme A carboxylase 2, a key regulatory protein of fatty acid beta oxidation, has been the primary focus of such research. When acetyl coenzyme A carboxylase 2 is inhibited, it interrupts the conversion of acetyl-CoA into malonyl-CoA, resulting in an increase in the rate of fatty acid beta oxidation. By utilizing samples from PAD patients and applying the pharmacological strategies developed for acetyl coenzyme A carboxylase 2 in diabetes and obesity to PAD, a potential new therapeutic avenue may emerge, offering hope for improved quality of life for individuals suffering from PAD.
Collapse
Affiliation(s)
- Cassandra E. Bradley
- Department of Biology, Baylor University, One Bear Place #97388, Waco, TX 76798, USA
| | - Emma Fletcher
- Department of Biology, Baylor University, One Bear Place #97388, Waco, TX 76798, USA
| | - Trevor Wilkinson
- Department of Biology, Baylor University, One Bear Place #97388, Waco, TX 76798, USA
| | - Andrew Ring
- Department of Biology, Baylor University, One Bear Place #97388, Waco, TX 76798, USA
| | - Lucas Ferrer
- Department of Surgery, University of Texas at Austin Dell Medical School, 1601 Trinity St, Room 6708A, Austin, TX 78712, USA
| | - Dimitrios Miserlis
- Department of Surgery, University of Texas at Austin Dell Medical School, 1601 Trinity St, Room 6708A, Austin, TX 78712, USA
| | - Pal Pacher
- National Institutes of Health, Bethesda, MD, USA
| | - Panagiotis Koutakis
- Department of Biology, Baylor University, One Bear Place #97388, Waco, TX 76798, USA
| |
Collapse
|
3
|
Koutakis P, Hernandez H, Miserlis D, Thompson JR, Papoutsi E, Mietus CJ, Haynatzki G, Kim JK, Casale GP, Pipinos II. Oxidative damage in the gastrocnemius predicts long-term survival in patients with peripheral artery disease. NPJ AGING 2024; 10:21. [PMID: 38580664 PMCID: PMC10997596 DOI: 10.1038/s41514-024-00147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/20/2024] [Indexed: 04/07/2024]
Abstract
Patients with peripheral artery disease (PAD) have increased mortality rates and a myopathy in their affected legs which is characterized by increased oxidative damage, reduced antioxidant enzymatic activity and defective mitochondrial bioenergetics. This study evaluated the hypothesis that increased levels of oxidative damage in gastrocnemius biopsies from patients with PAD predict long-term mortality rates. Oxidative damage was quantified as carbonyl adducts in myofibers of the gastrocnemius of PAD patients. The oxidative stress data were grouped into tertiles and the 5-year, all-cause mortality for each tertile was determined by Kaplan-Meier curves and compared by the Modified Peto test. A Cox-regression model was used to control the effects of clinical characteristics. Results were adjusted for age, sex, race, body mass index, ankle-brachial index, smoking, physical activity, and comorbidities. Of the 240 study participants, 99 died during a mean follow up of 37.8 months. Patients in the highest tertile of oxidative damage demonstrated the highest 5-year mortality rate. The mortality hazard ratios (HR) from the Cox analysis were statistically significant for oxidative damage (lowest vs middle tertile; HR = 6.33; p = 0.0001 and lowest vs highest; HR = 8.37; p < 0.0001). Survival analysis of a contemporaneous population of PAD patients identifies abundance of carbonyl adducts in myofibers of their gastrocnemius as a predictor of mortality rate independently of ankle-brachial index, disease stage and other clinical and myopathy-related covariates.
Collapse
Affiliation(s)
- Panagiotis Koutakis
- Department of Biology, Baylor University, Waco, TX, USA.
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Hernan Hernandez
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dimitrios Miserlis
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, TX, USA
| | - Jonathan R Thompson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Evlampia Papoutsi
- Department of Biology, Baylor University, Waco, TX, USA
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Constance J Mietus
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Neurological Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Gleb Haynatzki
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julian K Kim
- Department of Biology, Baylor University, Waco, TX, USA
| | - George P Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Iraklis I Pipinos
- Department of Surgery, 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.
| |
Collapse
|
4
|
Speichinger F, Gratl A, Raude B, Schawe L, Carstens J, Hering NA, Greiner A, Pesta D, Frese JP. Mitochondrial respiration in peripheral arterial disease depends on stage severity. J Cell Mol Med 2024; 28:e18126. [PMID: 38534092 DOI: 10.1111/jcmm.18126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/17/2023] [Accepted: 01/05/2024] [Indexed: 03/28/2024] Open
Abstract
Peripheral arterial disease (PAD) is an increasing cause of morbidity and its severity is graded based on clinical manifestation. To investigate the influence of the different stages on myopathy of ischemic muscle we analysed severity-dependent effects of mitochondrial respiration in PAD. Eighteen patients with severe PAD, defined as chronic limb-threatening ischemia, 47 patients with intermittent claudication (IC) and 22 non-ischemic controls were analysed. High-resolution respirometry (HRR) was performed on muscle biopsies of gastrocnemius and vastus lateralis muscle of patients in different PAD stages to investigate different respiratory states. Results from HRR are given as median and interquartile range and were normalized to citrate synthase activity (CSA), a marker for mitochondrial content. In order to account for inter-individual differences between patients and controls, we calculated the ratio of O₂-flux in gastrocnemius muscle over vastus muscle ('GV ratio'). CSA of the gastrocnemius muscle as a proxy for mitochondrial content was significantly lower in critical ischemia compared to controls. Mitochondrial respiration normalized to CSA was higher in IC compared to controls. Likewise, the GV ratio was significantly higher in IC compared to control. Mitochondrial respiration and CSA of PAD patients showed stage-dependent modifications with greater changes in the mild PAD stage group (IC).
Collapse
Affiliation(s)
- Fiona Speichinger
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of General and Visceral Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexandra Gratl
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ben Raude
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Larissa Schawe
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Carstens
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nina A Hering
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of General and Visceral Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Greiner
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Pesta
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Centre for Endocrinology, Diabetes and Preventive Medicine (CEDP), University Hospital Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Jan Paul Frese
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
5
|
Navi A, Patel H, Shiwen X, Baker D, Abraham D, Tsui J. Role of toll-like receptor 4 in skeletal muscle damage in chronic limb-threatening ischemia. JVS Vasc Sci 2024; 5:100194. [PMID: 38510939 PMCID: PMC10951510 DOI: 10.1016/j.jvssci.2024.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
Objective Toll-like receptors (TLRs) are key pattern recognition receptors in the innate immune system. In particular, the TLR4-mediated immune response has been implicated in ischemia-induced tissue injury. Mounting evidence supports a detrimental role of the innate immune system in the pathophysiology of skeletal muscle damage in patients with chronic limb-threatening ischemia (CLTI), in whom patient-oriented functional outcomes are poor. The overall aim of this study was to investigate the potential role of TLR4 in skeletal muscle dysfunction and damage in CLTI. Methods The role of TLR4 in ischemic muscle was investigated by (1) studying TLR4 expression and distribution in human gastrocnemius muscle biopsies, (2) evaluating the functional consequences of TLR4 inhibition in myotubes derived from human muscle biopsies, and (3) assessing the therapeutic potential of modulating TLR4 signaling in ischemic muscle in a mouse hindlimb ischemia model. Results TLR4 was found to be expressed in human muscle biopsies, with significant upregulation in samples from patients with CLTI. In vitro studies using cultured human myotubes demonstrated upregulation of TLR4 in ischemia, with activation of the downstream signaling pathway. Inhibition of TLR4 before ischemia was associated with reduced ischemia-induced apoptosis. Upregulation of TLR4 also occurred in ischemia in vivo and TLR4 inhibition was associated with decreased inflammatory cell infiltration and diminished apoptosis in the ischemic limb. Conclusions TLR4 is upregulated and activated in ischemic skeletal muscle in patients with CLTI. Modulating TLR4 signaling in vitro and in vivo was associated with attenuation of ischemia-induced skeletal muscle damage. This strategy could be explored further for potential clinical application.
Collapse
Affiliation(s)
- Ali Navi
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - Hemanshu Patel
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - Xu Shiwen
- Centre for Rheumatology & Connective Tissue Disease, University College London, London, United Kingdom
| | - Daryll Baker
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - David Abraham
- Centre for Rheumatology & Connective Tissue Disease, University College London, London, United Kingdom
| | - Janice Tsui
- Division of Surgery & Interventional Science, University College London, London, United Kingdom
| |
Collapse
|
6
|
Kumar A, Narkar VA. Nuclear receptors as potential therapeutic targets in peripheral arterial disease and related myopathy. FEBS J 2023; 290:4596-4613. [PMID: 35942640 PMCID: PMC9908775 DOI: 10.1111/febs.16593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 12/31/2022]
Abstract
Peripheral arterial disease (PAD) is a prevalent cardiovascular complication of limb vascular insufficiency, causing ischemic injury, mitochondrial metabolic damage and functional impairment in the skeletal muscle, and ultimately leading to immobility and mortality. While potential therapies have been mostly focussed on revascularization, none of the currently available pharmacological treatments are fully effective in PAD, often leading to amputations, particularly in chronic metabolic diseases. One major limitation of focussed angiogenesis and revascularization as a therapeutic strategy is a limited effect on metabolic restoration and muscle regeneration in the affected limb. Therefore, additional preclinical investigations are needed to discover novel treatment options for PAD preferably targeting multiple aspects of muscle recovery. In this review, we propose nuclear receptors expressed in the skeletal muscle as potential candidates for ischemic muscle repair in PAD. We review classic steroid and orphan receptors that have been reported to be involved in the regulation of paracrine muscle angiogenesis, oxidative metabolism, mitochondrial biogenesis and muscle regeneration, and discuss how these receptors could be critical for recovery from ischemic muscle damage. Furthermore, we identify existing gaps in our understanding of nuclear receptor signalling in the skeletal muscle and propose future areas of research that could be instrumental in exploring nuclear receptors as therapeutic candidates for treating PAD.
Collapse
Affiliation(s)
- Ashok Kumar
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX 77204
| | - Vihang A. Narkar
- Brown Foundation Institute of Molecular Medicine, UTHealth McGovern Medical School, Houston, TX, 77030
- University of Texas MD Anderson and UTHealth Graduate School of Biomedical Sciences, Houston, TX, 77030
| |
Collapse
|
7
|
Tran L, Xie B, Assaf E, Ferrari R, Pipinos II, Casale GP, Alvidrez RIM, Watkins S, Sachdev U. Transcriptomic Profiling Identifies Ferroptosis-Related Gene Signatures in Ischemic Muscle Satellite Cells Affected by Peripheral Artery Disease-Brief Report. Arterioscler Thromb Vasc Biol 2023; 43:2023-2029. [PMID: 37675635 PMCID: PMC10549760 DOI: 10.1161/atvbaha.123.319518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND We hypothesized that transcriptomic profiling of muscle satellite cells in peripheral artery disease (PAD) would identify damage-related pathways contributing to skeletal muscle myopathy. We identified a potential role for ferroptosis-a form of programmed lytic cell death by iron-mediated lipid peroxidation-as one such pathway. Ferroptosis promotes myopathy in ischemic cardiac muscle but has an unknown role in PAD. METHODS Muscle satellite cells from donors with PAD were obtained during surgery. cDNA libraries were processed for single-cell RNA sequencing using the 10X Genomics platform. Protein expression was confirmed based on pathways inferred by transcriptomic analysis. RESULTS Unsupervised cluster analysis of over 25 000 cells aggregated from 8 donor samples yielded distinct cell populations grouped by a shared unique transcriptional fingerprint. Quiescent cells were diminished in ischemic muscle while myofibroblasts and apoptotic cells were prominent. Differential gene expression demonstrated a surprising increase in genes associated with iron transport and oxidative stress and a decrease in GPX4 (glutathione peroxidase 4) in ischemic PAD-derived cells. Release of the danger signal HMGB1 (high mobility group box-1) correlated with ferroptotic markers including surface transferrin receptor and were higher in ischemia. Furthermore, lipid peroxidation in muscle satellite cells was modulated by ferrostatin, a ferroptosis inhibitor. Histology confirmed iron deposition and lipofuscin, an inducer of ferroptosis in PAD-affected muscle. CONCLUSIONS This report presents a novel finding that genes known to be involved in ferroptosis are differentially expressed in human skeletal muscle affected by PAD. Targeting ferroptosis may be a novel therapeutic strategy to reduce PAD myopathy.
