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Wu M, Yu J, Zhong A, Tang Y, Li M, Liu C, Sun D. Muscle ultrasound to identify prednisone-induced muscle damage in adults with nephrotic syndrome. Steroids 2024; 207:109434. [PMID: 38710261 DOI: 10.1016/j.steroids.2024.109434] [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: 10/26/2023] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Abstract
Steroid myopathy is a non-inflammatory toxic myopathy that primarily affects the proximal muscles of the lower limbs. Due to its non-specific symptoms, it is often overshadowed by patients' underlying conditions. Prolonged or high-dosage use of glucocorticoids leads to a gradual decline in muscle mass. There are no tools available to identify the course of steroid myopathy before the patient displays substantial clinical symptoms. In this study, we investigated individuals with nephrotic syndrome receiving prednisone who underwent muscle ultrasound to obtain cross-sectional and longitudinal pictures of three major proximal muscles in the lower limbs: the vastus lateralis, tibialis anterior, and medial gastrocnemius muscles. Our findings revealed that grip strength was impaired in the prednisolone group, creatine kinase levels were reduced within the normal range; echo intensity of the vastus lateralis and medial gastrocnemius muscles was enhanced, the pennation angle was reduced, and the tibialis anterior muscle exhibited increased echo intensity and decreased thickness. The total dose of prednisone and the total duration of treatment impacted the degree of muscle damage. Our findings indicate that muscle ultrasound effectively monitors muscle structure changes in steroid myopathy. Combining clinical symptoms, serum creatine kinase levels, and grip strength improves the accuracy of muscle injury evaluation.
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Affiliation(s)
- Mengmeng Wu
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Jinnuo Yu
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Ao Zhong
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Yifan Tang
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Manzhi Li
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Graduate School, Xuzhou Medical University, Xuzhou 221002, China
| | - Caixia Liu
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Dong Sun
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Clinical Research Center For Kidney Disease, Xuzhou Medical University, Xuzhou 221002, China.
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2
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Wu M, Liu C, Sun D. Glucocorticoid-Induced Myopathy: Typology, Pathogenesis, Diagnosis, and Treatment. Horm Metab Res 2024; 56:341-349. [PMID: 38224966 DOI: 10.1055/a-2246-2900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Glucocorticoid-induced myopathy is a non-inflammatory toxic myopathy typified by proximal muscle weakness, muscle atrophy, fatigue, and easy fatigability. These vague symptoms coupled with underlying disorders may mask the signs of glucocorticoid-induced myopathy, leading to an underestimation of the disease's impact. This review briefly summarizes the classification, pathogenesis, and treatment options for glucocorticoid-induced muscle wasting. Additionally, we discuss current diagnostic measures in clinical research and routine care used for diagnosing and monitoring glucocorticoid-induced myopathy, which includes gait speed tests, muscle strength tests, hematologic tests, bioelectrical impedance analysis (BIA), dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), electromyography, quantitative muscle ultrasound, histological examination, and genetic analysis. Continuous monitoring of patients receiving glucocorticoid therapy plays an important role in enabling early detection of glucocorticoid-induced myopathy, allowing physicians to modify treatment plans before significant clinical weakness arises.
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Affiliation(s)
- Mengmeng Wu
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Caixia Liu
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
| | - Dong Sun
- Department of Nephrology, Xuzhou Medical University Affiliated Hospital, Xuzhou, China
- Department of Internal Medicine and Diagnostics, Xuzhou Medical University, Xuzhou, China
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3
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Guerra S, Ledford JG, Melén E, Lavi I, Carsin AE, Stern DA, Zhai J, Vidal M, Bustamante M, Addison KJ, Vallecillo RG, Billheimer D, Koppelman GH, Garcia-Aymerich J, Lemonnier N, Fitó M, Dobaño C, Kebede Merid S, Kull I, McEachan RRC, Wright J, Chatzi L, Kogevinas M, Porta D, Narduzzi S, Ballester F, Esplugues A, Zabaleta C, Irizar A, Sunyer J, Halonen M, Bousquet J, Martinez FD, Anto JM. Creatine Kinase Is Decreased in Childhood Asthma. Am J Respir Crit Care Med 2023; 207:544-552. [PMID: 35876143 PMCID: PMC10870915 DOI: 10.1164/rccm.202010-3746oc] [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: 10/01/2020] [Accepted: 07/22/2022] [Indexed: 02/02/2023] Open
Abstract
Rationale: The identification of novel molecules associated with asthma may provide insights into the mechanisms of disease and their potential clinical implications. Objectives: To conduct a screening of circulating proteins in childhood asthma and to study proteins that emerged from human studies in a mouse model of asthma. Methods: We included 2,264 children from eight birth cohorts from the Mechanisms of the Development of ALLergy project and the Tucson Children's Respiratory Study. In cross-sectional analyses, we tested 46 circulating proteins for association with asthma in the selection stage and carried significant signals forward to a validation and replication stage. As CK (creatine kinase) was the only protein consistently associated with asthma, we also compared whole blood CK gene expression between subjects with and without asthma (n = 249) and used a house dust mite (HDM)-challenged mouse model to gain insights into CK lung expression and its role in the resolution of asthma phenotypes. Measurements and Main Results: As compared with the lowest CK tertile, children in the highest tertile had significantly lower odds for asthma in selection (adjusted odds ratio, 95% confidence interval: 0.31; 0.15-0.65; P = 0.002), validation (0.63; 0.42-0.95; P = 0.03), and replication (0.40; 0.16-0.97; P = 0.04) stages. Both cytosolic CK forms (CKM and CKB) were underexpressed in blood from asthmatics compared with control subjects (P = 0.01 and 0.006, respectively). In the lungs of HDM-challenged mice, Ckb expression was reduced, and after the HDM challenge, a CKB inhibitor blocked the resolution of airway hyperresponsiveness and reduction of airway mucin. Conclusions: Circulating concentrations and gene expression of CK are inversely associated with childhood asthma. Mouse models support a possible direct involvement of CK in asthma protection via inhibition of airway hyperresponsiveness and reduction of airway mucin.
