1
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Viana SMDNR, de Bruin VMS, Vasconcelos RS, Nogueira ANC, Mesquita R, de Bruin PFC. Melatonin supplementation enhances pulmonary rehabilitation outcomes in COPD: a randomized, double-blind, placebo-controlled study. Respir Med 2023; 220:107441. [PMID: 37944829 DOI: 10.1016/j.rmed.2023.107441] [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: 07/19/2023] [Revised: 10/08/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
Melatonin (MLT), the main product of the pineal gland, is involved in muscle tissue repair and regeneration, besides several other important physiologic functions. In COPD, MLT administration can improve lung oxidative stress and sleep quality, but its potential effects on the outcomes of pulmonary rehabilitation (PR) have not been previously investigated. A randomized controlled trial was undertaken to test the hypothesis that a combined approach of rehabilitative exercise training and MLT supplementation could maximize functional performance, health status and quality of life in patients with COPD. Thirty-nine individuals with COPD referred to a supervised PR program at the Federal University of Ceara, Brazil, were randomized to receive MLT (3 mg/day; n = 18) or placebo (n = 21). Exercise capacity (6-min walk test - 6MWT), health status (COPD assessment test), and quality of life (airways questionnaire 20) were investigated as primary outcomes. No differences were observed at baseline in demographic, anthropometric and clinical characteristics between MLT and placebo groups. At the end of PR, superiority of the MLT group was demonstrated in improvement in the distance covered in the 6MWT (71 ± 26 vs. 25 ± 36 m; p < 0.01), health status (-11 ± 6 vs. -3 ± 5; p < 0.01), and quality of life (-6.9 ± 3.0 vs. -1.9 ± 2.4; p < 0.01), compared to the placebo group. In conclusion, MLT supplementation during the course of 12 weeks of PR can improve functional capacity, health status and quality of life in patients with COPD. These findings may have significant implications for the management of this condition.
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Affiliation(s)
| | | | | | | | - Rafael Mesquita
- Federal University of Ceara, Fortaleza, Brazil; Masters Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, CE, Brazil
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2
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Fibrinogen is a promising biomarker for chronic obstructive pulmonary disease: evidence from a meta-analysis. Biosci Rep 2021; 40:225825. [PMID: 32677669 PMCID: PMC7383837 DOI: 10.1042/bsr20193542] [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: 10/07/2019] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 02/08/2023] Open
Abstract
Backgrounds: Some studies have reported association of circulating fibrinogen with the risk of chronic obstructive pulmonary disease (COPD), and the results are conflicting. To yield more information, we aimed to test the hypothesis that circulating fibrinogen is a promising biomarker for COPD by a meta-analysis. Methods: Data extraction and quality assessment were independently completed by two authors. Effect-size estimates are expressed as weighted mean difference (WMD) with 95% confidence interval (95% CI). Results: Forty-five articles involving 5586/18604 COPD patients/controls were incorporated. Overall analyses revealed significantly higher concentrations of circulating fibrinogen in COPD patients than in controls (WMD: 84.67 mg/dl; 95% CI: 64.24–105.10). Subgroup analyses by COPD course showed that the degree of increased circulating fibrinogen in patients with acute exacerbations of COPD (AECOPD) relative to controls (WMD: 182.59 mg/dl; 95% CI: 115.93–249.25) tripled when compared in patients with stable COPD (WMD: 56.12 mg/dl; 95% CI: 34.56–77.67). By COPD severity, there was a graded increase in fibrinogen with the increased severity of COPD relative to controls (Global Initiative for Obstructive Lung Disease (GOLD) I, II, III, and IV: WMD: 13.91, 29.19, 56.81, and 197.42 mg/dl; 95% CI: 7.70–20.11, 17.43–40.94, 39.20–74.41, and −7.88 to 402.73, respectively). There was a low probability of publication bias. Conclusion: Our findings indicate a graded, concentration-dependent, significant relation between higher circulating fibrinogen and more severity of COPD.
