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Rebalka IA, Noguchi KS, Bulyovsky KR, Badour MI, Juracic ES, Barrett K, Brahmbhatt A, Al-Khazraji B, Punthakee Z, Perry CGR, Kumbhare DA, MacDonald MJ, Hawke TJ. Targeting skeletal muscle health with exercise in people with type 1 diabetes: A protocol for HOMET1D, a prospective observational trial with matched controls. PLoS One 2024; 19:e0303448. [PMID: 38776307 PMCID: PMC11111001 DOI: 10.1371/journal.pone.0303448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Individuals with type 1 diabetes (T1D) experience a complex set of alterations to skeletal muscle metabolic, neuromuscular, and vascular health; collectively referred to as diabetic myopathy. While the full scope of diabetic myopathy is still being elucidated, evidence suggests that even when individuals with T1D are physically active, indices of myopathy still exist. As such, there is a question if adherence to current physical activity guidelines elicits improvements in skeletal muscle health indices similarly between individuals with and without T1D. The objectives of this trial are to: 1) compare baseline differences in skeletal muscle health between adults with and without T1D, 2) examine the association between participation in a home-based exercise program, detraining, and retraining, with changes in skeletal muscle health, and 3) examine the roles of age and sex on these associations. METHODS AND ANALYSIS This will be a prospective interventional trial. Younger (18-30 years) and older (45-65 years) males and females with T1D and matched individuals without T1D will engage in a four-phase, 18-week study sequentially consisting of a one-week lead-in period, 12-week exercise training program, one-week detraining period, and four-week retraining period. The exercise program will consist of aerobic and resistance exercise based on current guidelines set by Diabetes Canada. Metabolic, neuromuscular, and vascular outcome measures will be assessed four times: at baseline, post-exercise program, post-detraining, and post-retraining. Differences in baseline metrics between those with and without T1D will be examined with independent sample t-tests, and with two-way analyses of variance for age- and sex-stratified analyses. Changes across the duration of the study will be examined using mixed-model analyses. DISSEMINATION Findings from this research will be shared locally and internationally with research participants, clinicians, diabetes educators, and patient advocacy organizations via in-person presentations, social media, and scientific fora. TRIAL REGISTRATION NUMBER NCT05740514.
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Affiliation(s)
- Irena A. Rebalka
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth S. Noguchi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kayla R. Bulyovsky
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthew I. Badour
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Emma S. Juracic
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Khandra Barrett
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Aditya Brahmbhatt
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Baraa Al-Khazraji
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christopher G. R. Perry
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Dinesh A. Kumbhare
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Thomas J. Hawke
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Le T, Salas Sanchez A, Nashawi D, Kulkarni S, Prisby RD. Diabetes and the Microvasculature of the Bone and Marrow. Curr Osteoporos Rep 2024; 22:11-27. [PMID: 38198033 DOI: 10.1007/s11914-023-00841-3] [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] [Accepted: 12/04/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight the evidence of microvascular dysfunction in bone and marrow and its relation to poor skeletal outcomes in diabetes mellitus. RECENT FINDINGS Diabetes mellitus is characterized by chronic hyperglycemia, which may lead to microangiopathy and macroangiopathy. Micro- and macroangiopathy have been diagnosed in Type 1 and Type 2 diabetes, coinciding with osteopenia, osteoporosis, enhanced fracture risk and delayed fracture healing. Microangiopathy has been reported in the skeleton, correlating with reduced blood flow and perfusion, vasomotor dysfunction, microvascular rarefaction, reduced angiogenic capabilities, and augmented vascular permeability. Microangiopathy within the skeleton may be detrimental to bone and manifest as, among other clinical abnormalities, reduced mass, enhanced fracture risk, and delayed fracture healing. More investigations are required to elucidate the various mechanisms by which diabetic microvascular dysfunction impacts the skeleton.