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Affiliation(s)
- Stefano Guerra
- Asthma and Airway Disease Research Center
- ISGlobal, Barcelona, Spain
| | - Julie G. Ledford
- Asthma and Airway Disease Research Center
- Department of Cellular and Molecular Medicine
| | - Erik Melén
- Department of Clinical Science and Education and
- Sachs’ Children’s and Youth Hospital, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - Anne-Elie Carsin
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Jing Zhai
- Asthma and Airway Disease Research Center
| | - Marta Vidal
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Mariona Bustamante
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Dean Billheimer
- BIO5 Institute, and
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Gerard H. Koppelman
- Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Nathanaël Lemonnier
- Institute for Advanced Biosciences, UGA-INSERM U1209-CNRS UMR5309, Site Santé, Allée des Alpes, 38700 La Tronche, France
| | - Montserrat Fitó
- Cardiovascular Risk and Nutrition Group and
- CIBER de Fisiopatología de la Obesidad y Nutricion (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - Carlota Dobaño
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | | | - Inger Kull
- Department of Clinical Science and Education and
- Sachs’ Children’s and Youth Hospital, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - John Wright
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Manolis Kogevinas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Daniela Porta
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Silvia Narduzzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Ferran Ballester
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Nursing School, Universitat de València, Valencia, Spain
- FISABIO–Universitat Jaume I–Universitat de València Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
| | - Ana Esplugues
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Nursing School, Universitat de València, Valencia, Spain
- FISABIO–Universitat Jaume I–Universitat de València Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
| | - Carlos Zabaleta
- Pediatrics Service, Hospital de Zumárraga, Gipuzkoa, Spain
- Group of Environmental Epidemiology and Child Development, Biodonostia Health Research Institute, San Sebastian, Spain
| | - Amaia Irizar
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Group of Environmental Epidemiology and Child Development, Biodonostia Health Research Institute, San Sebastian, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Jean Bousquet
- University Hospital Montpellier, France; and
- Respiratory and Environmental Epidemiology Team, INSERM 1018, CESP Centre, Villejuif, France
| | | | - Josep M. Anto
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
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4
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Esteves GP, Mazzolani BC, Smaira FI, Mendes ES, de Oliveira GG, Roschel H, Gualano B, Pereira RMR, Dolan E. Nutritional recommendations for patients undergoing prolonged glucocorticoid therapy. Rheumatol Adv Pract 2022; 6:rkac029. [PMID: 35539442 PMCID: PMC9080102 DOI: 10.1093/rap/rkac029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/05/2022] [Indexed: 11/14/2022] Open
Abstract
Glucocorticoid (GC) therapy is a common treatment used in rheumatic and autoimmune diseases, owing to its anti-inflammatory and immunosuppressive effects. However, GC therapy can also induce a number of adverse effects, including muscle and bone loss, hypertension, metabolic perturbations and increased visceral adiposity. We review available evidence in this area and provide nutritional recommendations that might ameliorate these adverse effects. Briefly, optimizing calcium, vitamin D, sodium and protein intake and increasing consumption of unprocessed and minimally processed foods, while decreasing the consumption of ultra-processed foods, might counteract some of the specific challenges faced by these patients. Importantly, we identify a dearth of empirical data on how nutritional intervention might impact health-related outcomes in this population. Further research is required to investigate the clinical and therapeutic efficacy of these theory-based recommendations.
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Affiliation(s)
- Gabriel P Esteves
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Bruna Caruso Mazzolani
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Fabiana Infante Smaira
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Elizabeth Silva Mendes
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Gabriela Guimarães de Oliveira
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
| | - Rosa Maria R Pereira
- Bone Metabolism Laboratory, Rheumatology Division; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eimear Dolan
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Rheumatology Division; Faculdade de Medicina FMUSP
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5
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The Effect of Long-Lasting Swimming on Rats Skeletal Muscles Energy Metabolism after Nine Days of Dexamethasone Treatment. Int J Mol Sci 2022; 23:ijms23020748. [PMID: 35054933 PMCID: PMC8775511 DOI: 10.3390/ijms23020748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 12/04/2022] Open
Abstract
This study investigates the effect of Dexamethasone (Dex) treatment on blood and skeletal muscle metabolites level and skeletal muscle activity of enzymes related to energy metabolism after long-duration swimming. To evaluate whether Dex treatment, swimming, and combining these factors act on analyzed data, rats were randomly divided into four groups: saline treatment non-exercise and exercise and Dex treatment non-exercised and exercised. Animals in both exercised groups underwent long-lasting swimming. The concentration of lipids metabolites, glucose, and lactate were measured in skeletal muscles and blood according to standard colorimetric and fluorimetric methods. Also, activities of enzymes related to aerobic and anaerobic metabolism were measured in skeletal muscles. The results indicated that Dex treatment induced body mass loss and increased lipid metabolites in the rats’ blood but did not alter these changes in skeletal muscles. Interestingly, prolonged swimming applied after 9 days of Dex treatment significantly intensified changes induced by Dex; however, there was no difference in skeletal muscle enzymatic activities. This study shows for the first time the cumulative effect of exercise and Dex on selected elements of lipid metabolism, which seems to be essential for the patient’s health due to the common use of glucocorticoids like Dex.