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3
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Sadaka AS, Faisal A, Khalil YM, Mourad SM, Zidan MH, Polkey MI, Hopkinson NS. Reduced skeletal muscle endurance and ventilatory efficiency during exercise in adult smokers without airflow obstruction. J Appl Physiol (1985) 2021; 130:976-986. [DOI: 10.1152/japplphysiol.00762.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In adult smokers without airflow obstruction, the contributions of pulmonary and skeletal muscle functions to reduced exercise capacity are unclear. We found that non-COPD smokers had decreased exercise capacity and muscle endurance although strength was preserved compared with never-smoking controls. Exercise endurance was associated with quadriceps endurance and CO transfer factor. Despite similar physical activity levels, smokers developed leg fatigue, breathlessness, and displayed increased ventilation with reduced ventilatory efficiency at lower workloads, without exhibiting ventilatory constraint.
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Affiliation(s)
- Ahmed S. Sadaka
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Azmy Faisal
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
- Faculty of Physical Education for Men, Alexandria University, Alexandria, Egypt
| | - Yehia M. Khalil
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sahar M. Mourad
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed H. Zidan
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Michael I. Polkey
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Respiratory Medicine Department, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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4
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Yao Y, Zhou J, Diao X, Wang S. Association between tumor necrosis factor-α and chronic obstructive pulmonary disease: a systematic review and meta-analysis. Ther Adv Respir Dis 2020; 13:1753466619866096. [PMID: 31390957 PMCID: PMC6688146 DOI: 10.1177/1753466619866096] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Patients diagnosed with chronic obstructive pulmonary disease (COPD) have
increased risks for a series of physical and mental illnesses. Tumor
necrosis factor-α (TNF-α) has been reported to participate in the
development of COPD and its complications. However, the values of blood
TNF-α level used in the diagnosis of COPD remains controversial. In view of
this, we performed a systematic review and meta-analysis to evaluate the
correlation between TNF-α level and COPD. Methods: We searched PubMed, Web of Science, Embase and CNKI up to May 2018. The
selection criteria were set according to the PICOS framework. A
random-effects model was then applied to evaluate the overall effect sizes
by calculating standard mean difference (SMD) and its 95% confidence
intervals (CIs). Results: A total of 40 articles containing 4189 COPD patients and 1676 healthy
controls were included in this meta-analysis. The results indicated a
significant increase in TNF-α level in the COPD group compared with the
control group (SMD: 1.24, 95% CI: 0.78–1.71,
p < 0.00001). According to the subgroup analyses, we
noted that TNF-α level was associated with predicted first second of forced
expiration (FEV1) (%) and study region. However, no association
between TNF-α level and COPD was found when the participants were
nonsmokers, and the mean age was less than 60 years. Conclusions: Our results indicated that TNF-α level was increased in COPD patients when
compared with healthy controls. Illness progression and a diagnosis of COPD
might contribute to higher TNF-α levels. However, the underlying mechanism
still remains unknown and needs further investigation. The reviews of this paper are available via the supplemental
material section.