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Affiliation(s)
- Teresa Le
- Bone Vascular and Microcirculation Laboratory, Department of Kinesiology, University of Texas at Arlington, Arlington, TX, 76019, USA
| | - Amanda Salas Sanchez
- Bone Vascular and Microcirculation Laboratory, Department of Kinesiology, University of Texas at Arlington, Arlington, TX, 76019, USA
| | - Danyah Nashawi
- Bone Vascular and Microcirculation Laboratory, Department of Kinesiology, University of Texas at Arlington, Arlington, TX, 76019, USA
| | - Sunidhi Kulkarni
- Bone Vascular and Microcirculation Laboratory, Department of Kinesiology, University of Texas at Arlington, Arlington, TX, 76019, USA
| | - Rhonda D Prisby
- Bone Vascular and Microcirculation Laboratory, Department of Kinesiology, University of Texas at Arlington, Arlington, TX, 76019, USA.
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Chen SY, Wang YW, Chen WS, Hsiao MY. Update of Contrast-enhanced Ultrasound in Musculoskeletal Medicine: Clinical Perspectives - A Review. J Med Ultrasound 2023; 31:92-100. [PMID: 37576422 PMCID: PMC10413398 DOI: 10.4103/jmu.jmu_94_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 08/15/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) uses an intravascular contrast agent to enhance blood flow signals and assess microcirculation in different parts of the human body. Over the past decade, CEUS has become more widely applied in musculoskeletal (MSK) medicine, and the current review aims to systematically summarize current research on the application of CEUS in the MSK field, focusing on 67 articles published between January 2001 and June 2021 in online databases including PubMed, Scopus, and Embase. CEUS has been widely used for the clinical assessment of muscle microcirculation, tendinopathy, fracture nonunions, sports-related injuries, arthritis, peripheral nerves, and tumors, and can serve as an objective and quantitative evaluation tool for prognosis and outcome prediction. Optimal CEUS parameters and diagnostic cut off values for each disease category remain to be confirmed.
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Affiliation(s)
- Shao-Yu Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wei Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan
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Love KM, Barrett EJ, Malin SK, Reusch JEB, Regensteiner JG, Liu Z. Diabetes pathogenesis and management: the endothelium comes of age. J Mol Cell Biol 2021; 13:500-512. [PMID: 33787922 PMCID: PMC8530521 DOI: 10.1093/jmcb/mjab024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 12/03/2022] Open
Abstract
Endothelium, acting as a barrier, protects tissues against factors that provoke insulin resistance and type 2 diabetes and itself responds to the insult of insulin resistance inducers with altered function. Endothelial insulin resistance and vascular dysfunction occur early in the evolution of insulin resistance-related disease, can co-exist with and even contribute to the development of metabolic insulin resistance, and promote vascular complications in those affected. The impact of endothelial insulin resistance and vascular dysfunction varies depending on the blood vessel size and location, resulting in decreased arterial plasticity, increased atherosclerosis and vascular resistance, and decreased tissue perfusion. Women with insulin resistance and diabetes are disproportionately impacted by cardiovascular disease, likely related to differential sex-hormone endothelium effects. Thus, reducing endothelial insulin resistance and improving endothelial function in the conduit arteries may reduce atherosclerotic complications, in the resistance arteries lead to better blood pressure control, and in the microvasculature lead to less microvascular complications and more effective tissue perfusion. Multiple diabetes therapeutic modalities, including medications and exercise training, improve endothelial insulin action and vascular function. This action may delay the onset of type 2 diabetes and/or its complications, making the vascular endothelium an attractive therapeutic target for type 2 diabetes and potentially type 1 diabetes.