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6
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Steell L, Gray SR, Russell RK, MacDonald J, Seenan JP, Wong SC, Gaya DR. Pathogenesis of Musculoskeletal Deficits in Children and Adults with Inflammatory Bowel Disease. Nutrients 2021; 13:nu13082899. [PMID: 34445056 PMCID: PMC8398806 DOI: 10.3390/nu13082899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022] Open
Abstract
Musculoskeletal deficits are among the most commonly reported extra-intestinal manifestations and complications of inflammatory bowel disease (IBD), especially in those with Crohn’s disease. The adverse effects of IBD on bone and muscle are multifactorial, including the direct effects of underlying inflammatory disease processes, nutritional deficits, and therapeutic effects. These factors also indirectly impact bone and muscle by interfering with regulatory pathways. Resultantly, individuals with IBD are at increased risk of osteoporosis and sarcopenia and associated musculoskeletal morbidity. In paediatric IBD, these factors may contribute to suboptimal bone and muscle accrual. This review evaluates the main pathogenic factors associated with musculoskeletal deficits in children and adults with IBD and summarises the current literature and understanding of the musculoskeletal phenotype in these patients.
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Affiliation(s)
- Lewis Steell
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK; (L.S.); (S.R.G.)
| | - Stuart R. Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK; (L.S.); (S.R.G.)
| | - Richard K. Russell
- Department of Paediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh EH16 4TJ, UK;
| | - Jonathan MacDonald
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; (J.M.); (J.P.S.)
| | - John Paul Seenan
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; (J.M.); (J.P.S.)
| | - Sze Choong Wong
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow G51 4TF, UK;
| | - Daniel R. Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
- Correspondence:
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7
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Khodabukus A, Kaza A, Wang J, Prabhu N, Goldstein R, Vaidya VS, Bursac N. Tissue-Engineered Human Myobundle System as a Platform for Evaluation of Skeletal Muscle Injury Biomarkers. Toxicol Sci 2021; 176:124-136. [PMID: 32294208 DOI: 10.1093/toxsci/kfaa049] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Traditional serum biomarkers used to assess skeletal muscle damage, such as activity of creatine kinase (CK), lack tissue specificity and sensitivity, hindering early detection of drug-induced myopathies. Recently, a novel four-factor skeletal muscle injury panel (MIP) of biomarkers consisting of skeletal troponin I (sTnI), CK mass (CKm), fatty-acid-binding protein 3 (Fabp3), and myosin light chain 3, has been shown to have increased tissue specificity and sensitivity in rodent models of skeletal muscle injury. Here, we evaluated if a previously established model of tissue-engineered functional human skeletal muscle (myobundle) can allow detection of the MIP biomarkers after injury or drug-induced myotoxicity in vitro. We found that concentrations of three MIP biomarkers (sTnI, CKm, and Fabp3) in myobundle culture media significantly increased in response to injury by a known snake venom (notexin). Cerivastatin, a known myotoxic statin, but not pravastatin, induced significant loss of myobundle contractile function, myotube atrophy, and increased release of both traditional and novel biomarkers. In contrast, dexamethasone induced significant loss of myobundle contractile function and myotube atrophy, but decreased the release of both traditional and novel biomarkers. Dexamethasone also increased levels of matrix metalloproteinase-2 and -3 in the culture media which correlated with increased remodeling of myobundle extracellular matrix. In conclusion, this proof-of-concept study demonstrates that tissue-engineered human myobundles can provide an in vitro platform to probe patient-specific drug-induced myotoxicity and performance assessment of novel injury biomarkers to guide preclinical and clinical drug development studies.
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Affiliation(s)
- Alastair Khodabukus
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708-90281
| | - Amulya Kaza
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708-90281
| | - Jason Wang
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708-90281
| | - Neel Prabhu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708-90281
| | | | - Vishal S Vaidya
- Drug Research and Development, Pfizer, Groton, Connecticut 06340
| | - Nenad Bursac
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708-90281
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8
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Watanabe K, Sakai T, Kato S, Hashizume N, Horii N, Yoshikawa M, Hasegawa N, Iemitsu K, Tsuji K, Uchida M, Kanamori M, Iemitsu M. Conduction Velocity of Muscle Action Potential of Knee Extensor Muscle During Evoked and Voluntary Contractions After Exhaustive Leg Pedaling Exercise. Front Physiol 2020; 11:546. [PMID: 32536878 PMCID: PMC7267216 DOI: 10.3389/fphys.2020.00546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/30/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose Muscle fiber conduction velocity (CV) has been developed to estimate neuromuscular fatigue and measured during voluntary (VC) and electrically evoked (EC) contractions. Since CV during VC and EC reflect different physiological phenomena, the two parameters would show inconsistent changes under the conditions of neuromuscular fatigue. We investigated the time-course changes of CV during EC and VC after fatiguing exercise. Methods In 14 young males, maximal voluntary contraction (MVC) of knee extensor muscles, CV during electrical stimulation (CV-EC) and MVC (CV-VC) were measured before and immediately, 30 min, 60 min, 120 min, and 24 h after exhaustive leg pedaling exercise. Results CV-EC significantly increased immediately after the fatiguing exercise (p < 0.05) and had a significant negative correlation with MVC in merged data from all time-periods (r = -0.511, p < 0.001). CV-VC significantly decreased 30, 60, and 120 min after the fatiguing exercise (p < 0.05) and did not show any correlations with MVC (p > 0.05). Conclusion These results suggest that CV during EC and VC exhibits different time-course changes, and that CV during EC may be appropriate to estimate the degree of neuromuscular fatigue after fatiguing pedaling exercise.