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Affiliation(s)
- Yang Yao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, PR China
| | - Jing Zhou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, PR China
| | - Xin Diao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, PR China
| | - Shengyu Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, 710002, PR China
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5
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Furlanetto KC, Correia NS, Corso SD. Upper limbs: how physically limited is your patient? J Bras Pneumol 2020; 46:e20190430. [PMID: 32130348 PMCID: PMC7462677 DOI: 10.1590/1806-3713/e20190430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Karina Couto Furlanetto
- . Programa de Pós-Graduação em Ciências da Reabilitação associado entre Universidade Estadual de Londrina - UEL - e Universidade Norte do Paraná - UNOPAR - Londrina (PR) Brasil.,. Programa de Pós-Graduação em Ciências da Reabilitação da Universidade Nove de Julho - UNINOVE - São Paulo (SP) Brasil
| | - Natielly Soares Correia
- . Programa de Pós-Graduação em Ciências da Reabilitação associado entre Universidade Estadual de Londrina - UEL - e Universidade Norte do Paraná - UNOPAR - Londrina (PR) Brasil
| | - Simone Dal Corso
- . Programa de Pós-Graduação em Ciências da Reabilitação da Universidade Nove de Julho - UNINOVE - São Paulo (SP) Brasil
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6
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Abdulai RM, Jensen TJ, Patel NR, Polkey MI, Jansson P, Celli BR, Rennard SI. Deterioration of Limb Muscle Function during Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2019; 197:433-449. [PMID: 29064260 DOI: 10.1164/rccm.201703-0615ci] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Important features of both stable and acute exacerbation of chronic obstructive pulmonary disease (COPD) are skeletal muscle weakness and wasting. Limb muscle dysfunction during an exacerbation has been linked to various adverse outcomes, including prolonged hospitalization, readmission, and mortality. The contributing factors leading to muscle dysfunction are similar to those seen in stable COPD: disuse, nutrition/energy balance, hypercapnia, hypoxemia, electrolyte derangements, inflammation, and drugs (i.e., glucocorticoids). These factors may be the trigger for a downstream cascade of local inflammatory changes, pathway process alterations, and structural degradation. Ultimately, the clinical effects can be wide ranging and include reduced limb muscle strength. Current therapies, such as pulmonary/physical rehabilitation, have limited impact because of low participation rates. Recently, novel drugs have been developed in similar disorders, and learnings from these studies can be used as a foundation to facilitate discovery in patients hospitalized with a COPD exacerbation. Nevertheless, investigators should approach this patient population with knowledge of the limitations of each intervention. In this Concise Clinical Review, we provide an overview of acute muscle dysfunction in patients hospitalized with acute exacerbation of COPD and a strategic approach to drug development in this setting.
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Affiliation(s)
- Raolat M Abdulai
- 1 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,2 Respiratory, Inflammation, and Autoimmunity, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Boston, Massachusetts
| | - Tina Jellesmark Jensen
- 3 Respiratory, Inflammation, and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Naimish R Patel
- 2 Respiratory, Inflammation, and Autoimmunity, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Boston, Massachusetts.,4 Beth Israel Deaconess Hospital, Boston, Massachusetts
| | - Michael I Polkey
- 5 National Institute for Health Research, Respiratory Biomedical Research Unit at the Royal Brompton Hospital and Imperial College London, London, United Kingdom
| | - Paul Jansson
- 3 Respiratory, Inflammation, and Autoimmunity, IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Bartolomé R Celli
- 1 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,6 Harvard Medical School, Boston, Massachusetts
| | - Stephen I Rennard
- 7 Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska; and.,8 Clinical Discovery Unit, Early Clinical Development, IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
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7
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Rozenberg D, Martelli V, Vieira L, Orchanian-Cheff A, Keshwani N, Singer LG, Mathur S. Utilization of non-invasive imaging tools for assessment of peripheral skeletal muscle size and composition in chronic lung disease: A systematic review. Respir Med 2017; 131:125-134. [DOI: 10.1016/j.rmed.2017.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022]
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8
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Tsuji T, Yamaguchi K, Kikuchi R, Nakamura H, Misaka R, Nagai A, Aoshiba K. Improvement of metabolic disorders by an EP 2 receptor agonist via restoration of the subcutaneous adipose tissue in pulmonary emphysema. Prostaglandins Other Lipid Mediat 2017; 130:16-22. [PMID: 28263859 DOI: 10.1016/j.prostaglandins.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/16/2017] [Accepted: 03/01/2017] [Indexed: 02/07/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is often associated with co-morbidities. Metabolic disorders like hyperlipidemia and diabetes occur also in underweight COPD patients, although the mechanism is uncertain. Subcutaneous adipose tissue (SAT) plays an important role in energy homeostasis, since restricted capacity to increase fat cell number with increase in fat cell size occurring instead, is associated with lipotoxicity and metabolic disorders. The aim of this study is to show the protective role of SAT for the metabolic disorders in pulmonary emphysema of a murine model. We found ectopic fat accumulation and impaired glucose homeostasis with wasting of SAT in a murine model of elastase-induced pulmonary emphysema (EIE mice) reared on a high-fat diet. ONO-AE1-259, a selective E-prostanoid (EP) 2 receptor agonist, improved angiogenesis and subsequently adipogenesis, and finally improved ectopic fat accumulation and glucose homeostasis with restoration of the capacity for storage of surplus energy in SAT. These results suggest that metabolic disorders like hyperlipidemia and diabetes occured in underweight COPD is partially due to the less capacity for storage of surplus energy in SAT, though the precise mechanism is uncertained. Our data pave the way for the development of therapeutic interventions for metabolic disorders in emphysema patients, e.g., use of pro-angiogenic agents targeting the capacity for storage of surplus energy in the subcutaneous adipose tissue.