Collapse
Affiliation(s)
- Lillian Tran
- University of Pittsburgh Medical Center Department of Surgery
| | - Bowen Xie
- University of Pittsburgh Medical Center Department of Surgery
| | - Edwyn Assaf
- University of Pittsburgh Medical Center Department of Surgery
| | - Ricardo Ferrari
- University of Pittsburgh Medical Center Department of Surgery
| | - Iraklis I. Pipinos
- University of Nebraska Medical Center Department of Surgery and the VAResearch Service, VA Nebraska-Western Iowa Health Care System
| | - George P. Casale
- University of Nebraska Medical Center Department of Surgery and the VAResearch Service, VA Nebraska-Western Iowa Health Care System
| | | | - Simon Watkins
- University of Pittsburgh Center for Biologic Imaging
| | - Ulka Sachdev
- University of Pittsburgh Medical Center Department of Surgery
| |
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Adhami M, Martin NK, Maguire C, Courtenay AJ, Donnelly RF, Domínguez-Robles J, Larrañeta E. Drug loaded implantable devices to treat cardiovascular disease. Expert Opin Drug Deliv 2023; 20:507-522. [PMID: 36924328 DOI: 10.1080/17425247.2023.2190580] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
INTRODUCTION It is widely acknowledged that cardiovascular diseases (CVDs) continue to be the leading cause of death globally. Furthermore, CVDs are the leading cause of diminished quality of life for patients, frequently as a result of their progressive deterioration. Medical implants that release drugs into the body are active implants that do more than just provide mechanical support; they also have a therapeutic role. Primarily, this is achieved through the controlled release of active pharmaceutical ingredients (API) at the implementation site. AREAS COVERED In this review, the authors discuss drug-eluting stents, drug-eluting vascular grafts, and drug-eluting cardiac patches with the aim of providing a broad overview of the three most common types of cardiac implant. EXPERT OPINION Drug eluting implants are an ideal alternative to traditional drug delivery because they allow for accurate drug release, local drug delivery to the target tissue, and minimise the adverse side effects associated with systemic administration. Despite the fact that there are still challenges that need to be addressed, the ever-evolving new technologies are making the fabrication of drug eluting implants a rewarding therapeutic endeavour with the possibility for even greater advances.
Collapse
Affiliation(s)
| | | | | | - Aaron J Courtenay
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, UK
| | | | - Juan Domínguez-Robles
- School of Pharmacy, Queen's University Belfast, UK.,Department of Pharmacy and Pharmaceutical Technology, University of Seville, Seville, Spain
| | | |
Collapse
|
10
|
Bapat GM, Bashir AZ, Malcolm P, Johanning JM, Pipinos II, Myers SA. A biomechanical perspective on walking in patients with peripheral artery disease. Vasc Med 2023; 28:77-84. [PMID: 36759931 PMCID: PMC9997455 DOI: 10.1177/1358863x221146207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The most common symptom of peripheral artery disease (PAD) is intermittent claudication, which consists of debilitating leg pain during walking. In clinical settings, the presence of PAD is often noninvasively evaluated using the ankle-brachial index and imaging of the arterial supply. Furthermore, various questionnaires and functional tests are commonly used to measure the severity and negative effect of PAD on quality of life. However, these evaluations only provide information on vascular insufficiency and severity of the disease, but not regarding the complex mechanisms underlying walking impairments in patients with PAD. Biomechanical analyses using motion capture and ground reaction force measurements can provide insight into the underlying mechanisms to walking impairments in PAD. This review analyzes the application of biomechanics tools to identify gait impairments and their clinical implications on rehabilitation of patients with PAD. A total of 18 published journal articles focused on gait biomechanics in patients with PAD were studied. This narriative review shows that the gait of patients with PAD is impaired from the first steps that a patient takes and deteriorates further after the onset of claudication leg pain. These results point toward impaired muscle function across the ankle, knee, and hip joints during walking. Gait analysis helps understand the mechanisms operating in PAD and could also facilitate earlier diagnosis, better treatment, and slower progression of PAD.
Collapse
Affiliation(s)
- Ganesh M Bapat
- Department of Mechanical Engineering, BITS Pilani K K Birla Goa Campus, Goa, India
| | - Ayisha Z Bashir
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Philippe Malcolm
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Jason M Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, NE, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA.,Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
11
|
Anderson EM, Kim K, Fazzone BJ, Harland KC, Hu Q, Salyers Z, Palzkill VR, Cort TA, Kunz EM, Martin AJ, Neal D, O’Malley KA, Berceli SA, Ryan TE, Scali ST. Influences of renal insufficiency and ischemia on mitochondrial bioenergetics and limb dysfunction in a novel murine iliac arteriovenous fistula model. JVS Vasc Sci 2022; 3:345-362. [PMID: 36439698 PMCID: PMC9692039 DOI: 10.1016/j.jvssci.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Hand disability after hemodialysis access surgery has been common yet has remained poorly understood. Arteriovenous fistula (AVF) hemodynamic perturbations have not reliably correlated with the observed measures of hand function. Chronic kidney disease (CKD) is known to precipitate myopathy; however, the interactive influences of renal insufficiency and ischemia on limb outcomes have remained unknown. We hypothesized that CKD would contribute to access-related hand dysfunction via altered mitochondrial bioenergetics. Using a novel murine AVF model, we sought to characterize the skeletal muscle outcomes in mice with and without renal insufficiency. Methods Male, 8-week-old C57BL/6J mice were fed either an adenine-supplemented diet to induce renal insufficiency (CKD) or a casein-based control chow (CON). After 2 weeks of dietary intervention, the mice were randomly assigned to undergo iliac AVF surgery (n = 12/group) or a sham operation (n = 5/group). Measurements of aortoiliac hemodynamics, hindlimb perfusion, and hindlimb motor function were collected for 2 weeks. The mice were sacrificed on postoperative day 14 to assess skeletal muscle histopathologic features and mitochondrial function. To assess the late outcome trends, 20 additional mice had undergone CKD induction and sham (n = 5) or AVF (n = 15) surgery and followed up for 6 weeks postoperatively before sacrifice. Results The adenine-fed mice had had a significantly reduced glomerular filtration rate and elevated blood urea nitrogen, confirming the presence of CKD. The sham mice had a 100% survival rate and AVF cohorts an 82.1% survival rate with an 84.4% AVF patency rate. The aorta and inferior vena cava velocity measurements and the vessel diameter had increased after AVF creation (P < .0001 vs sham). The AVF groups had had a 78.4% deficit in paw perfusion compared with the contralateral limb after surgery (P < .0001 vs sham). Mitochondrial function was influenced by the presence of CKD. The respiratory capacity of the CKD-sham mice (8443 ± 1509 pmol/s/mg at maximal energy demand) was impaired compared with that of the CON-sham mice (12,870 ± 1203 pmol/s/mg; P = .0001). However, this difference was muted after AVF creation (CKD-AVF, 4478 ± 3685 pmol/s/mg; CON-AVF, 5407 ± 3582 pmol/s/mg; P = .198). The AVF cohorts had had impairments in grip strength (vs sham; P < .0001) and gait (vs sham; P = .012). However, the presence of CKD did not significantly alter the measurements of gross muscle function. The paw perfusion deficits had persisted 6 weeks postoperatively for the AVF mice (P < .0001 vs sham); however, the myopathy had resolved (grip strength, P = .092 vs sham; mitochondrial respiration, P = .108 vs sham). Conclusions CKD and AVF-induced distal limb ischemia both impaired skeletal muscle mitochondrial function. Renal insufficiency was associated with a baseline myopathy that was exacerbated by the acute ischemic injury resulting from AVF creation. However, ischemia was the primary driver of the observed phenotype of gross motor impairment. This model reliably reproduced the local and systemic influences that contribute to access-related hand dysfunction and provides a platform for further mechanistic and therapeutic investigation.
Collapse
Affiliation(s)
- Erik M. Anderson
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Kyoungrae Kim
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, FL
| | - Brian J. Fazzone
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Kenneth C. Harland
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Qiongyao Hu
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Zach Salyers
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, FL
| | - Victoria R. Palzkill
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, FL
| | - Tomas A. Cort
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, FL
| | - Eric M. Kunz
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, FL
| | - Andrew J. Martin
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Dan Neal
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Kerri A. O’Malley
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Scott A. Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Terence E. Ryan
- Department of Applied Physiology and Kinesiology, Center for Exercise Science, University of Florida, Gainesville, FL
| | - Salvatore T. Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| |
Collapse
|
12
|
Gratl A, Lobenwein D, Gummerer M, Wipper S. Die Etablierung eines neuen Forschungskonzepts an einem universitären Standort. GEFÄSSCHIRURGIE 2022; 27:239-245. [PMID: 35702688 PMCID: PMC9185131 DOI: 10.1007/s00772-022-00900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
Neben der klinischen Tätigkeit haben an einem universitären Standort Forschung und Lehre einen großen Stellenwert. Durch die Etablierung eines neuen Forschungslabors an der Universitätsklinik für Gefäßchirurgie der Medizinischen Universität Innsbruck wurden die infrastrukturellen Voraussetzungen zur Gestaltung eines neuen Forschungsschwerpunkts geschaffen. Die Kooperation mit nationalen und internationalen Partnern war für diesen Prozess essenziell. Nicht nur in der Planung und Ausstattung der Räumlichkeiten, sondern auch in der Entwicklung von Studienprotokollen und zur kritischen Diskussion von Ergebnissen ist der Aufbau eines Netzwerkes von großer Bedeutung. Durch die Etablierung der experimentellen Gefäßchirurgie Innsbruck ist nun die Realisierung von Projekten der Grundlagenforschung und der translationalen Forschung an diesem universitären Standort möglich. Zudem spielt die Lehrforschung eine immer größere Rolle, insbesondere um die Ausbildungsstruktur möglichst praxisnah zu gestalten, Nachwuchs anzuwerben und die immer komplexer werdenden Techniken auch praxisnah zu vermitteln.
Collapse
Affiliation(s)
- Alexandra Gratl
- Univ.-Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich
| | - Daniela Lobenwein
- Univ.-Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich
| | - Maria Gummerer
- Univ.-Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich
| | - Sabine Wipper
- Univ.-Klinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Österreich
| |
Collapse
|
13
|
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: 24] [Impact Index Per Article: 12.0] [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.