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Affiliation(s)
- Kohei Watanabe
- Laboratory of Neuromuscular Biomechanics, School of International Liberal Studies, Chukyo University, Nagoya, Japan
| | - Taiki Sakai
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Shosaku Kato
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Natsuka Hashizume
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Naoki Horii
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan.,Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Maki Yoshikawa
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Natsuki Hasegawa
- Research Organization of Science and Technology, Ritsumeikan University, Kusatsu, Japan
| | - Keiko Iemitsu
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Katsunori Tsuji
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Masakata Uchida
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Masao Kanamori
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Motoyuki Iemitsu
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
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9
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Caetano MR, Maranhão AA, Peixoto EM, Alamy AH, Casseta AP, Rodrigues Filho JC. Diaphragm quantitative electromyography in difficult-to-treat asthmatic patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:550-554. [PMID: 31508680 DOI: 10.1590/0004-282x20190085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/29/2019] [Indexed: 11/22/2022]
Abstract
Quantitative electromyography is an important tool to evaluate myopathies, and some difficult-to-treat asthmatic patients may have a subclinical corticosteroid myopathic process, using only inhaled corticosteroid, according to some studies. In this report, diaphragm quantitative electromyography was used to evaluate asthmatic difficult-to-treat patients, comparing them with a control group. Significant differences were obtained in amplitude, duration and size index of motor unit action potentials, with lower parameters in the asthmatic patients, which may indicate a myopathic process.
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Affiliation(s)
- Marcelo R Caetano
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Neurocirurgia, Rio de Janeiro RJ, Brasil
| | - Analucia A Maranhão
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Tórax, Rio de Janeiro RJ, Brasil
| | - Eduardo M Peixoto
- Universidade Federal do Estado do Rio de Janeiro, Faculdade de Enfermagem, Rio de Janeiro RJ, Brasil
| | - Alexandre H Alamy
- Neuroclass, Departamento de Neurofisiologia, Rio de Janeiro RJ, Brasil
| | - Ana Paula Casseta
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Cardiologia, Rio de Janeiro RJ, Brasil
| | - Julio C Rodrigues Filho
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Tórax, Rio de Janeiro RJ, Brasil
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10
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Minetto MA, Caresio C, Salvi M, D'Angelo V, Gorji NE, Molinari F, Arnaldi G, Kesari S, Arvat E. Ultrasound-based detection of glucocorticoid-induced impairments of muscle mass and structure in Cushing's disease. J Endocrinol Invest 2019; 42:757-768. [PMID: 30443856 DOI: 10.1007/s40618-018-0979-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the glucocorticoid-induced impairments of muscle mass and structure in patients presenting different stages of steroid myopathy progression. METHODS Thirty-three patients (28 women) affected by active (N = 20) and remitted (N = 13) Cushing's disease were recruited and the following variables were assessed: walking speed, handgrip strength, total body and appendicular muscle mass by bioelectrical impedance analysis (BIA), thickness and echo intensity of lower limb muscles by ultrasonography. RESULTS The two groups of patients showed comparable values of both handgrip strength [median (interquartile range) values: active disease: 27.4 (7.5) kg vs. remitted disease: 26.4 (9.4) kg; P = 0.58] and walking speed [active disease: 1.0 (0.2) m/s vs. remitted disease: 1.1 (0.3) m/s; P = 0.43]. Also, the thickness of the four muscles and all BIA-derived sarcopenic indices were comparable (P > 0.05 for all comparisons) between the two groups. On the contrary, the echo intensity of vastus lateralis, tibialis anterior (lower portion), and medial gastrocnemius was significantly (P < 0.05 for all comparisons) higher in patients with active disease compared to patients with remitted disease. Finally, significant negative correlations were found in the whole group of patients between muscle echo intensity and muscle function assessments. CONCLUSIONS We provided preliminary evidence that the ultrasound-derived measurements of muscle thickness and echo intensity can be useful to detect and track the changes of muscle mass and structure in patients with steroid myopathy and we suggest that the combined assessment of muscle mass, strength, and performance should be systematically applied in the routine examination of steroid myopathy patients.
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Affiliation(s)
- M A Minetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - C Caresio
- Biolab, Department of Electronics and Telecommunications, Polytechnic University of Turin, Turin, Italy
| | - M Salvi
- Biolab, Department of Electronics and Telecommunications, Polytechnic University of Turin, Turin, Italy
| | - V D'Angelo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - N E Gorji
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - F Molinari
- Biolab, Department of Electronics and Telecommunications, Polytechnic University of Turin, Turin, Italy
| | - G Arnaldi
- Clinic of Endocrinology and Metabolic Diseases, Ospedali Riuniti di Ancona University Hospital, Ancona, Italy
| | - S Kesari
- Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute and Pacific Neuroscience Institute, Santa Monica, CA, USA
| | - E Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
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11
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Additional Effects of Nutritional Antioxidant Supplementation on Peripheral Muscle during Pulmonary Rehabilitation in COPD Patients: A Randomized Controlled Trial. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:5496346. [PMID: 31178967 PMCID: PMC6501222 DOI: 10.1155/2019/5496346] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/24/2019] [Indexed: 11/30/2022]
Abstract
Background Skeletal muscle dysfunction in patients with chronic obstructive pulmonary disease (COPD) is not fully reversed by exercise training. Antioxidants are critical for muscle homeostasis and adaptation to training. However, COPD patients experience antioxidant deficits that worsen after training and might impact their muscle response to training. Nutritional antioxidant supplementation in combination with pulmonary rehabilitation (PR) would further improve muscle function, oxidative stress, and PR outcomes in COPD patients. Methods Sixty-four COPD patients admitted to inpatient PR were randomized to receive 28 days of oral antioxidant supplementation targeting the previously observed deficits (PR antioxidant group; α-tocopherol: 30 mg/day, ascorbate: 180 mg/day, zinc gluconate: 15 mg/day, selenomethionine: 50 μg/day) or placebo (PR placebo group). PR consisted of 24 sessions of moderate-intensity exercise training. Changes in muscle endurance (primary outcome), oxidative stress, and PR outcomes were assessed. Results Eighty-one percent of the patients (FEV1 = 58.9 ± 20.0%pred) showed at least one nutritional antioxidant deficit. Training improved muscle endurance in the PR placebo group (+37.4 ± 45.1%, p < 0.001), without additional increase in the PR antioxidant group (-6.6 ± 11.3%; p = 0.56). Nevertheless, supplementation increased the α-tocopherol/γ-tocopherol ratio and selenium (+58 ± 20%, p < 0.001, and +16 ± 5%, p < 0.01, respectively), muscle strength (+11 ± 3%, p < 0.001), and serum total proteins (+7 ± 2%, p < 0.001), and it tended to increase the type I fiber proportion (+32 ± 17%, p = 0.07). The prevalence of muscle weakness decreased in the PR antioxidant group only, from 30.0 to 10.7% (p < 0.05). Conclusions While the primary outcome was not significantly improved, COPD patients demonstrate significant improvements of secondary outcomes (muscle strength and other training-refractory outcomes), suggesting a potential “add-on” effect of the nutritional antioxidant supplementation (vitamins C and E, zinc, and selenium) during PR. This trial is registered with NCT01942889.