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Affiliation(s)
- Takao Tsuji
- Institute of Geriatrics, Tokyo Women's Medical University, 2-15-1 Shibuya, Shibuya, Tokyo 150-0002, Japan; Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuou, Ami, Inashiki, Ibaraki 300-0395, Japan.
| | - Kazuhiro Yamaguchi
- Division of Comprehensive Sleep Medicine, Tokyo Women's Medical University, 8-1,Kawada-cho, Sinjuku, Tokyo 162-8666, Japan.
| | - Ryota Kikuchi
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuou, Ami, Inashiki, Ibaraki 300-0395, Japan.
| | - Hiroyuki Nakamura
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuou, Ami, Inashiki, Ibaraki 300-0395, Japan.
| | - Ryoichi Misaka
- Institute of Geriatrics, Tokyo Women's Medical University, 2-15-1 Shibuya, Shibuya, Tokyo 150-0002, Japan.
| | - Atsushi Nagai
- Reserch Institute for Respiratory Diseases, Shin-yurigaoka GeneralHospital, 255 Asou, Kawasaki, Kanagawa 215-0026, Japan.
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuou, Ami, Inashiki, Ibaraki 300-0395, Japan.
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9
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Gouzi F, Maury J, Bughin F, Blaquière M, Ayoub B, Mercier J, Perez-Martin A, Pomiès P, Hayot M. Impaired training-induced adaptation of blood pressure in COPD patients: implication of the muscle capillary bed. Int J Chron Obstruct Pulmon Dis 2016; 11:2349-2357. [PMID: 27703345 PMCID: PMC5038574 DOI: 10.2147/copd.s113657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background and aims Targeting the early mechanisms in exercise-induced arterial hypertension (which precedes resting arterial hypertension in its natural history) may improve cardiovascular morbidity and mortality in COPD patients. Capillary rarefaction, an early event in COPD before vascular remodeling, is a potential mechanism of exercise-induced and resting arterial hypertension. Impaired training-induced capillarization was observed earlier in COPD patients; thus, this study compares the changes in blood pressure (BP) during exercise in COPD patients and matches control subjects (CSs) after a similar exercise training program, in relationship with muscle capillarization. Methods Resting and maximal exercise diastolic pressure (DP) and systolic pressure (SP) were recorded during a standardized cardiopulmonary exercise test, and a quadriceps muscle biopsy was performed before and after training. Results A total of 35 CSs and 49 COPD patients (forced expiratory volume in 1 second =54%±22% predicted) completed a 6-week rehabilitation program and improved their symptom-limited maximal oxygen uptake (VO2SL: 25.8±6.1 mL/kg per minute vs 27.9 mL/kg per minute and 17.0±4.7 mL/kg per minute vs 18.3 mL/kg per minute; both P<0.001). The improvement in muscle capillary-to-fiber (C/F) ratio was significantly greater in CSs vs COPD patients (+11%±9% vs +23%±21%; P<0.05). Although maximal exercise BP was reduced in CSs (DP: 89±10 mmHg vs 85±9 mmHg; P<0.001/SP: 204±25 mmHg vs 196±27 mmHg; P<0.05), it did not change in COPD patients (DP: 94±14 mmHg vs 97±16 mmHg; P=0.46/SP: 202±27 mmHg vs 208±24 mmHg; P=0.13). The change in muscle C/F ratio was negatively correlated with maximal exercise SP in CSs and COPD patients (r=−0.41; P=0.02). Conclusion COPD patients showed impaired training-induced BP adaptation related to a change in muscle capillarization, suggesting the possibility of blunted angiogenesis.