Collapse
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
| |
Collapse
|
14
|
Dinkel D, Hassan M, Rech JP, Despiegelaere H, Johanning J, Pipinos I, Myers S. Assessing Wear Time and Perceptions of Wearing an Ankle Foot Orthosis in Patients with Peripheral Artery Disease. PM R 2022; 15:493-500. [PMID: 35488854 PMCID: PMC9617808 DOI: 10.1002/pmrj.12829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is a cardiovascular disease that effects patients' walking ability. An ankle foot orthosis (AFO) may improve patients' walking distances. Little research has explored if patients wear a prescribed AFO and their perceptions of wearing the device. OBJECTIVE To assess wear time of an AFO and explore perceptions of wearing the device in patients with peripheral artery disease. DESIGN Convergent mixed methods. SETTING The study was administered through a tertiary care medical center and the research subjects used the device in an outpatient setting in and out of their homes during their regular activities. PARTICIPANTS Patients were referred to the study by their vascular surgeon. Thirty-six patients, all older adult males, were enrolled in this study. Fourteen patients completed the study and 11 supplied sufficient accelerometer data. INTERVENTIONS An AFO was worn for 3 months. An accelerometer was placed on the AFO for 7 days at midpoint (1.5 months) and endpoint of the intervention (3 months) to assess wear time. Semi-structured interviews explored patients' perceptions of wearing the AFO. MAIN OUTCOME MEASURE The primary outcome measure was wear time measured objectively via accelerometer and subjectively via interview. RESULTS Patients (n = 14) wore the AFO around 8 hours/day. Most patients felt they wore the AFO a majority of the time. Patients reported barriers such as challenges wearing the AFO during daily household activities (using stairs, being on uneven terrain), discomfort, clothing or footwear issues, and driving challenges. Positive impacts of wearing the AFO were also reported, primarily the ability to walk further. CONCLUSIONS An AFO may be an acceptable therapeutic intervention to improve perceived walking performance in older adult males with PAD. Addressing patients' perceptions of the AFO and barriers to wear are essential to increasing the positive impact the device has on patients' ambulatory activity. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha
| | - Mahdi Hassan
- Department of Biomechanics, University of Nebraska at Omaha.,Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System
| | - John P Rech
- School of Health & Kinesiology, University of Nebraska at Omaha
| | - Holly Despiegelaere
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System
| | - Jason Johanning
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System.,Department of Surgery, University of Nebraska Medical Center
| | - Iraklis Pipinos
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System.,Department of Surgery, University of Nebraska Medical Center
| | - Sara Myers
- Department of Biomechanics, University of Nebraska at Omaha.,Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System
| |
Collapse
|
15
|
Yang Q, Li C, Chen Q. SS31 Ameliorates Oxidative Stress via the Restoration of Autophagic Flux to Protect Aged Mice From Hind Limb Ischemia. Front Cardiovasc Med 2022; 9:789331. [PMID: 35497980 PMCID: PMC9046554 DOI: 10.3389/fcvm.2022.789331] [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: 10/04/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Oxidative stress and impaired autophagic flux play important roles in the development of peripheral artery disease (PAD). SS31 is considered an important antioxidant peptide and autophagy regulator. We aimed to investigate the role of SS31 in PAD myopathy and its possible mechanism both in vivo and in vitro. Methods A hind limb ischemia (HLI) model was established with old C57BL/6 (14-month-old) mice. Mice in the SS31 group were intraperitoneally injected with SS31 (3 mg/kg) for 4 weeks. We examined skeletal muscle function and histomorphology, autophagy-related protein levels and reactive oxygen species (ROS) content. For the in vitro experiments, after C2C12 myotubes were treated with CoCl2, SS31, and chloroquine (CQ) or rapamycin (RAPA), we measured ROS content, autophagy-related protein levels and antioxidant enzyme expression. Results SS31 treatment effectively enhanced the recovery of skeletal muscle function, alleviated skeletal muscle injury and suppressed mitochondrial ROS production in ischemic limbs. SS31 reduced apoptosis and oxidative stress, and SS31 restored impaired autophagic flux by inhibiting the AKT-mTOR pathway. In vitro studies showed that SS31 restored autophagic flux and improved oxidative stress in C2C12 cells. Moreover, phosphorylated AKT (p-AKT) and phosphorylated mTOR (p-mTOR) levels were reduced. Conclusion These experiments indicated that SS31 can inhibit oxidative stress by restoring autophagic flux to reverse hypoxia-induced injury in vivo and in vitro.
Collapse
|
16
|
Ziegler L, Hedin U, Gottsäter A. Circulating Biomarkers in Lower Extremity Artery Disease. Eur Cardiol 2022; 17:e09. [PMID: 35401792 PMCID: PMC8978021 DOI: 10.15420/ecr.2021.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022] Open
Abstract
Lower extremity artery disease (LEAD), a chronic condition with disturbed lower extremity circulation due to narrowing of the arteries, is predominantly caused by atherosclerosis and is associated with the presence of cardiovascular risk factors and an increased risk of cardiovascular events. LEAD is prevalent among older individuals and predicted to rise with the ageing population. In progressive disease, the patient experiences symptoms of ischaemia when walking and, in advanced critical limb-threatening ischaemia, even at rest. However, LEAD is asymptomatic in most patients, delaying diagnosis and treatment. In this setting, circulating biomarkers may facilitate earlier diagnosis in selected individuals. This review provides a broad overview of the circulating biomarkers investigated to date in relation to LEAD and discusses their usefulness in clinical practice.
Collapse
Affiliation(s)
- Louise Ziegler
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Ulf Hedin
- Vascular Surgery Division, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Anders Gottsäter
- Department of Medicine, Lund University, Malmö, Sweden; Department of Medicine, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
17
|
Antonellis P, Mohammadzadeh Gonabadi A, Myers SA, Pipinos II, Malcolm P. Metabolically efficient walking assistance using optimized timed forces at the waist. Sci Robot 2022; 7:eabh1925. [PMID: 35294219 DOI: 10.1126/scirobotics.abh1925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The metabolic rate of walking can be reduced by applying a constant forward force at the center of mass. It has been shown that the metabolically optimal constant force magnitude minimizes propulsion ground reaction force at the expense of increased braking. This led to the hypothesis that selectively assisting propulsion could lead to greater benefits. We used a robotic waist tether to evaluate the effects of forward forces with different timings and magnitudes. Here, we show that it is possible to reduce the metabolic rate of healthy participants by 48% with a greater efficiency ratio of metabolic cost reduction per unit of net aiding work compared with other assistive robots. This result was obtained using a sinusoidal force profile with peak timing during the middle of the double support. The same timing could also reduce the metabolic rate in patients with peripheral artery disease. A model explains that the optimal force profile accelerates the center of mass into the inverted pendulum movement during single support. Contrary to the hypothesis, the optimal force timing did not entirely coincide with propulsion. Within the field of wearable robotics, there is a trend to use devices to mimic biological torque or force profiles. Such bioinspired actuation can have relevant benefits; however, our results demonstrate that this is not necessarily optimal for reducing metabolic rate.
Collapse
Affiliation(s)
- Prokopios Antonellis
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA.,Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP-32, Portland, OR 97239, USA
| | - Arash Mohammadzadeh Gonabadi
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA.,Rehabilitation Engineering Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospital, 5401 South Street, Lincoln, NE 68506, USA
| | - Sara A Myers
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA.,Department of Surgery and Research Service, Veterans Affairs Nebraska-Western Iowa Medical Center, Omaha, NE 68105, USA
| | - Iraklis I Pipinos
- Department of Surgery and Research Service, Veterans Affairs Nebraska-Western Iowa Medical Center, Omaha, NE 68105, USA.,Department of Surgery, University of Nebraska Medical Center, 982500 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Philippe Malcolm
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA
| |
Collapse
|
18
|
Oberdier MT, AlGhatrif M, Adelnia F, Zampino M, Morrell CH, Simonsick E, Fishbein K, Lakatta EG, McDermott MM, Ferrucci L. Ankle-Brachial Index and Energy Production in People Without Peripheral Artery Disease: The BLSA. J Am Heart Assoc 2022; 11:e019014. [PMID: 35253449 PMCID: PMC9075330 DOI: 10.1161/jaha.120.019014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
Background Lower ankle-brachial index (ABI) values within the 0.90 to 1.40 range are associated with poorer mitochondrial oxidative capacity of thigh muscles in cross-sectional analyses. Whether ABI decline is associated with greater declines in thigh muscle oxidative capacity with aging is unknown. Method and Results We analyzed data from 228 participants (100 men) of the BLSA (Baltimore Longitudinal Study of Aging), aged 39 to 97 years, with an ABI between 0.9 and 1.40 at baseline and at follow-up (mean follow-up period of 2.8 years). We examined mitochondrial oxidative capacity of the left thigh muscle, by measuring the postexercise phosphocreatine recovery rate constant (kPCr) from phosphorus-31 magnetic resonance spectroscopy. Greater kPCr indicated higher mitochondrial oxidative capacity. Although kPCr was available on the left leg only, ABI was measured in both legs. Longitudinal rates of change (Change) of left and right ABI and kPCr of the left thigh muscle were estimated using linear mixed effects models, and their association was analyzed by standardized multiple linear regressions. In multivariate analysis including sex, age, baseline kPCr, both left and right baseline ABI, and ABI change in both legs, (kPCr)Change was directly associated with ipsilateral (left) (ABI)Change (standardized [STD]-β=0.14; P=0.0168) but not with contralateral (right) (ABI)Change (P=0.22). Adjusting for traditional cardiovascular risk factors, this association remained significant (STD-β=0.18; P=0.0051). (kPCr)Change was steeper in White race participants (STD-β=0.16; P=0.0122) and body mass index (STD-β=0.13; P=0.0479). There was no significant association with current smoking status (P=0.63), fasting glucose (P=0.28), heart rate (P=0.67), mean blood pressure (P=0.78), and low-density lipoprotein (P=0.75), high-density lipoprotein (P=0.82), or triglycerides (P=0.15). Conclusions In people without peripheral arterial disease, greater decline in ABI over time, but not baseline ABI, was associated with faster decline in thigh mitochondrial oxidative capacity in the ipsilateral leg. Further studies are needed to examine whether early interventions that improve lower extremity muscle perfusion can improve and prevent the decline of muscle energetics.
Collapse
Affiliation(s)
- Matt T. Oberdier
- Laboratory of Cardiovascular ScienceNational Institute on AgingBaltimoreMD
- Longitudinal Studies SectionNational Institute on AgingBaltimoreMD
| | - Majd AlGhatrif
- Laboratory of Cardiovascular ScienceNational Institute on AgingBaltimoreMD
- Longitudinal Studies SectionNational Institute on AgingBaltimoreMD
- Department of MedicineJohns Hopkins School of MedicineBaltimoreMD
| | - Fatemeh Adelnia
- Longitudinal Studies SectionNational Institute on AgingBaltimoreMD
| | - Marta Zampino
- Longitudinal Studies SectionNational Institute on AgingBaltimoreMD
| | - Christopher H. Morrell
- Laboratory of Cardiovascular ScienceNational Institute on AgingBaltimoreMD
- Loyola University MarylandBaltimoreMD
| | | | - Kenneth Fishbein
- Laboratory of Clinical InvestigationNational Institute on AgingBaltimoreMD
| | - Edward G. Lakatta
- Laboratory of Cardiovascular ScienceNational Institute on AgingBaltimoreMD
| | - Mary M. McDermott
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Luigi Ferrucci
- Longitudinal Studies SectionNational Institute on AgingBaltimoreMD
| |
Collapse
|
19
|
Cornelis N, Chatzinikolaou PN, Buys R, De Wilde C, Fourneau I, Claes J, Goetschalckx K, Cornelissen V. Near infrared spectroscopy to evaluate the effect of a hybrid exercise programme on peripheral muscle metabolism in patients with intermittent claudication: an exploratory PROSECO-IC sub study. J Sports Sci 2022; 40:1031-1041. [PMID: 35271414 DOI: 10.1080/02640414.2022.2045062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Intermittent claudication (IC) is characterized by decreased blood flow and oxygen delivery to the lower-limb muscles, resulting in pain and impaired functional capacity. This study evaluated the effects of a 12-week hybrid walking intervention on muscle oxygenation and functional capacity in 38 patients with IC (Rutherford I-III). Functional capacity was evaluated by means of two different treadmill test protocols and a six-minute walk test (6MWT). Muscle oxygenation was assessed during the treadmill tests using near-infrared spectroscopy. After the intervention, maximal walking distance was significantly increased (p < 0.001) during the progressive maximal treadmill test (mean (SD): +155 (SD 177) metres) and 6MWT (+18 (SD 29) metres) metres, with concomitant improvements in muscle oxygenation measures. Deoxygenation was slower during the progressive maximal test (p < 0.001) and reoxygenation was faster during recovery (p = 0.045). During the more submaximal test, oxygenated haemoglobin was better preserved (p = 0.040). Slower deoxygenation was more pronounced in the high responders of the progressive maximal treadmill test (p = 0.002). The findings suggest that preserved oxygen availability and slower deoxygenation during exercise could partly explain the improvements in functional capacity.