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12
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Minetto MA, Caresio C, D'Angelo V, Lanfranco F, Ghizzoni L, Roatta S, Arvat E, Kesari S. Diagnostic evaluation in steroid-induced myopathy: case report suggesting clinical utility of quantitative muscle ultrasonography. Endocr Res 2018; 43:235-245. [PMID: 29648902 DOI: 10.1080/07435800.2018.1461904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We present a patient with adrenal Cushing's syndrome causing steroid myopathy. The purpose of the case report is to illustrate the clinical usefulness of quantitative muscle ultrasonography for the assessment of glucocorticoid-induced changes in muscle mass (MM) and structure. METHODS Assessments of physical performance, muscle strength, MM (i.e., total body skeletal MM, appendicular skeletal MM, and thickness of lower limb muscles), and muscle structure (i.e., echo intensity of lower limb muscles) were performed in the patient both in the active phase of the disease (preoperatively) and 6 months after surgical intervention (postoperatively). RESULTS Muscle strength, physical performance, and MM were low both preoperatively and postoperatively. We also found preoperatively an increased echo intensity that normalized postoperatively. CONCLUSIONS Clinical implications of these findings are double-fold. First, although the muscle structure can recover quickly in steroid myopathy patients, the recovery of MM may take months to years. Second, we show that muscle echo intensity can be useful to track the progression of steroid myopathy overtime and may help to indicate early response to therapeutic interventions. Further prospective studies are needed to confirm the value of muscle echo intensity in patients with endogenous or exogenous Cushing's syndrome presenting with steroid myopathy.
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Affiliation(s)
- Marco Alessandro Minetto
- a Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences , University of Turin , Turin , Italy
- b Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences , University of Turin , Turin , Italy
| | - Cristina Caresio
- c Biolab, Department of Electronics and Telecommunications , Politecnico di Torino , Turin , Italy
| | - Valentina D'Angelo
- d Oncological Endocrinology Unit, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Fabio Lanfranco
- a Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Lucia Ghizzoni
- a Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Silvestro Roatta
- e Department of Neuroscience , University of Turin , Turin , Italy
| | - Emanuela Arvat
- d Oncological Endocrinology Unit, Department of Medical Sciences , University of Turin , Turin , Italy
| | - Santosh Kesari
- f Department of Translational Neurosciences and Neurotherapeutics , John Wayne Cancer Institute and Pacific Neuroscience Institute , Santa Monica , CA , USA
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Minetto MA, D'Angelo V, Arvat E, Kesari S. Diagnostic work-up in steroid myopathy. Endocrine 2018; 60:219-223. [PMID: 29143179 DOI: 10.1007/s12020-017-1472-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Steroid myopathy is a well-known sign of endogenous Cushing's syndrome as well as a side effect of glucocorticoid administration. The clinical finding of muscle weakness and the clinical inspection of the muscle size are the most commonly used diagnostic tools, sometimes in combination with needle electromyography, but there are no means to detect the myopathy before the appearance of clinical or electrodiagnostic signs. Until now, no guidelines have been produced for a disease-specific evaluation of muscle impairment in patients with Cushing's syndrome. REVIEW We reviewed the measurement properties and limitations of the following tools that are currently adopted in clinical research and routine care for diagnosis and monitoring of steroid myopathy: muscle strength assessment; needle biopsy; intramuscular and surface electromyography; laboratory assays; muscle mass assessments (through bioelectrical impedance analysis, dual-energy X-ray absorptiometry, and computed tomography). CONCLUSIONS We suggest that the management of steroid myopathy patients in clinical research and practice would benefit from a multidisciplinary approach based on the combined assessment of muscle mass, strength, and performance. However, further studies are required to establish an operational definition of steroid myopathy and to identify population-specific criteria for diagnosis of the myopathic process.