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Affiliation(s)
- Fares Gouzi
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
| | - Jonathan Maury
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Pulmonary Rehabilitation Center "La Solane", 5 Santé Group, Osséja
| | - François Bughin
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
| | - Marine Blaquière
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
| | - Bronia Ayoub
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
| | - Jacques Mercier
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
| | - Antonia Perez-Martin
- Dysfunction of Vascular Interfaces Laboratory, EA 2992, University of Montpellier; Department of Vascular Medicine and Investigations, Nîmes University Hospital, Nîmes, France
| | - Pascal Pomiès
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier
| | - Maurice Hayot
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier; Department of Clinical Physiology, Montpellier University Hospital, Montpellier
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10
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Azevedo DDP, Medeiros WM, de Freitas FFM, Ferreira Amorim C, Gimenes ACO, Neder JA, Chiavegato LD. High oxygen extraction and slow recovery of muscle deoxygenation kinetics after neuromuscular electrical stimulation in COPD patients. Eur J Appl Physiol 2016; 116:1899-910. [PMID: 27468840 DOI: 10.1007/s00421-016-3442-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 07/22/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE It was hypothesized that patients with chronic obstructive pulmonary disease (COPD) would exhibit a slow muscle deoxygenation (HHb) recovery time when compared with sedentary controls. METHODS Neuromuscular electrical stimulation (NMES 40 and 50 mA, 50 Hz, 400 µs) was employed to induce isometric contraction of the quadriceps. Microvascular oxygen extraction (µO2EF) and HHb were estimated by near-infrared spectroscopy (NIRS). Recovery kinetic was characterized by measuring the time constant Tau (HHb-τ). Torque and work were measured by isokinetic dynamometry in 13 non-hypoxaemic patients with moderate-to-severe COPD [SpO2 = 94.1 ± 1.6 %; FEV1 (% predict) 48.0 ± 9.6; GOLD II-III] and 13 age- and sex-matched sedentary controls. RESULTS There was no desaturation in either group during NMES. Torque and work were reduced in COPD versus control for 40 and 50 mA [torque (Nm) 50 mA = 28.9 ± 6.9 vs 46.1 ± 14.2; work (J) 50 mA = 437.2 ± 130.0 vs. 608.3 ± 136.8; P < 0.05 for all]. High µO2EF values were observed in the COPD group at both NMES intensities (corrected by muscle mass 50 mA = 6.18 ± 1.1 vs. 4.68 ± 1.0 %/kg; corrected by work 50 mA = 0.12 ± 0.05 vs. 0.07 ± 0.02 %/J; P < 0.05 for all). Absolute values of HHb-τ (50 mA = 31.11 ± 9.27 vs. 18.08 ± 10.70 s), corrected for muscle mass (50 mA 3.80 ± 1.28 vs. 2.05 ± 1.45 s/kg) and corrected for work (50 mA = 0.08 ± 0.04 vs. 0.03 ± 0.02 s/J) were reduced in COPD (P < 0.05 for all). The variables behaviour for 40 mA was similar to those of 50 mA. CONCLUSIONS COPD patients exhibited a slower muscle deoxygenation recovery time after NMES. The absence of desaturation, low torque and work, high µO2EF and high values for recovery time corrected by muscle mass and work suggest that intrinsic muscle dysfunction has an impact on muscle recovery capacity.
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Affiliation(s)
- Diego de Paiva Azevedo
- Master's and Doctoral Program in Physical Therapy, Universidade de São Paulo (UNICID), Sao Paulo, SP, Brazil
| | - Wladimir Musetti Medeiros
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Rua Professor Francisco de Castro 54, Vila Clementino, Sao Paulo, CEP 04020-050, Brazil
| | | | - Cesar Ferreira Amorim
- Master's and Doctoral Program in Physical Therapy, Universidade de São Paulo (UNICID), Sao Paulo, SP, Brazil
| | - Ana Cristina Oliveira Gimenes
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Rua Professor Francisco de Castro 54, Vila Clementino, Sao Paulo, CEP 04020-050, Brazil
| | - Jose Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Rua Professor Francisco de Castro 54, Vila Clementino, Sao Paulo, CEP 04020-050, Brazil
| | - Luciana Dias Chiavegato
- Master's and Doctoral Program in Physical Therapy, Universidade de São Paulo (UNICID), Sao Paulo, SP, Brazil. .,Pulmonary Function and Clinical Exercise Physiology Unit, Division of Respiratory Medicine, Federal University of Sao Paulo (UNIFESP), Rua Professor Francisco de Castro 54, Vila Clementino, Sao Paulo, CEP 04020-050, Brazil.