Collapse
Affiliation(s)
- Nils Cornelis
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium
| | - Panagiotis N Chatzinikolaou
- Department of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roselien Buys
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium
| | - Camille De Wilde
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Cardiovascular sciences, KU Leuven, Leuven, Belgium
| | - Jomme Claes
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium
| | | | | |
Collapse
|
20
|
Su W, Liang L, Zhou L, Cao Y, Zhou X, Liu S, Wang Q, Zhang H. Macrophage Paired Immunoglobulin-Like Receptor B Deficiency Promotes Peripheral Atherosclerosis in Apolipoprotein E–Deficient Mice. Front Cell Dev Biol 2022; 9:783954. [PMID: 35321392 PMCID: PMC8936951 DOI: 10.3389/fcell.2021.783954] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Peripheral atherosclerotic disease (PAD) is the narrowing or blockage of arteries that supply blood to the lower limbs. Given its complex nature, bioinformatics can help identify crucial genes involved in the progression of peripheral atherosclerosis. Materials and Methods: Raw human gene expression data for 462 PAD arterial plaque and 23 normal arterial samples were obtained from the GEO database. The data was analyzed using an integrated, multi-layer approach involving differentially-expressed gene analysis, KEGG pathway analysis, GO term enrichment analysis, weighted gene correlation network analysis, and protein-protein interaction analysis. The monocyte/macrophage-expressed leukocyte immunoglobulin-like receptor B2 (LILRB2) was strongly associated with the human PAD phenotype. To explore the role of the murine LILRB2 homologue PirB in vivo, we created a myeloid-specific PirB-knockout Apoe−/− murine model of PAD (PirBMΦKO) to analyze femoral atherosclerotic burden, plaque features of vulnerability, and monocyte recruitment to femoral atherosclerotic lesions. The phenotypes of PirBMΦKO macrophages under various stimuli were also investigated in vitro. Results:PirBMΦKO mice displayed increased femoral atherogenesis, a more vulnerable plaque phenotype, and enhanced monocyte recruitment into lesions. PirBMΦKO macrophages showed enhanced pro-inflammatory responses and a shift toward M1 over M2 polarization under interferon-γ and oxidized LDL exposure. PirBMΦKO macrophages also displayed enhanced efferocytosis and reduced lipid efflux under lipid exposure. Conclusion: Macrophage PirB reduces peripheral atherosclerotic burden, stabilizes peripheral plaque composition, and suppresses macrophage accumulation in peripheral lesions. Macrophage PirB inhibits pro-inflammatory activation, inhibits efferocytosis, and promotes lipid efflux, characteristics critical to suppressing peripheral atherogenesis.
Collapse
Affiliation(s)
- Wenhua Su
- Department of Cardiology, First People’s Hospital of Yunnan Province, Kunming, China
- Faculty of Life Science and Biotechnology, Kunming University of Science and Technology, Kunming, China
| | - Liwen Liang
- Department of Cardiology, First People’s Hospital of Yunnan Province, Kunming, China
| | - Liang Zhou
- Department of Cardiology, First People’s Hospital of Yunnan Province, Kunming, China
| | - Yu Cao
- Department of Cardiology, First People’s Hospital of Yunnan Province, Kunming, China
- Department of Cardiovascular Surgery, First People’s Hospital of Yunnan Province, Kunming, China
| | - Xiuli Zhou
- Department of Cardiology, First People’s Hospital of Yunnan Province, Kunming, China
| | - Shiqi Liu
- Department of Cardiology, First People’s Hospital of Yunnan Province, Kunming, China
| | - Qian Wang
- Department of Cardiology, First People’s Hospital of Yunnan Province, Kunming, China
| | - Hong Zhang
- Department of Cardiology, First People’s Hospital of Yunnan Province, Kunming, China
- *Correspondence: Hong Zhang,
| |
Collapse
|
21
|
The Influence of Treadmill Training on the Bioelectrical Activity of the Lower Limb Muscles in Patients with Intermittent Claudication. J Clin Med 2022; 11:jcm11051302. [PMID: 35268393 PMCID: PMC8910932 DOI: 10.3390/jcm11051302] [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: 01/08/2022] [Revised: 02/02/2022] [Accepted: 02/24/2022] [Indexed: 12/07/2022] Open
Abstract
Aim: Intermittent claudication is the most common symptomatic manifestation of peripheral arterial disease (PAD), presenting as ischemic leg muscle pain and gait dysfunction. The aim of this study was to evaluate the changes in bioelectrical activity of the lower limb muscles activity in claudicating patients over a 12-week period of supervised treadmill training and to verify the hypothesis as to which muscles of lower limbs are activated by training treatment—the proximal, as compensatory mechanism, or the distal, which are the most ischemic. Methods: The study comprised 45 patients aged 60–70 years (height 168.8 ± 6.8 cm, weight 78.9 ± 9.2 kg) with PAD and unilateral intermittent claudication (Fontaine stage IIa/IIb), who participated in a 12-week supervised treadmill training program. Surface electromyography (sEMG) of the gastrocnemius lateralis (GaL), gastrocnemius medialis (GaM), tibialis anterior (TA), biceps femoris (BF), rectus femoris (RF) and gluteus medius (GM) muscles in the claudicated leg were continuously measured during the treadmill test. The average mean amplitude and mean amplitude range of the sEMG signal were analyzed. Results: During the treadmill test, after 12 weeks of training, the average mean amplitude of the GM (105 ± 43 vs. 74 ± 38%, p = 0.000008, ES = 0.76), BF (41 ± 22 vs. 33 ± 12%, p = 0.006, ES = 0.45) and GaM (134 ± 50 vs. 114 ± 30%, p = 0.007, ES = 0.48) muscles was significantly lower compared with baseline. The mean amplitude range was significantly decreased after 12 weeks of training in the GM (229 ± 64 vs. 181 ± 62%, p = 0.008, ES = 0.77) and BF (110 ± 69 vs. 84 ± 31%, p = 0.0002, ES = 0.48) muscles. After 12 weeks of training, the mean amplitude range of the TA muscle was significantly higher compared with baseline (104 ± 46 vs. 131 ± 53%, p = 0.001, ES = 0.54), but without significant changes in the average mean amplitude value. The most favorable changes, suggesting the lowest muscle fatigue and the highest walking capacity, were found in patients with the longest walking time. Conclusions: The obtained results may suggest that after 12 weeks of treadmill training, beneficial changes occurred in both the proximal and distal muscles. Therefore, greater foot plantar flexion and stronger push-off as well as greater hip extension may be considered the main mechanisms of observed gait pattern improvement. It may also be suggested that the therapy of gait alterations in patients with PAD should be focused not only on calf muscle pump improvement, but also on proximal hip extensor strengthening.
Collapse
|
22
|
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.
Collapse
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
| | | |
Collapse
|
23
|
Gardner AW, Montgomery PS, Wang M, Shen B, Afaq A, Khurana A. LIGHT AND MODERATE INTENSITY PHYSICAL ACTIVITY ARE ASSOCIATED WITH BETTER AMBULATION, QUALITY OF LIFE, AND VASCULAR MEASUREMENTS IN PATIENTS WITH CLAUDICATION. J Vasc Surg 2022; 75:1739-1749. [PMID: 34999217 PMCID: PMC9038648 DOI: 10.1016/j.jvs.2021.12.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine whether patients with claudication who reported performing either light-intensity physical activity (LPA) or moderate-to-vigorous intensity physical activity (MVPA) had higher levels of objectively-determined physical activity, and better physical function, health-related quality of life (HRQoL), and vascular measures, consisting of exercise time to minimum calf muscle oxygen saturation (StO2) and high-sensitivity C-reactive protein, than patients who reported being physically sedentary. METHODS Two hundred sixty-nine patients were assessed on the Johnson Space Center physical activity scale. Patients were grouped according to whether they performed no physical activities (n=75), LPA (n=140), or MVPA (n=54). Primary measurements were total daily steps obtained from a step activity monitor worn for one week, peak walking time obtained from a treadmill test, the physical function score on the Medical Outcomes Study Short-Form 36 survey to assess HRQoL, and high-sensitivity C-reactive protein. RESULTS Total daily steps (mean±SD) was significantly different among groups, as both the LPA group (7878±2808 steps/day) and the MVPA group (8551±3365 steps/day) took more daily steps (p<0.01) than the sedentary group (3323±986 steps/day). Treadmill peak walking time was significantly different among groups, as both the LPA group (433±296 sec) and the MVPA group (548±300 sec) had greater peak walking time (p<0.01) than the sedentary group (302±210 sec). Physical function score was significantly different among groups, as both the LPA group (44±20%) and the MVPA group (58±19%) had higher scores (p<0.01) than the sedentary group (36±20%). Exercise time to the minimum calf muscle StO2 was significantly different among groups, as both the LPA group (215±238 sec) and the MVPA group (377±351 sec) had greater values (p<0.05 and p<0.01, respectively) than the sedentary group (147±172 sec). Finally, high-sensitivity C-reactive protein was significantly different among groups, as both the LPA group (4.8±5.5 mg/L) and the MVPA group (3.5±3.6 mg/L) had lower values (p<0.01) than the sedentary group (8.6±8.4 mg/L). CONCLUSIONS Patients with claudication who reported performing LPA had greater amounts of objectively-determined physical activity levels and better physical function, HRQoL, and vascular measures than those who reported being physically sedentary. Furthermore, these favorable results associated with LPA were even more pronounced in patients who performed MVPA than in patients who were sedentary. The clinical significance is that engaging in any physical activity, even at relatively light intensity, is associated with favorable health and vascular measures in patients with claudication.
Collapse
Affiliation(s)
- Andrew W Gardner
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA; University of Oklahoma Health Sciences Center, Oklahoma City, OK.
| | - Polly S Montgomery
- Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, Hershey, PA; University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Biyi Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Azhar Afaq
- Inpatient Physician Associates, Fort Worth, TX
| | - Aman Khurana
- Prairie Cardiovascular Consultants, Springfield, IL
| |
Collapse
|
24
|
Deev RV, Mavlikeev MO, Plotnikov MV, Gazizov IM, Maksimov AV, Kiyasov AP. [Pathohistological characteristics of muscles in patients with chronic lower limb ischemia]. Arkh Patol 2022; 84:5-13. [PMID: 35166472 DOI: 10.17116/patol2022840115] [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] [Indexed: 06/14/2023]
Abstract
UNLABELLED Despite the widespread occurrence of ischemic diseases of the lower extremities, including atherosclerosis and diseases with an autoimmune component of their pathogenesis, the pathohistological signs of damage and concomitant chronic ischemia, compensatory tissue responses as intracellular and cellular regeneration remain out of the field of vision in researchers. OBJECTIVE To assess the signs of damage (the extent of necrosis and apoptosis, capillary density (CD)) and regeneration (the cross-sectional muscle fiber area (CSMFA), the proportion of centrinucleated muscle fibers (CNMFs), and that of connective tissue), by using the gastrocnemius medial head biopsy specimens obtained from patients with heterogeneous forms of chronic lower limb obliterating diseases (CLLODs). SUBJECTS AND METHODS The investigation included the biopsy specimens obtained from 44 men under 65 years of age (their mean age was 54±9.8 years) with Stage IIB-IV chronic limb ischemia (according to the A.V. Pokrovsky-Fontaine classification) with its history of at least six months. The nosological entities were atherosclerotic lesion in 33 patients (distal atherosclerosis n=13), multistage lesion (n=8), and Leriche's syndrome (n=12); autoimmune-mediated vascular injury in 11 patients (Buerger's disease (n=7) and nonspecific aortoarteritis (n=4)). The similar muscle fragments obtained during autopsy from the deceased without obvious signs of cardiovascular system diseases were examined as a control. RESULTS It was found that there was a statistically significant difference between the nosological entities, as compared to the control in terms of CD and CSMFA (a decrease), the proportion of CNMFs and that of connective tissue (an increase). No substantial differences were found in the studied parameters between the nosological entities. CONCLUSION The findings may suggest the universal mechanism for damage to striated muscle tissue because of circulatory hypoxia, regardless of its etiology and the common character of tissue compensatory-adaptive responses (regeneration).