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Affiliation(s)
- Marco Alessandro Minetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy.
| | - Valentina D'Angelo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Santosh Kesari
- Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute and Pacific Neuroscience Institute, Santa Monica, CA, USA
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Abstract
Glucocorticoids (GC), produced and released by the adrenal glands, regulate numerous physiological processes in a wide range of tissues. Because of their profound immunosuppressive and anti-inflammatory actions, GC are extensively used for the treatment of immune and inflammatory conditions, the management of organ transplantation, and as a component of chemotherapy regimens for cancers. However, both pathologic endogenous elevation and long-term use of exogenous GC are associated with severe adverse effects. In particular, excess GC has devastating effects on the musculoskeletal system. GC increase bone resorption and decrease formation leading to bone loss, microarchitectural deterioration and fracture. GC also induce loss of muscle mass and strength leading to an increased incidence of falls. The combined effects on bone and muscle account for the increased fracture risk with GC. This review summarizes the advance in knowledge in the last two decades about the mechanisms of action of GC in bone and muscle and the attempts to interfere with the damaging actions of GC in these tissues with the goal of developing more effective therapeutic strategies.
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Affiliation(s)
- Amy Y Sato
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, 46202
| | - Munro Peacock
- Department of Medicine, Division of Endocrinology, Indiana University School of Medicine, Indianapolis, Indiana, 46202
| | - Teresita Bellido
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, 46202.,Department of Medicine, Division of Endocrinology, Indiana University School of Medicine, Indianapolis, Indiana, 46202.,Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, 46202
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15
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Baudry S, Motta G, Botter A, Duchateau J, Minetto MA. Neural Correlates to the Increase in Maximal Force after Dexamethasone Administration. Med Sci Sports Exerc 2017; 50:218-224. [PMID: 28930864 DOI: 10.1249/mss.0000000000001425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study investigated the effects of short-term glucocorticoid administration on voluntary activation and intracortical inhibitory and facilitatory circuits. METHODS Seventeen healthy men participated in a pseudorandomized double-blind study to receive either dexamethasone (8 mg·d, n = 9 subjects) or placebo (n = 8 subjects) for 7 d. The ankle dorsiflexion torque, corresponding EMG of the tibialis anterior, and voluntary activation assessed by the interpolated twitch method using transcranial magnetic stimulation (TMS) were measured during a maximal voluntary contraction (MVC). Short-latency intracortical inhibition (SICI) and intracortical facilitation (ICF) were assessed at rest and during submaximal contraction (50% MVC torque) by paired-pulse TMS with the conditioning stimulus set at 0.8× of motor threshold and delivered 2 ms (SICI) and 13 ms (ICF) before the test stimulus (1.2× motor threshold). RESULTS The MVC torque (+14%), tibialis anterior EMG (+31%), and voluntary activation (+3%) increased after glucocorticoid treatment (P < 0.05). The increase in voluntary activation was associated with the gain in MVC torque (r = 0.56; P = 0.032). The level of SICI and the duration of the EMG silent period that followed the test TMS decreased (-18.6% and -13.5%, respectively) during the 50% MVC after treatment (P < 0.05), whereas no significant change was observed for ICF. Neither SICI nor ICF changed after treatment when assessed at rest. CONCLUSIONS Short-term dexamethasone treatment induced specific decrease in the excitability of intracortical inhibitory circuits that likely contributed to the increase in the voluntary activation and associated MVC torque.
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Affiliation(s)
- Stéphane Baudry
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, BELGIUM
| | - Giovanna Motta
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, BELGIUM
| | - Alberto Botter
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, BELGIUM
| | - Jacques Duchateau
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, BELGIUM
| | - Marco A Minetto
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, BELGIUM.,Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, BELGIUM
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16
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Ward LM, Kinnett K, Bonewald L. Proceedings of a Parent Project Muscular Dystrophy Bone Health Workshop: Morbidity due to osteoporosis in DMD: The Path Forward May 12-13, 2016, Bethesda, Maryland, USA. Neuromuscul Disord 2017; 28:64-76. [PMID: 28756052 DOI: 10.1016/j.nmd.2017.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/04/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Leanne M Ward
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Middletown, OH, USA
| | - Lynda Bonewald
- Indiana Center for Musculoskeletal Health, Departments of Anatomy and Cell Biology and Orthopaedic Surgery, Indiana University, Indianapolis, IN, USA
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Sato AY, Richardson D, Cregor M, Davis HM, Au ED, McAndrews K, Zimmers TA, Organ JM, Peacock M, Plotkin LI, Bellido T. Glucocorticoids Induce Bone and Muscle Atrophy by Tissue-Specific Mechanisms Upstream of E3 Ubiquitin Ligases. Endocrinology 2017; 158:664-677. [PMID: 28359087 PMCID: PMC5460781 DOI: 10.1210/en.2016-1779] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022]
Abstract
Glucocorticoid excess, either endogenous with diseases of the adrenal gland, stress, or aging or when administered for immunosuppression, induces bone and muscle loss, leading to osteopenia and sarcopenia. Muscle weakness increases the propensity for falling, which, combined with the lower bone mass, increases the fracture risk. The mechanisms underlying glucocorticoid-induced bone and muscle atrophy are not completely understood. We have demonstrated that the loss of bone and muscle mass, decreased bone formation, and reduced muscle strength, hallmarks of glucocorticoid excess, are accompanied by upregulation in both tissues in vivo of the atrophy-related genes atrogin1, MuRF1, and MUSA1. These are E3 ubiquitin ligases traditionally considered muscle-specific. Glucocorticoids also upregulated atrophy genes in cultured osteoblastic/osteocytic cells, in ex vivo bone organ cultures, and in muscle organ cultures and C2C12 myoblasts/myotubes. Furthermore, glucocorticoids markedly increased the expression of components of the Notch signaling pathway in muscle in vivo, ex vivo, and in vitro. In contrast, glucocorticoids did not increase Notch signaling in bone or bone cells. Moreover, the increased expression of atrophy-related genes in muscle, but not in bone, and the decreased myotube diameter induced by glucocorticoids were prevented by inhibiting Notch signaling. Thus, glucocorticoids activate different mechanisms in bone and muscle that upregulate atrophy-related genes. However, the role of these genes in the effects of glucocorticoids in bone is unknown. Nevertheless, these findings advance our knowledge of the mechanism of action of glucocorticoids in the musculoskeletal system and provide the basis for novel therapies to prevent glucocorticoid-induced atrophy of bone and muscle.