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11
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Patel MS, Donaldson AV, Lewis A, Natanek SA, Lee JY, Andersson YM, Haji G, Jackson SG, Bolognese BJ, Foley JP, Podolin PL, Bruijnzeel PLB, Hart N, Hopkinson NS, Man WDC, Kemp PR, Polkey MI. Klotho and smoking--An interplay influencing the skeletal muscle function deficits that occur in COPD. Respir Med 2016; 113:50-6. [PMID: 27021580 DOI: 10.1016/j.rmed.2016.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/05/2016] [Accepted: 02/11/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Klotho is an 'anti-ageing' hormone and transmembrane protein; Klotho deficient mice develop a similar ageing phenotype to smokers including emphysema and muscle wasting. The objective of this study was to evaluate skeletal muscle and circulating Klotho protein in smokers and COPD patients and to relate Klotho levels to relevant skeletal muscle parameters. We sought to validate our findings by undertaking complimentary murine studies. METHODS Fat free mass, quadriceps strength and spirometry were measured in 87 participants (61 COPD, 13 'healthy smokers' and 13 never smoking controls) in whom serum and quadriceps Klotho protein levels were also measured. Immunohistochemistry was performed to demonstrate the location of Klotho protein in human skeletal muscle and in mouse skeletal muscle in which regeneration was occurring following injury induced by electroporation. In a separate study, gastrocnemius Klotho protein was measured in mice exposed to 77 weeks of smoke or sham air. RESULTS Quadriceps Klotho levels were lower in those currently smoking (p = 0.01), irrespective of spirometry, but were not lower in patients with COPD. A regression analysis identified current smoking status as the only independent variable associated with human quadriceps Klotho levels, an observation supported by the finding that smoke exposed mice had lower gastrocnemius Klotho levels than sham exposed mice (p = 0.005). Quadriceps Klotho levels related to local oxidative stress but were paradoxically higher in patients with established muscle wasting or weakness; the unexpected relationship with low fat free mass was the only independent association. Within locomotor muscle, Klotho localized to the plasma membrane and to centralized nuclei in humans and in mice with induced muscle damage. Serum Klotho had an independent association with quadriceps strength but did not relate to quadriceps Klotho levels or to spirometric parameters. CONCLUSIONS Klotho is expressed in skeletal muscle and levels are reduced by smoking. Despite this, quadriceps Klotho protein expression in those with established disease appears complex as levels were paradoxically elevated in COPD patients with established muscle wasting. Whilst serum Klotho levels were not reduced in smokers or COPD patients and were not associated with quadriceps Klotho protein, they did relate to quadriceps strength.
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Affiliation(s)
- M S Patel
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK; Imperial College London, UK
| | - A V Donaldson
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK; Imperial College London, UK
| | | | - S A Natanek
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK; Imperial College London, UK
| | | | | | - G Haji
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK; Imperial College London, UK
| | | | - B J Bolognese
- Respiratory Therapeutic Area, GlaxoSmithKline, King of Prussia, PA, USA
| | - J P Foley
- Respiratory Therapeutic Area, GlaxoSmithKline, King of Prussia, PA, USA
| | - P L Podolin
- Respiratory Therapeutic Area, GlaxoSmithKline, King of Prussia, PA, USA
| | | | - N Hart
- NIHR Comprehensive Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - N S Hopkinson
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK; Imperial College London, UK
| | - W D-C Man
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK; Imperial College London, UK
| | | | - M I Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK; Imperial College London, UK.