Collapse
Affiliation(s)
- R V Deev
- I.I. Mechnikov North-Western State Medical University of the Ministry of Health of Russia, St. Petersburg, Russia
| | - M O Mavlikeev
- I.I. Mechnikov North-Western State Medical University of the Ministry of Health of Russia, St. Petersburg, Russia
| | - M V Plotnikov
- Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan, Russia
| | - I M Gazizov
- Kazan State Medical University of the Ministry of Health of Russia, Kazan, Russia
| | - A V Maksimov
- Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan, Russia
| | - A P Kiyasov
- Kazan (Volga) Federal University, Kazan, Russia
| |
Collapse
|
25
|
Ischemia-Reperfusion Injury in Peripheral Artery Disease and Traditional Chinese Medicine Treatment. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4954070. [PMID: 34899949 PMCID: PMC8660193 DOI: 10.1155/2021/4954070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/18/2021] [Indexed: 12/12/2022]
Abstract
Peripheral artery disease (PAD) is a serious public health issue, characterized by circulation disorder of the lower extreme that reduces the physical activity of the lower extremity muscle. The artery narrowed by atherosclerotic lesions initiates limb ischemia. In the progression of treatment, reperfusion injury is still inevitable. Ischemia-reperfusion injury induced by PAD is responsible for hypoxia and nutrient deficiency. PAD triggers hindlimb ischemia and reperfusion (I/R) cycles through various mechanisms, mainly including mitochondrial dysfunction and inflammation. Alternatively, mitochondrial dysfunction plays a central role. The I/R injury may cause cells' injury and even death. However, the mechanism of I/R injury and the way of cell damage or death are still unclear. We review the pathophysiology of I/R injury, which is majorly about mitochondrial dysfunction. Then, we focus on the cell damage and death during I/R injury. Further comprehension of the progress of I/R will help identify biomarkers for diagnosis and therapeutic targets to PAD. In addition, traditional Chinese medicine has played an important role in the treatment of I/R injury, and we will make a brief introduction.
Collapse
|
26
|
Lanzi S, Nussbaumer P, Calanca L, Mazzolai L, Malatesta D. Descending stair walking in patients with symptomatic lower extremity peripheral artery disease: A pilot study. Vasc Med 2021; 27:171-173. [PMID: 34865584 PMCID: PMC8996288 DOI: 10.1177/1358863x211058784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Stefano Lanzi
- Heart and Vessel Department, Division of Angiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Paula Nussbaumer
- Institute of Sport Sciences, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Luca Calanca
- Heart and Vessel Department, Division of Angiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Lucia Mazzolai
- Heart and Vessel Department, Division of Angiology, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Vaud, Switzerland
| |
Collapse
|
27
|
Deppen JN, Ginn SC, Kim NH, Wang L, Voll RJ, Liang SH, Goodman MM, Oshinski JN, Levit RD. A Swine Hind Limb Ischemia Model Useful for Testing Peripheral Artery Disease Therapeutics. J Cardiovasc Transl Res 2021; 14:1186-1197. [PMID: 34050499 PMCID: PMC8627534 DOI: 10.1007/s12265-021-10134-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/03/2021] [Indexed: 01/27/2023]
Abstract
Currently, there is no large animal model of sustained limb ischemia suitable for testing novel angiogenic therapeutics for peripheral artery disease (PAD) such as drugs, genes, materials, or cells. We created a large animal model suitable for efficacy assessment of these therapies by testing 3 swine hind limb ischemia (HLI) variations and quantifying vascular perfusion, muscle histology, and limb function. Ligation of the ipsilateral external and bilateral internal iliac arteries produced sustained gait dysfunction compared to isolated external iliac or unilateral external and internal iliac artery ligations. Hyperemia-dependent muscle perfusion deficits, depressed limb blood pressure, arteriogenesis, muscle atrophy, and microscopic myopathy were quantifiable in ischemic limbs 6 weeks post-ligation. Porcine mesenchymal stromal cells (MSCs) engineered to express a reporter gene were visualized post-administration via positron emission tomography (PET) in vivo. These results establish a preclinical platform enabling better optimization of PAD therapies, including cellular therapeutics, increasing bench-to-bedside translational success. A preclinical platform for porcine studies of peripheral artery disease therapies including (1) a hind limb ischemia model and (2) non-invasive MSC viability and retention assessment via PET.
Collapse
Affiliation(s)
- Juline N Deppen
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sydney C Ginn
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Na Hee Kim
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Lanfang Wang
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ronald J Voll
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven H Liang
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mark M Goodman
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - John N Oshinski
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca D Levit
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
28
|
Supervised Exercise Training Improves 6 min Walking Distance and Modifies Gait Pattern during Pain-Free Walking Condition in Patients with Symptomatic Lower Extremity Peripheral Artery Disease. SENSORS 2021; 21:s21237989. [PMID: 34883993 PMCID: PMC8659842 DOI: 10.3390/s21237989] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 12/24/2022]
Abstract
This study aimed to investigate the effects of supervised exercise training (SET) on spatiotemporal gait and foot kinematics parameters in patients with symptomatic lower extremity peripheral artery disease (PAD) during a 6 min walk test. Symptomatic patients with chronic PAD (Fontaine stage II) following a 3 month SET program were included. Prior to and following SET, a 6 min walk test was performed to assess the 6 min walking distance (6MWD) of each patient. During this test, spatiotemporal gait and foot kinematics parameters were assessed during pain-free and painful walking conditions. Twenty-nine patients with PAD (65.4 ± 9.9 years.) were included. The 6MWD was significantly increased following SET (+10%; p ≤ 0.001). The walking speed (+8%) and stride frequency (+5%) were significantly increased after SET (p ≤ 0.026). The stride length was only significantly increased during the pain-free walking condition (+4%, p = 0.001), whereas no significant differences were observed during the condition of painful walking. Similarly, following SET, the relative duration of the loading response increased (+12%), the relative duration of the foot-flat phase decreased (−3%), and the toe-off pitch angle significantly increased (+3%) during the pain-free walking condition alone (p ≤ 0.05). A significant positive correlation was found between changes in the stride length (r = 0.497, p = 0.007) and stride frequency (r = 0.786, p ≤ 0.001) during pain-free walking condition and changes in the 6MWD. A significant negative correlation was found between changes in the foot-flat phase during pain-free walking condition and changes in the 6MWD (r = −0.567, p = 0.002). SET was found to modify the gait pattern of patients with symptomatic PAD, and many of these changes were found to occur during pain-free walking. The improvement in individuals’ functional 6 min walk test was related to changes in their gait pattern.
Collapse
|
29
|
Wilburn D, Ismaeel A, Machek S, Fletcher E, Koutakis P. Shared and distinct mechanisms of skeletal muscle atrophy: A narrative review. Ageing Res Rev 2021; 71:101463. [PMID: 34534682 DOI: 10.1016/j.arr.2021.101463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/30/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022]
Abstract
Maintenance of skeletal muscle mass and function is an incredibly nuanced balance of anabolism and catabolism that can become distorted within different pathological conditions. In this paper we intend to discuss the distinct intracellular signaling events that regulate muscle protein atrophy for a given clinical occurrence. Aside from the common outcome of muscle deterioration, several conditions have at least one or more distinct mechanisms that creates unique intracellular environments that facilitate muscle loss. The subtle individuality to each of these given pathologies can provide both researchers and clinicians with specific targets of interest to further identify and increase the efficacy of medical treatments and interventions.
Collapse
Affiliation(s)
- Dylan Wilburn
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX 76706, USA
| | - Ahmed Ismaeel
- Department of Biology, Baylor University, Waco, TX 76706, USA
| | - Steven Machek
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX 76706, USA
| | - Emma Fletcher
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX 76706, USA; Department of Biology, Baylor University, Waco, TX 76706, USA
| | | |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Li C, Nie F, Liu X, Chen M, Chi D, Li S, Pipinos II, Li X. Antioxidative and Angiogenic Hyaluronic Acid-Based Hydrogel for the Treatment of Peripheral Artery Disease. ACS APPLIED MATERIALS & INTERFACES 2021; 13:45224-45235. [PMID: 34519480 DOI: 10.1021/acsami.1c11349] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Peripheral arterial disease (PAD) is a progressive atherosclerotic disorder characterized by blockages of the arteries supplying the lower extremities. Ischemia initiates oxidative damage and mitochondrial dysfunction in the legs of PAD patients, causing injury to the tissues of the leg, significant decline in walking performance, leg pain while walking, and in the most severe cases, nonhealing ulcers and gangrene. Current clinical trials based on cells/stem cells, the trophic factor, or gene therapy systems have shown some promising results for the treatment of PAD. Biomaterial matrices have been explored in animal models of PAD to enhance these therapies. However, current biomaterial approaches have not fully met the essential requirements for minimally invasive intramuscular delivery to the leg. Ideally, a biomaterial should present properties to ameliorate oxidative stress/damage and failure of angiogenesis. Recently, we have created a thermosensitive hyaluronic acid (HA) hydrogel with antioxidant capacity and skeletal muscle-matching stiffness. Here, we further optimized HA hydrogels with the cell adhesion peptide RGD to facilitate the development of vascular-like structures in vitro. The optimized HA hydrogel reduced intracellular reactive oxygen species levels and preserved vascular-like structures against H2O2-induced damage in vitro. HA hydrogels also provided prolonged release of the vascular endothelial growth factor (VEGF). After injection into rat ischemic hindlimb muscles, this VEGF-releasing hydrogel reduced lipid oxidation, regulated oxidative-related genes, enhanced local blood flow in the muscle, and improved running capacity of the treated rats. Our HA hydrogel system holds great potential for the treatment of the ischemic legs of patients with PAD.
Collapse
Affiliation(s)
- Cui Li
- Department of Physiology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Fujiao Nie
- Hunan Engineering Technology Research Center for the Prevention and Treatment of Otorhinolaryngologic Diseases and Protection of Visual Function with Chinese Medicine, Human University of Chinese Medicine, Changsha, Hunan 410208, China
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Xiaoyan Liu
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Meng Chen
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - David Chi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Shuai Li
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
| | - Xiaowei Li
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska 68198, United States
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| |
Collapse
|
32
|
Fassora M, Calanca L, Jaques C, Mazzolai L, Kayser B, Lanzi S. Intensity-dependent effects of exercise therapy on walking performance and aerobic fitness in symptomatic patients with lower-extremity peripheral artery disease: A systematic review and meta-analysis. Vasc Med 2021; 27:158-170. [PMID: 34579581 PMCID: PMC9003762 DOI: 10.1177/1358863x211034577] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We investigated how nonpain-based exercise therapy intensity (light-to-moderate or vigorous) affects improvements in walking performance and cardiorespiratory fitness of patients with symptomatic lower-extremity peripheral artery disease (PAD). We searched the Embase, MEDLINE, Cochrane, Web of Science, and Google Scholar databases up to April 2021 and included randomized controlled trials reporting training therapies targeting exercise intensity (heart rate, oxygen consumption, or perceived exertion). The main outcomes were walking performance (pain-free [PFWD] and maximal [MWD] walking distance) and cardiorespiratory fitness (V̇O2peak). Secondary subanalyses examined the training modality (walking or other modalities) and the approach (high-intensity interval or moderate-intensity training). A total of 1132 patients were included. Light-to-moderate was superior to vigorous exercise intensity in improving MWD (223 m [95% CI 174 to 271], p < 0.00001; 153 m [95% CI 113 to 193], p < 0.00001; respectively) and PFWD (130 m [95% CI 87 to 173], p < 0.00001; 83 m [95% CI 61 to 104], p < 0.00001; respectively). When training modalities were considered, walking at a vigorous intensity (272 m [95% CI 207 to 337], p < 0.00001) showed the largest improvement in MWD compared to other exercise modalities. A larger increase in V̇O2peak was observed following vigorous (3.0 mL O2·kg-1·min-1 [95% CI 2.4 to 3.6], p < 0.00001) compared to light-to-moderate (1.1 mL O2·kg-1·min-1 [95% CI 0.4 to 1.7], p = 0.001) exercise intensity. These results indicate that vigorous was less effective than light-to-moderate intensity in improving walking performance, whereas it was more effective in improving V̇O2peak. When the training modalities were considered, walking at a vigorous intensity showed the greatest improvement in MWD. (PROSPERO Registration No.: CRD42020199469).