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Affiliation(s)
- Amy Y. Sato
- Department of Anatomy and Cell Biology
- Indiana Center for Musculoskeletal Health, Indianapolis, Indiana 46202
| | | | | | - Hannah M. Davis
- Department of Anatomy and Cell Biology
- Indiana Center for Musculoskeletal Health, Indianapolis, Indiana 46202
| | - Ernie D. Au
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202
- Indiana Center for Musculoskeletal Health, Indianapolis, Indiana 46202
| | - Kevin McAndrews
- Department of Anatomy and Cell Biology
- Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202
| | - Teresa A. Zimmers
- Department of Anatomy and Cell Biology
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202
- Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202
- Indiana Center for Musculoskeletal Health, Indianapolis, Indiana 46202
| | - Jason M. Organ
- Department of Anatomy and Cell Biology
- Department of Biomedical Engineering, Indiana University–Purdue University, Indianapolis, Indiana 46202; and
- Indiana Center for Musculoskeletal Health, Indianapolis, Indiana 46202
| | - Munro Peacock
- Department of Medicine, Division of Endocrinology, and
- Indiana Center for Musculoskeletal Health, Indianapolis, Indiana 46202
| | - Lilian I. Plotkin
- Department of Anatomy and Cell Biology
- Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202
- Indiana Center for Musculoskeletal Health, Indianapolis, Indiana 46202
| | - Teresita Bellido
- Department of Anatomy and Cell Biology
- Department of Medicine, Division of Endocrinology, and
- Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana 46202
- Indiana Center for Musculoskeletal Health, Indianapolis, Indiana 46202
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D'Angelo V, Beccuti G, Berardelli R, Karamouzis I, Zichi C, Giordano R, Minetto MA, Maccario M, Ghigo E, Arvat E. Cushing's syndrome is associated with sleep alterations detected by wrist actigraphy. Pituitary 2015. [PMID: 26208446 DOI: 10.1007/s11102-015-0667-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The association between the hypothalamic-pituitary-adrenal (HPA) axis and sleep is well described. It is also known that HPA axis disturbances have an effect on sleep. In fact, patients affected by Cushing's syndrome (CS) often complain about poor sleep quality. Our aim was to evaluate objective sleep quality and duration in patients with Cushing's syndrome in active phase, using wrist actigraphy. PATIENTS AND METHODS In 12 patients with active CS without ongoing specific therapy (11 F, 1 M; age 40.0 ± 10.9 years; BMI 28.4 ± 6.7 kg/m(2)) and 12 healthy control subjects (HS) (11 F, 1 M; age 44.0 ± 11.0 years; BMI 23.9 ± 4.2 kg/m(2)) an actigraphic evaluation was performed on 3 consecutive days under free living conditions. Objective measurement of sleep duration and quality was estimated by an actiwatch, which is a wristwatch-like device used to detect motor activity. RESULTS In CS patients, wrist actigraphy showed higher fragmented sleep (fragmentation index CS 16.2 ± 4.2, HS 13.0 ± 3.6; p = 0.034) and increased nocturnal motor activity (total activity score CS 8318 ± 4308, HS 4971 ± 2372; p = 0.020; mean activity score CS 8.7 ± 4.2, HS 5.4 ± 2.2; p = 0.030; mean score in active time CS 104.8 ± 39.2, HS 74.8 ± 23.1; p = 0.030). On the contrary, actual sleep time resulted similar in CS and HS. No correlation was found between sleep alterations and urinary free cortisol in patients. CONCLUSIONS The impaired actigraphic parameters described in our study suggest that hypercortisolism is associated with sleep alterations, which could contribute to the worsening of life quality and metabolic comorbidities associated with CS. These results have to be confirmed in a larger cohort of patients, using more accurate instruments for sleep assessment.
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Affiliation(s)
- Valentina D'Angelo
- Division of Oncologic Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Guglielmo Beccuti
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Rita Berardelli
- Division of Oncologic Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ioannis Karamouzis
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Clizia Zichi
- Division of Oncologic Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberta Giordano
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Marco Alessandro Minetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mauro Maccario
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Emanuela Arvat
- Division of Oncologic Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy.
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Minetto MA, Qaisar R, Agoni V, Motta G, Longa E, Miotti D, Pellegrino MA, Bottinelli R. Quantitative and qualitative adaptations of muscle fibers to glucocorticoids. Muscle Nerve 2015; 52:631-9. [PMID: 25594832 DOI: 10.1002/mus.24572] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 12/29/2014] [Accepted: 01/07/2015] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The aim of this study was to understand the effects of short-term glucocorticoid administration in healthy subjects. METHODS Five healthy men received dexamethasone (8 mg/day) for 7 days. Vastus lateralis muscle biopsy and knee extension torque measurement were performed before and after administration. A large number of individual muscle fibers were dissected from the biopsy samples (pre-administration: n = 165, post-administration: n = 177). RESULTS Maximal knee extension torque increased after administration (∼ 13%), whereas both type 1 and type 2A fibers had decreased cross-sectional area (type 1: ∼ 11%, type 2A: ∼ 17%), myosin loss (type 1: ∼ 18%, type 2A: ∼ 32%), and loss of specific force (type 1: ∼ 24%, type 2A: ∼ 33%), which were preferential for fast fibers. CONCLUSION Short-term dexamethasone administration in healthy subjects elicits quantitative and qualitative adaptations of muscle fibers that precede (and may predict) the clinical appearance of myopathy in glucocorticoid-treated subjects.