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Pleguezuelos E, Esquinas C, Moreno E, Guirao L, Ortiz J, Garcia-Alsina J, Merí A, Miravitlles M. Muscular Dysfunction in COPD: Systemic Effect or Deconditioning? Lung 2016; 194:249-57. [DOI: 10.1007/s00408-015-9838-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/26/2015] [Indexed: 12/21/2022]
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13
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Wei J, Xiong XF, Lin YH, Zheng BX, Cheng DY. Association between serum interleukin-6 concentrations and chronic obstructive pulmonary disease: a systematic review and meta-analysis. PeerJ 2015; 3:e1199. [PMID: 26336642 PMCID: PMC4556145 DOI: 10.7717/peerj.1199] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/29/2015] [Indexed: 02/05/2023] Open
Abstract
Background. Interleukin-6 (IL-6) is an important pro-inflammatory cytokine and has been implicated to play a role in the systemic inflammation of patients with chronic obstructive pulmonary disease (COPD). We conducted this meta-analysis to assess the association between serum IL-6 concentrations and COPD. Methods. PubMed and Embase were searched for eligible studies. Data were extracted by two investigators (Wei J, Xiong XF) independently and analyzed using Review Manager 5.3 and STATA 12.0 software. Standard mean differences (SMDs) and 95% confidence intervals (CI) were calculated. Results. Thirty-three studies were included in this meta-analysis. The serum IL-6 concentrations were higher in patients with stable COPD than healthy controls (SMD = 0.65, 95% CI [0.51–0.79]). COPD patients without major comorbidities also showed higher IL-6 levels than healthy controls (SMD = 0.74, 95% CI [0.56–0.91]). COPD patients with an forced expiratory volume in one second (FEV1) of either <50% predicted or >50% predicted had increased IL-6 concentrations compared to healthy controls (SMD = 0.77, 95% CI [0.48–1.05], SMD = 1.01, 95% CI [0.43–1.59], respectively). The serum IL-6 concentrations between mild-moderate and severe-very severe COPD patient groups were not found to be significant (SMD = −0.1, 95% CI [−0.65–0.44]). Conclusions. This meta-analysis indicated that patients with stable COPD had higher serum IL-6 concentrations than healthy controls. No evidence showing positive or negative association between IL-6 concentrations and the severity of pulmonary function impairment was found. The correlation between IL-6 levels and pulmonary function was weak in different severities of stable COPD patients.
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Affiliation(s)
- Jia Wei
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Feng Xiong
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yi-Hua Lin
- Department of Respiratory Medicine, First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Bi-Xia Zheng
- Department of Respiratory Medicine, Third People's Hospital, Chengdu, Sichuan, China
| | - De-Yun Cheng
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Abstract
Nutritional issues are increasingly recognised in the course of respiratory diseases, from primary prevention to advanced disease care. During the 2014 ERS International Congress in Munich, Germany, the topic was addressed in a Clinical Year in Review session. This review highlights new insights in generic and disease-specific nutritional issues from recently published peer-reviewed articles. The clinical relevance of obesity was highlighted in primary and secondary prevention across all respiratory diseases. Radiographic imaging was explored for characterisation of metabolic phenotypes as an integrated part of diagnostic work-up. Muscle regenerative defects and the autophagy-lysosome pathway were identified as new leads for combatting muscle wasting.