Collapse
Affiliation(s)
- Mattia Fassora
- Institute of Sport Sciences of the University of Lausanne, Switzerland
| | - Luca Calanca
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Switzerland
| | - Cécile Jaques
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences of the University of Lausanne, Switzerland
| | - Stefano Lanzi
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Switzerland
| |
Collapse
|
33
|
Stavres J, Wang J, Sica CT, Blaha C, Herr M, Pai S, Cauffman A, Vesek J, Yang QX, Sinoway LI. Diffusion tensor imaging indices of acute muscle damage are augmented after exercise in peripheral arterial disease. Eur J Appl Physiol 2021; 121:2595-2606. [PMID: 34106324 PMCID: PMC10445221 DOI: 10.1007/s00421-021-04711-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/05/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Although it is known that peripheral arterial disease (PAD) is associated with chronic myopathies, the acute muscular responses to exercise in this population are less clear. This study used diffusion tensor imaging (DTI) to compare acute exercise-related muscle damage between PAD patients and healthy controls. METHODS Eight PAD patients and seven healthy controls performed graded plantar flexion in the bore of a 3T MRI scanner. Exercise began at 2 kg and increased by 2 kg every 2 min until failure, or completion of 10 min of exercise. DTI images were acquired from the lower leg pre- and post-exercise, and were analyzed for mean diffusivity, fractional anisotropy (FA), and eigenvalues 1-3 (λ1-3) of the medial gastrocnemius (MG) and tibialis anterior (TA). RESULTS Results indicated a significant leg by time interaction for mean diffusivity, explained by a significantly greater increase in diffusivity of the MG in the most affected legs of PAD patients (11.1 × 10-4 ± 0.5 × 10-4 mm2/s vs. 12.7 × 10-4 ± 1.2 × 10-4 mm2/s at pre and post, respectively, P = 0.02) compared to healthy control subjects (10.8 × 10-4 ± 0.3 × 10-4 mm2/s vs. 11.2 × 10-4 ± 0.5 × 10-4 mm2/s at pre and post, respectively, P = 1.0). No significant differences were observed for the TA, or λ1-3 (all P ≥ 0.06). Moreover, no reciprocal changes were observed for FA in either group (all P ≥ 0.29). CONCLUSION These data suggest that calf muscle diffusivity increases more in PAD patients compared to controls after exercise. These findings are consistent with the notion that acute exercise results in increased muscle damage in PAD.
Collapse
Affiliation(s)
- Jon Stavres
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Jianli Wang
- Department of Radiology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Christopher T Sica
- Department of Radiology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Cheryl Blaha
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Michael Herr
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Samuel Pai
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Aimee Cauffman
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jeffrey Vesek
- Department of Molecular Biology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Qing X Yang
- Department of Radiology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Neurosurgery, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Lawrence I Sinoway
- Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
34
|
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.
Collapse
|
35
|
High-Intensity Interval Training and Moderate-Intensity Continuous Training Attenuate Oxidative Damage and Promote Myokine Response in the Skeletal Muscle of ApoE KO Mice on High-Fat Diet. Antioxidants (Basel) 2021; 10:antiox10070992. [PMID: 34206159 PMCID: PMC8300650 DOI: 10.3390/antiox10070992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 01/11/2023] Open
Abstract
The purpose of this study was to investigate the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on the skeletal muscle in Apolipoprotein E knockout (ApoE KO) and wild-type (WT) C57BL/6J mice. ApoE KO mice fed with a high-fat diet were randomly allocated into: Control group without exercise (ApoE-/- CON), HIIT group (ApoE-/- HIIT), and MICT group (ApoE-/- MICT). Exercise endurance, blood lipid profile, muscle antioxidative capacity, and myokine production were measured after six weeks of interventions. ApoE-/- CON mice exhibited hyperlipidemia and increased oxidative stress, compared to the WT mice. HIIT and MICT reduced blood lipid levels, ROS production, and protein carbonyl content in the skeletal muscle, while it enhanced the GSH generation and potently promoted mRNA expression of genes involved in the production of irisin and BAIBA. Moreover, ApoE-/- HIIT mice had significantly lower plasma HDL-C content, mRNA expression of MyHC-IIx and Vegfa165 in EDL, and ROS level; but remarkably higher mRNA expression of Hadha in the skeletal muscle than those of ApoE-/- MICT mice. These results demonstrated that both exercise programs were effective for the ApoE KO mice by attenuating the oxidative damage and promoting the myokines response and production. In particular, HIIT was more beneficial to reduce the ROS level in the skeletal muscle.
Collapse
|
36
|
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.
Collapse
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.
| |
Collapse
|
37
|
Pedersen BL, Helledie G, Eiken FL, Lawaetz J, Eiberg JP, Quistorff B. Effect of revascularisation on lower extremity muscle function in combined type 2 diabetes and critical limb threatening ischemia. INT ANGIOL 2021; 40:323-334. [PMID: 34008931 DOI: 10.23736/s0392-9590.21.04661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Critical limb-threatening ischemia (CLTI) and type 2 diabetes (T2D) frequently co-exist and often with less favourable outcome after revascularisation. The objective was to evaluate the effects of revascularisation on muscle function, perfusion and mitochondrial respiration in patients with combined CLTI and T2D. METHODS A prospective translational observational study. Two groups of patients facing unilateral peripheral revascularisation was included: Patients suffering from combined disease with CLTI+T2D (n= 14) and patients suffering from CLTI (n= 15). During pedal exercise testing, calf muscle perfusion was monitored with near-infrared spectroscopy (NIRS) and leg arterial volume flow in the common femoral artery with duplex ultrasound. Calf muscle biopsy and subsequent assessment of mitochondrial respiratory capacity on isolated muscle fibres was performed. Tests was performed before and six weeks after revascularisation. RESULTS After revascularisation, patients CLTI+T2D improved in muscle force from 8.48 kg (CI: 7.49-9.46) to 13.11 kg (CI: 11.58-14.63), (P<.001). Conversely, muscle force in patients suffering from nondiabetic CLTI decreased from 10.03 kg (CI: 9.1-10.96) to 9.73 kg (CI: 8.77- 10.69), (P=0.042). Muscle oxygenation during exercise improved more in the CLTI+T2D group 6.36 AUC (Area Under Curve), ((μM/kg)s) (CI: 5.71-7.01) compared to 2.11 ((μM/kg)s) (CI:1.38-2.83) in the CLTI group (P=.002). No improvement or difference between groups regarding mitochondrial function was detected. CONCLUSIONS Patients with combined CLTI+T2D, had an unsuspected better effect of revascularisation compared to patients with non-diabetic CLTI, in terms of increased muscle force (MVC) and improved muscle perfusion. Further studies are needed to elucidate the apparent interaction of the CLTI and T2D syndromes.
Collapse
Affiliation(s)
- Brian L Pedersen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark -
| | - Gladis Helledie
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Frederik L Eiken
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Jonathan Lawaetz
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn Quistorff
- Department of Biomedical Sciences, Nuclear Magnetic Resonance Centre, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
38
|
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.
Collapse
|
39
|
Cornelis N, Chatzinikolaou P, Buys R, Fourneau I, Claes J, Cornelissen V. The Use of Near Infrared Spectroscopy to Evaluate the Effect of Exercise on Peripheral Muscle Oxygenation in Patients with Lower Extremity Artery Disease: A Systematic Review. Eur J Vasc Endovasc Surg 2021; 61:837-847. [PMID: 33810977 DOI: 10.1016/j.ejvs.2021.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/07/2021] [Accepted: 02/03/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Near infrared spectroscopy (NIRS) has been suggested as a new diagnostic tool in patients with lower extremity artery disease (LEAD). The aim of this systematic review was to summarise the impact of exercise therapy on lower limb muscle oxygenation, evaluated by NIRS, in patients with LEAD, and to give an overview on NIRS instruments and methodology. DATA SOURCES MEDLINE and Embase. REVIEW METHODS A systematic search was conducted in MEDLINE and Embase, from the earliest date available until 16 March 2020, to identify peer reviewed studies involving the use of NIRS in the evaluation of exercise training on muscle oxygenation in patients with LEAD. Primary outcomes were NIRS derived variables during treadmill exercise. Effect sizes were calculated as standardised mean differences. Assessment of methodological quality was done using a combined checklist from the Cochrane bias and the quality assessment tool for before and after studies without a control group. RESULTS Eleven original trials were included involving 16 exercise groups and four control groups. Tissue saturation index (TSI) at rest remained unchanged following the exercise interventions. Exercise training increased time to minimum TSI during exercise (range effect sizes: +0.172 to +0.927). In addition, exercise training led to a faster recovery to half and full TSI rest values in most intervention groups (range effect sizes -0.046 to -0.558 and -0.269 to -0.665, respectively). Finally, NIRS data reproducibility and analytic methods were under reported in the included studies. CONCLUSION The available data suggest that exercise training improves de-oxygenation and re-oxygenation patterns, as measured with NIRS, in patients with LEAD. Whereas NIRS is a promising tool in the evaluation of LEAD, the low number of randomised controlled trials, as well as large heterogeneity in NIRS assessment methods, outcome measures, and instrumentation, warrants more research to better understand the role of muscle oxygenation associated with exercise induced improvements in walking capacity.
Collapse
Affiliation(s)
- Nils Cornelis
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium.
| | - Panagiotis Chatzinikolaou
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium; Department of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roselien Buys
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Cardiovascular sciences, KU Leuven, Leuven, Belgium
| | - Jomme Claes
- Department of Rehabilitation sciences, KU Leuven, Leuven, Belgium
| | | |
Collapse
|
40
|
Guilleron C, Beaune B, Durand S, Pouliquen C, Henni S, Abraham P. Gait alterations in patient with intermittent claudication: Effect of unilateral vs bilateral ischemia. Clin Physiol Funct Imaging 2021; 41:292-301. [PMID: 33675152 DOI: 10.1111/cpf.12698] [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] [Received: 07/24/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We seek to evaluate whether ischemia extent (unilateral or bilateral) impacts spatiotemporal and neuromuscular gait parameters differently in patients with peripheral arterial disease and presenting intermittent claudication (PAD-IC). METHODS Two groups of PAD-IC patients: unilateral (Unilat-IC; n = 15), bilateral (Bilat-IC; n = 15) and a group of control subjects with similar risk factors (n = 15) were evaluated during a constant load treadmill walking test. Spatiotemporal parameters and neuromuscular activation in tibialis anterior and gastrocnemius medialis were recorded. Patients were instructed to describe their pain during walking test, and three phases were analysed: pain-free, onset of pain and maximum pain in PAD-IC patients. FINDINGS Single leg stance in the asymptomatic leg of Unilat-IC increases and becomes higher than the symptomatic leg and the Bilat-IC legs at maximum pain. Step time is higher and cadence is lower in PAC-IC than in controls. Tibialis anterior activation peak in Unilat-IC continuously decreases between phases and becomes lower than in Bilat-IC during maximum pain. Tibialis anterior activation time is higher in Bilat-IC and in the asymptomatic leg than in the symptomatic of Unilat-IC during all the phases. Gastrocnemius medialis activation peak in Bilat-IC decreases with pain. Gastrocnemius medialis activation time in the symptomatic leg of Unilat-IC presents a significant decrease between pain-free and maximum pain phases. INTERPRETATION Ischemia impacts gait in PAD-IC patients differently according to its extent between legs compared to controls. Imbalance between legs in Unilat-IC induces compensatory mechanism and an asymmetrical pattern. Bilat-IC should not be simply considered as a 'double' Unilat-IC when evaluating gait.