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Affiliation(s)
- Marco Alessandro Minetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Rizwan Qaisar
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Valentina Agoni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giovanna Motta
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti, 14, 10126, Turin, Italy
| | - Emanuela Longa
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Danilo Miotti
- Fondazione Salvatore Maugeri, Scientific Institute of Pavia, Pavia, Italy
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Baudry S, Lanfranco F, Merletti R, Duchateau J, Minetto MA. Effects of Short-Term Dexamethasone Administration on Corticospinal Excitability. Med Sci Sports Exerc 2014; 46:695-701. [DOI: 10.1249/mss.0000000000000162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Steroid myopathy in patients with chronic respiratory diseases. J Neurol Sci 2013; 338:96-101. [PMID: 24380687 DOI: 10.1016/j.jns.2013.12.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/19/2013] [Accepted: 12/11/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Corticosteroid-induced myopathy is a well known clinical entity, and experimental studies showed decreased rate of protein synthesis and increased rate of protein breakdown in muscles of chronically treated animals. OBJECTIVE The present observational study was aimed to evaluate skeletal muscle functions in asthmatics and patients with other chronic respiratory diseases treated by inhaled or oral corticosteroids. METHODS Thirty six patients with respiratory diseases were included into the study. The physician-rated peripheral motor deficits scale, stepper test and ankle/wrist index were used for assessment of muscle functions. The effects of length of glucocorticoids intake on muscle functions were evaluated. RESULTS Sixty five per cent of patients using corticosteroids daily during 1 year and longer reported weakness in legs, and 20% of these patients demonstrated objective signs of the muscle weakness. The performance on the stepper test was significantly worse in patients chronically using corticosteroids in comparison with the control group (10.9 ± 3.4 steps vs 16.1 ± 2.4 steps per 10s, respectively; F=21.6, p<0.001). In addition, a proportion of patients using corticosteroids for at least 18 months were characterized by muscle hypotrophy at a dominant leg. CONCLUSION Chronic intake of inhaled corticosteroids induces clinically significant decrease of muscle functions at least after 1-year of daily treatment.
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Skalsky AJ, Oskarsson B, Han JJ, Richman D. Current pharmacologic management in selected neuromuscular diseases. Phys Med Rehabil Clin N Am 2012; 23:801-20. [PMID: 23137738 DOI: 10.1016/j.pmr.2012.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
For generations, the neuromuscular disorder care community has focused on establishing the correct diagnosis and providing supportive care. As the pathophysiology and genetics of these conditions became better understood, novel treatments targeting the disease mechanism were developed. This has led to some significant disease-modifying and supportive treatments for several neuromuscular disorders. The current treatments for amyotrophic lateral sclerosis (ALS), neuromuscular junction disorders, inflammatory myopathies, and myotonia are reviewed. Additionally, investigational treatments for ALS, Duchenne muscular dystrophy, and spinal muscular atrophy are discussed.
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Affiliation(s)
- Andrew J Skalsky
- Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA 92123, USA.
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Menotti F, Bazzucchi I, Felici F, Damiani A, Gori MC, Macaluso A. Neuromuscular function after muscle fatigue in Charcot-Marie-Tooth type 1A patients. Muscle Nerve 2012; 46:434-9. [DOI: 10.1002/mus.23366] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Assessment of the electrophysiological properties of the muscle fibers of a transplanted hand. Transplantation 2011; 92:1202-7. [PMID: 21978996 DOI: 10.1097/tp.0b013e318234b31b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The muscle fibers in a transplanted hand remain denervated for a long period of time after the transplant. This prolonged inactivity may change the electrophysiological membrane properties of muscle fibers, as observed in long-term denervation. We investigated whether electrophysiological properties of the muscle fibers are preserved in a transplanted hand even after several months of denervation. Specifically, we assessed the dependence of muscle fiber conduction velocity (CV) on discharge rate in motor units of the abductor digiti minimi muscle. METHODS Surface electromyography signals were recorded from the transplanted hand of a patient who was 35 years of age at the time of the transplant. In each of 11 experimental sessions performed over a period of 23 months after the transplant, the subject was asked to linearly increase the activation or to maintain a maximum activation of the abductor digiti minimi muscle for 60 sec. Individual motor unit action potentials were identified from the electromyography recordings and muscle fiber CV was estimated for each action potential as a function of the time interval separating the action potential from the preceding discharge (interspike interval [ISI]). RESULTS The baseline (ISI >1000 msec) CV was 3.8±0.3 m/sec. CV decreased monotonically with increasing ISI (R=0.95). For ISI in the range 0 to 10 msec, muscle fiber CV was 24.9%±16.3% higher than the baseline value (P<0.05). CONCLUSIONS The results indicate that in the investigated muscle, the baseline value of CV and its dependency on discharge rate were similar as in able-bodied individuals, despite a period of several months of denervation.
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Minetto MA, Lanfranco F, Motta G, Allasia S, Arvat E, D'Antona G. Steroid myopathy: some unresolved issues. J Endocrinol Invest 2011; 34:370-5. [PMID: 21677507 DOI: 10.1007/bf03347462] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Steroid myopathy is a non-inflammatory toxic myopathy that occurs as side effect of exogenous and endogenous glucocorticoid excess. The purpose of this review is to examine issues that limit our understanding of this myopathy with respect to nosology, etiopathogenesis, conditioning factors, and muscle fiber selectivity. We suggest that if more data were available on these issues, the understanding of steroid myopathy would be enhanced substantially, thus allowing an early detection of its occurrence (before the appearance of clinical or laboratory signs) and a proper treatment of the patients.
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Affiliation(s)
- M A Minetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy.
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