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15
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Puig-Vilanova E, Ausin P, Martinez-Llorens J, Gea J, Barreiro E. Do epigenetic events take place in the vastus lateralis of patients with mild chronic obstructive pulmonary disease? PLoS One 2014; 9:e102296. [PMID: 25013984 PMCID: PMC4094498 DOI: 10.1371/journal.pone.0102296] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/16/2014] [Indexed: 12/11/2022] Open
Abstract
Muscle dysfunction is a major comorbidity in Chronic Obstructive Pulmonary Disease (COPD). Several biological mechanisms including epigenetic events regulate muscle mass and function in models of muscle atrophy. Investigations conducted so far have focused on the elucidation of biological mechanisms involved in muscle dysfunction in advanced COPD. We assessed whether the epigenetic profile may be altered in the vastus lateralis of patients with mild COPD, normal body composition, and mildly impaired muscle function and exercise capacity. In vastus lateralis (VL) of mild COPD patients with well-preserved body composition and in healthy age-matched controls, expression of DNA methylation, muscle-enriched microRNAs, histone acetyltransferases (HTAs) and deacetylases (HDACs), protein acetylation, small ubiquitin-related modifier (SUMO) ligases, and muscle structure were explored. All subjects were clinically evaluated. Compared to healthy controls, in the VL of mild COPD patients, muscle function and exercise capacity were moderately reduced, DNA methylation levels did not differ, miR-1 expression levels were increased and positively correlated with both forced expiratory volume in one second (FEV1) and quadriceps force, HDAC4 protein levels were increased, and muscle fiber types and sizes were not different. Moderate skeletal muscle dysfunction is a relevant feature in patients with mild COPD and preserved body composition. Several epigenetic events are differentially expressed in the limb muscles of these patients, probably as an attempt to counterbalance the underlying mechanisms that alter muscle function and mass. The study of patients at early stages of their disease is of interest as they are a target for timely therapeutic interventions that may slow down the course of the disease and prevent the deleterious effects of major comorbidities.
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Affiliation(s)
- Ester Puig-Vilanova
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Pilar Ausin
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Juana Martinez-Llorens
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Joaquim Gea
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Esther Barreiro
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- * E-mail:
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16
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Basic VT, Jacobsen A, Sirsjö A, Abdel-Halim SM. TNF stimulation induces VHL overexpression and impairs angiogenic potential in skeletal muscle myocytes. Int J Mol Med 2014; 34:228-36. [PMID: 24820910 DOI: 10.3892/ijmm.2014.1776] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/24/2014] [Indexed: 11/06/2022] Open
Abstract
Decreased skeletal muscle capillarization is considered to significantly contribute to the development of pulmonary cachexia syndrome (PCS) and progressive muscle wasting in several chronic inflammatory diseases, including chronic obstructive pulmonary disease (COPD). It is unclear to which extent the concurrent presence of systemic inflammation contributes to decreased skeletal muscle capillarization under these conditions. The present study was designed to examine in vitro the effects of the pro-inflammatory cytokine, tumor necrosis factor (TNF), on the regulation of hypoxia-angiogenesis signal transduction and capillarization in skeletal muscles. For this purpose, fully differentiated C2C12 skeletal muscle myocytes were stimulated with TNF and maintained under normoxic or hypoxic conditions. The expression levels of the putative elements of the hypoxia-angiogenesis signaling cascade were examined using qPCR, western blot analysis and immunofluorescence. Under normoxic conditinos, TNF stimulation increased the protein expression of anti-angiogenic von-Hippel Lindau (VHL), prolyl hydroxylase (PHD)2 and ubiquitin conjugating enzyme 2D1 (Ube2D1), as well as the total ubiquitin content in the skeletal muscle myocytes. By contrast, the expression levels of hypoxia-inducible factor 1‑α (HIF1-α) and those of its transcriptional targets, vascular endothelial growth factor (VEGF)A and glucose transporter 1 (Glut1), were markedly reduced. In addition, hypoxia increased the expression of the VHL transcript and further elevated the VHL protein expression levels in C2C12 myocytes following TNF stimulation. Consequently, an impaired angiogenic potential was observed in the TNF-stimulated myocytes during hypoxia. In conclusion, TNF increases VHL expression and disturbs hypoxia-angiogenesis signal transduction in skeletal muscle myocytes. The current findings provide a mechanism linking systemic inflammation and impaired angiogenesis in skeletal muscle. This is particularly relevant to further understanding the mechanisms mediating muscle wasting and cachexia in patients with chronic inflammatory diseases, such as COPD.
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Affiliation(s)
- Vladimir T Basic
- Department of Clinical Medicine, Örebro University, Örebro, Sweden
| | - Annette Jacobsen
- Department of Clinical Medicine, Örebro University, Örebro, Sweden
| | - Allan Sirsjö
- Department of Clinical Medicine, Örebro University, Örebro, Sweden
| | - Samy M Abdel-Halim
- Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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