Collapse
Affiliation(s)
- Céline Guilleron
- Le Mans Université, Movement - Interactions - Performance, MIP, Le Mans, France.,UMR CNRS 6015 INSERM 1083, University of Angers, Angers, France.,Department of Vascular Medicine, University hospital of Angers, Angers, France
| | - Bruno Beaune
- Le Mans Université, Movement - Interactions - Performance, MIP, Le Mans, France
| | - Sylvain Durand
- Le Mans Université, Movement - Interactions - Performance, MIP, Le Mans, France
| | - Camille Pouliquen
- Le Mans Université, Movement - Interactions - Performance, MIP, Le Mans, France
| | - Samir Henni
- UMR CNRS 6015 INSERM 1083, University of Angers, Angers, France.,Department of Vascular Medicine, University hospital of Angers, Angers, France
| | - Pierre Abraham
- UMR CNRS 6015 INSERM 1083, University of Angers, Angers, France.,Sports Medicine, University Hospital of Angers, Angers, France
| |
Collapse
|
41
|
Li C, Kitzerow O, Nie F, Dai J, Liu X, Carlson MA, Casale GP, Pipinos II, Li X. Bioengineering strategies for the treatment of peripheral arterial disease. Bioact Mater 2021; 6:684-696. [PMID: 33005831 PMCID: PMC7511653 DOI: 10.1016/j.bioactmat.2020.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 12/21/2022] Open
Abstract
Peripheral arterial disease (PAD) is a progressive atherosclerotic disorder characterized by narrowing and occlusion of arteries supplying the lower extremities. Approximately 200 million people worldwide are affected by PAD. The current standard of operative care is open or endovascular revascularization in which blood flow restoration is the goal. However, many patients are not appropriate candidates for these treatments and are subject to continuous ischemia of their lower limbs. Current research in the therapy of PAD involves developing modalities that induce angiogenesis, but the results of simple cell transplantation or growth factor delivery have been found to be relatively poor mainly due to difficulties in stem cell retention and survival and rapid diffusion and enzymolysis of growth factors following injection of these agents in the affected tissues. Biomaterials, including hydrogels, have the capability to protect stem cells during injection and to support cell survival. Hydrogels can also provide a sustained release of growth factors at the injection site. This review will focus on biomaterial systems currently being investigated as carriers for cell and growth factor delivery, and will also discuss biomaterials as a potential stand-alone method for the treatment of PAD. Finally, the challenges of development and use of biomaterials systems for PAD treatment will be reviewed.
Collapse
Affiliation(s)
- Cui Li
- Mary & Dick Holland Regenerative Medicine Program and Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, United States
| | - Oliver Kitzerow
- Department of Genetics Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, United States
| | - Fujiao Nie
- Mary & Dick Holland Regenerative Medicine Program and Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, United States
| | - Jingxuan Dai
- Mary & Dick Holland Regenerative Medicine Program and Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, United States
| | - Xiaoyan Liu
- Mary & Dick Holland Regenerative Medicine Program and Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, United States
| | - Mark A. Carlson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, United States
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, 68198, United States
- Omaha VA Medical Center, Omaha, NE, 68105, United States
| | - George P. Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, United States
| | - Iraklis I. Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, United States
| | - Xiaowei Li
- Mary & Dick Holland Regenerative Medicine Program and Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, United States
| |
Collapse
|
42
|
Liu Q, Pan S, Liu S, Zhang S, Willerson JT, Martin JF, Dixon RAF. Suppressing Hippo signaling in the stem cell niche promotes skeletal muscle regeneration. STEM CELLS (DAYTON, OHIO) 2021; 39:737-749. [PMID: 33529408 DOI: 10.1002/stem.3343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/28/2020] [Indexed: 11/11/2022]
Abstract
Lack of blood flow to the lower extremities in peripheral arterial disease causes oxygen and nutrient deprivation in ischemic skeletal muscles, leading to functional impairment. Treatment options for muscle regeneration in this scenario are lacking. Here, we selectively targeted the Hippo pathway in myofibers, which provide architectural support for muscle stem cell niches, to facilitate functional muscle recovery in ischemic extremities by promoting angiogenesis, neovascularization, and myogenesis. We knocked down the core Hippo pathway component, Salvador (SAV1), by using an adeno-associated virus 9 (AAV9) vector expressing a miR30-based triple short-hairpin RNA (shRNA), controlled by a muscle-specific promoter. In a mouse hindlimb-ischemia model, AAV9 SAV1 shRNA administration in ischemic muscles induced nuclear localization of the Hippo effector YAP, accelerated perfusion restoration, and increased exercise endurance. Intravascular lectin labeling of the vasculature revealed enhanced angiogenesis. Using 5-ethynyl-2'-deoxyuridine to label replicating cellular DNA in vivo, we found SAV1 knockdown concurrently increased paired box transcription factor Pax7+ muscle satellite cell and CD31+ endothelial cell proliferation in ischemic muscles. To further study Hippo suppression in skeletal muscle regeneration, we used a cardiotoxin-induced muscle damage model in adult (12-15 weeks old) and aged mice (26-month old). Two weeks after delivery of AAV9 SAV1 shRNA into injured muscles, the distribution of regenerative myofibers shifted toward a larger cross-sectional area and increased capillary density compared with mice receiving AAV9 control. Together, these findings suggest our approach may have clinical promise in regenerative therapy for leg ischemia and muscle injury.
Collapse
Affiliation(s)
- Qi Liu
- Wafic Said Molecular Cardiology Research Laboratories, Texas Heart Institute, Houston, Texas, USA
| | - Su Pan
- Wafic Said Molecular Cardiology Research Laboratories, Texas Heart Institute, Houston, Texas, USA
| | - Shijie Liu
- Cardiomyocyte Renewal Laboratory, Texas Heart Institute, Houston, Texas, USA
| | - Sui Zhang
- Cardiomyocyte Renewal Laboratory, Texas Heart Institute, Houston, Texas, USA
| | | | - James F Martin
- Cardiomyocyte Renewal Laboratory, Texas Heart Institute, Houston, Texas, USA.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA
| | - Richard A F Dixon
- Wafic Said Molecular Cardiology Research Laboratories, Texas Heart Institute, Houston, Texas, USA
| |
Collapse
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
Guilleron C, Maktouf W, Beaune B, Henni S, Abraham P, Durand S. Coactivation pattern in leg muscles during treadmill walking in patients suffering from intermittent claudication. Gait Posture 2021; 84:245-253. [PMID: 33383535 DOI: 10.1016/j.gaitpost.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 10/26/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In patients with peripheral arterial disease and presenting intermittent claudication (PAD-IC), the pain due to ischemia impacts gait parameters, particularly in cases of unilateral disease. Deterioration of gait parameters in a pathological context is frequently associated with increased coactivation (simultaneous activation of agonist and antagonist muscles around a joint). RESEARCH QUESTION Does unilateral PAD-IC affect the coactivation pattern during walking? Does the coactivation pattern change with increasing pain intensity? METHOD We evaluated symptomatic and asymptomatic legs in 17 subjects with unilateral PAD-IC and 16 without PAD-IC (control group), during walking. Tibialis anterior (TA) and gastrocnemius medialis (GM) electromyographic activity, and peaks of vertical ground reaction force were recorded in this prospective study. We analyzed the coactivation index (CI(GM/TA)) during three periods (pain-free, pain and maximum pain) and phases of the gait cycle. Statistical analysis was carried out using the ANOVA procedure. RESULTS During single support, CI(GM/TA) increases in the symptomatic leg during the pain period (+28 %) and in the asymptomatic leg during the maximum pain period (+29 %). During second double support, CI(GM/TA) increases in the symptomatic leg only (+49 %). In these gait phases, pain elicits differences in CI(GM/TA) between legs (p < 0.05). Second peak force decreases in the symptomatic leg only (-9%) and is negatively correlated with CI(GM/TA) during the three periods (r = -0.57; -0.76 and -0.78 respectively, p < 0.05). No difference is found in the control group. SIGNIFICANCE The appearance and development of pain in the lower limbs is associated with a higher level of CI(GM/TA), revealing a compensatory gait pattern in PAD-IC patients. Optimal prevention, rehabilitation and re-training strategies for PAD-IC patients should take into consideration neuromuscular compensatory mechanisms between asymptomatic and symptomatic legs.
Collapse
Affiliation(s)
- Céline Guilleron
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France; UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France; Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100 Angers, France
| | - Waël Maktouf
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France
| | - Bruno Beaune
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France
| | - Samir Henni
- UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France; Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100 Angers, France
| | - Pierre Abraham
- Sports Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France; UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Sylvain Durand
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France.
| |
Collapse
|
45
|
Chen M, Li C, Nie F, Liu X, Pipinos II, Li X. Synthesis and characterization of a hyaluronic acid-based hydrogel with antioxidative and thermosensitive properties. RSC Adv 2020; 10:33851-33860. [PMID: 35519025 PMCID: PMC9056774 DOI: 10.1039/d0ra07208g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/04/2020] [Indexed: 02/01/2023] Open
Abstract
Peripheral arterial disease (PAD) is initiated by progressive atherosclerotic blockages of the arteries supplying the lower extremities. The most common presentation of PAD is claudication (leg pain and severe walking limitation), with many patients progressing to limb threatening ischemia and amputation. Biomaterial approaches are just beginning to be explored in the therapy of PAD with different materials now being evaluated for the delivery of cells or growth factors in animal models of PAD. A biomaterial matrix optimized for minimally invasive injection in the ischemic leg muscles of patients with PAD is urgently needed. There are several important requirements for optimal delivery, retention, and performance of a biomaterial matrix in the mechanically, histologically, and biochemically dynamic intramuscular environment of the PAD leg. Ideally, the material should have mechanical properties matching those of the recipient muscle, undergo minimal swelling, and should introduce properties that can ameliorate the mechanisms operating in PAD like oxidative stress and damage. Here we have developed an injectable, antioxidative, and thermosensitive hydrogel system based on hyaluronic acid (HA). We first synthesized a unique crosslinker of disulfide-modified poloxamer F127 diacrylate. This crosslinker led to the creation of a thermosensitive HA hydrogel with minimal swelling and muscle-matching mechanical properties. We introduced unique disulfide groups into hydrogels which functioned as an effective reactive oxygen species scavenger, exhibited hydrogen peroxide (H2O2)-responsive degradation, and protected cells against H2O2-induced damage. Our antioxidative thermosensitive HA hydrogel system holds great potential for the treatment of the ischemic legs of patients with PAD.
Collapse
Affiliation(s)
- Meng Chen
- Mary & Dick Holland Regenerative Medicine Program, Department of Neurological Sciences, University of Nebraska Medical Center Omaha NE 68198 USA
| | - Cui Li
- Mary & Dick Holland Regenerative Medicine Program, Department of Neurological Sciences, University of Nebraska Medical Center Omaha NE 68198 USA
| | - Fujiao Nie
- Mary & Dick Holland Regenerative Medicine Program, Department of Neurological Sciences, University of Nebraska Medical Center Omaha NE 68198 USA
| | - Xiaoyan Liu
- Mary & Dick Holland Regenerative Medicine Program, Department of Neurological Sciences, University of Nebraska Medical Center Omaha NE 68198 USA
| | - Iraklis I Pipinos
- Department of Surgery, University of Nebraska Medical Center Omaha NE 68198 USA
| | - Xiaowei Li
- Mary & Dick Holland Regenerative Medicine Program, Department of Neurological Sciences, University of Nebraska Medical Center Omaha NE 68198 USA
| |
Collapse
|
46
|
Abnormal Microvascular Architecture, Fibrosis, and Pericyte Characteristics in the Calf Muscle of Peripheral Artery Disease Patients with Claudication and Critical Limb Ischemia. J Clin Med 2020; 9:jcm9082575. [PMID: 32784470 PMCID: PMC7464726 DOI: 10.3390/jcm9082575] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 01/05/2023] Open
Abstract
Work from our laboratory documents pathological events, including myofiber oxidative damage and degeneration, myofibrosis, micro-vessel (diameter = 50–150 μm) remodeling, and collagenous investment of terminal micro-vessels (diameter ≤ 15 µm) in the calf muscle of patients with Peripheral Artery Disease (PAD). In this study, we evaluate the hypothesis that the vascular pathology associated with the legs of PAD patients encompasses pathologic changes to the smallest micro-vessels in calf muscle. Biopsies were collected from the calf muscle of control subjects and patients with Fontaine Stage II and Stage IV PAD. Slide specimens were evaluated by Quantitative Multi-Spectral and Fluorescence Microscopy. Inter-myofiber collagen, stained with Masson Trichrome (MT), was increased in Stage II patients, and more substantially in Stage IV patients in association with collagenous thickening of terminal micro-vessel walls. Evaluation of the Basement Membrane (BM) of these vessels reveals increased thickness in Stage II patients, and increased thickness, diameter, and Collagen I deposition in Stage IV patients. Coverage of these micro-vessels with pericytes, key contributors to fibrosis and BM remodeling, was increased in Stage II patients, and was greatest in Stage IV patients. Vascular pathology of the legs of PAD patients extends beyond atherosclerotic main inflow arteries and affects the entire vascular tree—including the smallest micro-vessels.
Collapse
|
47
|
Ismaeel A, Papoutsi E, Miserlis D, Lavado R, Haynatzki G, Casale GP, Bohannon WT, Smith RS, Eidson JL, Brumberg R, Hayson A, Kirk JS, Castro C, Sawicki I, Konstantinou C, Brewster LP, Pipinos II, Koutakis P. The Nitric Oxide System in Peripheral Artery Disease: Connection with Oxidative Stress and Biopterins. Antioxidants (Basel) 2020; 9:E590. [PMID: 32640613 PMCID: PMC7402092 DOI: 10.3390/antiox9070590] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [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.
Collapse
Affiliation(s)
- Ahmed Ismaeel
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32304, USA; (A.I.); (E.P.)
| | - Evlampia Papoutsi
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32304, USA; (A.I.); (E.P.)
| | - Dimitrios Miserlis
- Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA;
| | - Ramon Lavado
- Department of Environmental Science, Baylor University, Waco, TX 76798, USA;
| | - Gleb Haynatzki
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - George P. Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA; (G.P.C.); (I.I.P.)
| | - William T. Bohannon
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX 76508, USA; (W.T.B.); (R.S.S.); (J.L.E.); (I.S.)
| | - Robert S. Smith
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX 76508, USA; (W.T.B.); (R.S.S.); (J.L.E.); (I.S.)
| | - Jack Leigh Eidson
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX 76508, USA; (W.T.B.); (R.S.S.); (J.L.E.); (I.S.)
| | - Robert Brumberg
- Vascular Surgery Associates, Tallahassee, FL 32308, USA; (R.B.); (A.H.)
| | - Aaron Hayson
- Vascular Surgery Associates, Tallahassee, FL 32308, USA; (R.B.); (A.H.)
| | - Jeffrey S. Kirk
- Department of Vascular Surgery, Capital Regional Medical Center, Tallahassee, FL 32308, USA; (J.S.K.); (C.C.)
| | - Carlos Castro
- Department of Vascular Surgery, Capital Regional Medical Center, Tallahassee, FL 32308, USA; (J.S.K.); (C.C.)
| | - Ian Sawicki
- Department of Surgery, Baylor Scott & White Medical Center, Temple, TX 76508, USA; (W.T.B.); (R.S.S.); (J.L.E.); (I.S.)
| | - Charalambos Konstantinou
- Department of Electrical & Computer Engineering, Florida State University, Tallahassee, FL 32310, USA;
| | - Luke P. Brewster
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Iraklis I. Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA; (G.P.C.); (I.I.P.)
- Department of Surgery and Research Service, Veterans Affairs-Western Iowa Medical Center, Omaha, NE 68105, USA
| | - Panagiotis Koutakis
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32304, USA; (A.I.); (E.P.)
| |
Collapse
|
48
|
Signorelli SS, Marino E, Scuto S, Di Raimondo D. Pathophysiology of Peripheral Arterial Disease (PAD): A Review on Oxidative Disorders. Int J Mol Sci 2020; 21:ijms21124393. [PMID: 32575692 PMCID: PMC7352779 DOI: 10.3390/ijms21124393] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/13/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022] Open
Abstract
Peripheral arterial disease (PAD) is an atherosclerotic disease that affects a wide range of the world’s population, reaching up to 200 million individuals worldwide. PAD particularly affects elderly individuals (>65 years old). PAD is often underdiagnosed or underestimated, although specificity in diagnosis is shown by an ankle/brachial approach, and the high cardiovascular event risk that affected the PAD patients. A number of pathophysiologic pathways operate in chronic arterial ischemia of lower limbs, giving the possibility to improve therapeutic strategies and the outcome of patients. This review aims to provide a well detailed description of such fundamental issues as physical exercise, biochemistry of physical exercise, skeletal muscle in PAD, heme oxygenase 1 (HO-1) in PAD, and antioxidants in PAD. These issues are closely related to the oxidative stress in PAD. We want to draw attention to the pathophysiologic pathways that are considered to be beneficial in order to achieve more effective options to treat PAD patients.
Collapse
Affiliation(s)
- Salvatore Santo Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (E.M.); (S.S.)
- Correspondence: ; Tel.: +39-09-5378-2545
| | - Elisa Marino
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (E.M.); (S.S.)
| | - Salvatore Scuto
- Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (E.M.); (S.S.)
| | - Domenico Di Raimondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90127 Palermo, Italy;
| |
Collapse
|
49
|
Koller A, Fazzini F, Lamina C, Rantner B, Kollerits B, Stadler M, Klein-Weigel P, Fraedrich G, Kronenberg F. Mitochondrial DNA copy number is associated with all-cause mortality and cardiovascular events in patients with peripheral arterial disease. J Intern Med 2020; 287:569-579. [PMID: 32037598 PMCID: PMC7318579 DOI: 10.1111/joim.13027] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/18/2019] [Accepted: 01/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dysfunctional mitochondria have an influence on inflammation and increased oxidative stress due to an excessive production of reactive oxygen species. The mitochondrial DNA copy number (mtDNA-CN) is a potential biomarker for mitochondrial dysfunction and has been associated with various diseases. However, results were partially contrasting which might have been caused by methodological difficulties to quantify mtDNA-CN. OBJECTIVE We aimed to investigate whether mtDNA-CN is associated with peripheral arterial disease (PAD) as well as all-cause mortality and cardiovascular events during seven years of follow-up. METHODS A total of 236 male patients with PAD from the Cardiovascular Disease in Intermittent Claudication (CAVASIC) study were compared with 249 age- and diabetes-matched controls. MtDNA-CN was measured with a well-standardized plasmid-normalized quantitative PCR-based assay determining the ratio between mtDNA-CN and nuclear DNA. RESULTS Individuals in the lowest quartile of mtDNA-CN had a twofold increased risk for PAD which, however, was no longer significant after adjusting for leukocytes and platelets. About 67 of the 236 patients had already experienced a cardiovascular event at baseline and those in the lowest mtDNA-CN quartile had a 2.34-fold increased risk for these events (95% CI 1.08-5.13). During follow-up, 37 PAD patients died and 66 patients experienced a cardiovascular event. Patients in the lowest mtDNA-CN quartile had hazard ratios of 2.66 (95% CI 1.27-5.58) for all-cause-mortality and 1.82 (95% CI 1.02-3.27) for cardiovascular events compared with the combined quartile 2-4 (adjusted for age, smoking, CRP, diabetes, prevalent cardiovascular disease, leukocytes and platelets). CONCLUSION This investigation supports the hypothesis of mitochondrial dysfunction in peripheral arterial disease and shows an association of low mtDNA-CNs with all-cause-mortality and prevalent and incident cardiovascular disease in PAD patients with intermittent claudication.
Collapse
Affiliation(s)
- A Koller
- From the, Department of Genetics and Pharmacology, Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - F Fazzini
- From the, Department of Genetics and Pharmacology, Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Lamina
- From the, Department of Genetics and Pharmacology, Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - B Rantner
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - B Kollerits
- From the, Department of Genetics and Pharmacology, Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Stadler
- 3rd Medical Department of Metabolic Diseases and Nephrology, Hietzing Hospital, Vienna, Austria.,Diabetes Research Group, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - P Klein-Weigel
- Clinic of Angiology, Center of Vascular Medicine, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - G Fraedrich
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - F Kronenberg
- From the, Department of Genetics and Pharmacology, Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
50
|
Nwadozi E, Rudnicki M, De Ciantis M, Milkovich S, Pulbere A, Roudier E, Birot O, Gustafsson T, Ellis CG, Haas TL. High-fat diet pre-conditioning improves microvascular remodelling during regeneration of ischaemic mouse skeletal muscle. Acta Physiol (Oxf) 2020; 229:e13449. [PMID: 32012450 DOI: 10.1111/apha.13449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 12/25/2022]
Abstract
AIM Critical limb ischaemia (CLI) is characterized by inadequate angiogenesis, arteriolar remodelling and chronic myopathy, which are most severe in type 2 diabetic patients. Hypertriglyceridaemia, commonly observed in these patients, compromises macrovascular function. However, the effects of high-fat diet-induced increases in circulating lipids on microvascular remodelling are not established. Here, we investigated if high-fat diet would mimic the detrimental effect of type 2 diabetes on post-ischaemia vascular remodelling and muscle regeneration, using a mouse model of hindlimb ischaemia. METHODS Male C57Bl6/J mice were fed with normal or high-fat diets for 8 weeks prior to unilateral femoral artery ligation. Laser doppler imaging was used to assess limb perfusion recovery. Vascular recovery, inflammation, myofibre regeneration and fibrosis were assessed at 4 or 14 days post-ligation by histology and RNA analyses. Capillary-level haemodynamics were assessed by intravital microscopy of control and regenerating muscles 14 days post-ligation. RESULTS High-fat diet increased muscle succinate dehydrogenase activity and capillary-level oxygen supply. At 4 days post-ligation, no diet differences were detected in muscle damage, inflammatory infiltration or capillary activation. At 14 days post-ligation, high fat-fed mice displayed accelerated limb blood flow recovery, elevated capillary and arteriole densities as well as greater red blood cell supply rates and capillary-level oxygen supply. Regenerating muscles from high fat-fed mice displayed lower interstitial fat and collagen deposition. CONCLUSION The muscle-level adaptations to high-fat diet improved multiple aspects of muscle recovery in response to ischaemia and did not recapitulate the worse outcomes seen in diabetic CLI patients.
Collapse
Affiliation(s)
- Emmanuel Nwadozi
- School of Kinesiology and Health Science Muscle Health Research Centre Angiogenesis Research Group York University Toronto ON Canada
| | - Martina Rudnicki
- School of Kinesiology and Health Science Muscle Health Research Centre Angiogenesis Research Group York University Toronto ON Canada
| | - Matthew De Ciantis
- School of Kinesiology and Health Science Muscle Health Research Centre Angiogenesis Research Group York University Toronto ON Canada
| | - Stephanie Milkovich
- Department of Medical Biophysics University of Western Ontario London ON Canada
| | - Alexandru Pulbere
- School of Kinesiology and Health Science Muscle Health Research Centre Angiogenesis Research Group York University Toronto ON Canada
| | - Emilie Roudier
- School of Kinesiology and Health Science Muscle Health Research Centre Angiogenesis Research Group York University Toronto ON Canada
| | - Olivier Birot
- School of Kinesiology and Health Science Muscle Health Research Centre Angiogenesis Research Group York University Toronto ON Canada
| | - Thomas Gustafsson
- Division of Clinical Physiology Department of Laboratory Medicine Karolinska Institutet Stockholm Sweden
- Unit of Clinical Physiology Karolinska University Hospital Stockholm Sweden
| | | | - Tara L. Haas
- School of Kinesiology and Health Science Muscle Health Research Centre Angiogenesis Research Group York University Toronto ON Canada
| |
Collapse
|