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MESH Headings
- Age Factors
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/ethnology
- Cardiovascular Diseases/metabolism
- Cardiovascular Diseases/physiopathology
- Comorbidity
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/physiopathology
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Exercise
- Female
- Humans
- Hypoglycemic Agents/pharmacology
- Hypoglycemic Agents/therapeutic use
- Insulin Resistance
- Male
- Racial Groups
- Risk Factors
- Sex Factors
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Affiliation(s)
- Kaitlin M Love
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Eugene J Barrett
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Steven K Malin
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA
- Division of Endocrinology, Metabolism and Nutrition, Rutgers University, New Brunswick, NJ, USA
- New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ, USA
- Institute of Translational Medicine and Research, Rutgers University, New Brunswick, NJ, USA
| | - Jane E B Reusch
- Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Judith G Regensteiner
- Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Zhenqi Liu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
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Souza-Silva E, Ascenso R, Tonussi CR, da Silva-Santos JE. Detection of blood flow perfusion and post - occlusive reactive hyperemia in the skeletal muscle of rats. Life Sci 2021; 278:119571. [PMID: 33961851 DOI: 10.1016/j.lfs.2021.119571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
AIMS Post-occlusive reactive hyperemia (PORH) remains poorly understood in the skeletal muscle system. This study was designed to validate an alternative strategy of PORH detection in rodents. Additionally, we explored the hypothesis that PORH is influenced by experimental models associated with impaired function of the skeletal muscle. MATERIALS AND METHODS Wistar rats were anesthetized, and blood flow was assessed by laser Doppler in the anterior tibialis muscle, before and immediately after 5 s, 30 s, 3 min, or 5 min of flow occlusion, obtained through a cuff inflated to 300 mmHg around the thigh of the animals. KEY FINDINGS In healthy animals, deflating the cuff resulted in a fast increment of local blood flow, characterizing the PORH after 5 s to 5 min of cuff occlusion and its dependence on flow occlusion duration. Importantly, we found different profiles of PORH in animals pretreated with reserpine (accelerated peak and reduced half recovery time), streptozotocin (increased peak), or subjected to muscle contraction in stretching (delayed peak), approaches used as experimental models to study fibromyalgia, type II diabetes mellitus, and soreness induced by unaccustomed eccentric exercise, respectively. SIGNIFICANCE We demonstrated that the profile of PORH in the anterior tibialis muscle of rats is sensitive to a variety of experimental models often associated with the skeletal muscle functionality, providing a useful strategy to explore how and whether changes in local regulation of blood flow can contribute to the development of skeletal muscle associated symptoms in clinically relevant conditions.
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Affiliation(s)
- Eduardo Souza-Silva
- Laboratory of Cardiovascular Biology and Department of Pharmacology, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88049-970 Florianópolis, Santa Catarina, Brazil; Laboratory of Neurobiology of Nociception, Department of Pharmacology, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88049-970 Florianópolis, Santa Catarina, Brazil.
| | - Ruy Ascenso
- Laboratory of Cardiovascular Biology and Department of Pharmacology, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88049-970 Florianópolis, Santa Catarina, Brazil
| | - Carlos Rogério Tonussi
- Laboratory of Neurobiology of Nociception, Department of Pharmacology, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88049-970 Florianópolis, Santa Catarina, Brazil
| | - José Eduardo da Silva-Santos
- Laboratory of Cardiovascular Biology and Department of Pharmacology, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88049-970 Florianópolis, Santa Catarina, Brazil.
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Liu B, Hu L, Wang L, Xing D, Peng L, Chen P, Zeng F, Liu WV, Liu H, Zha Y. Evaluation of microvascular permeability of skeletal muscle and texture analysis based on DCE-MRI in alloxan-induced diabetic rabbits. Eur Radiol 2021; 31:5669-5679. [PMID: 33547478 DOI: 10.1007/s00330-021-07705-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 11/24/2020] [Accepted: 01/21/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To estimate the microvascular permeability and perfusion of skeletal muscle by using quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and explore the feasibility of using texture analysis (TA) to evaluate subtle structural changes of diabetic muscles. METHODS Twenty-four rabbits were randomly divided into diabetic (n = 14) and control (n = 10) groups, and underwent axial DCE-MRI of the multifidus muscle (0, 4, 8, 12, and 16 weeks after alloxan injection). The pharmacokinetic model was used to calculate the permeability parameters; texture parameters were extracted from volume transfer constant (Ktrans) map. The two-sample t test/Mann-Whitney U test, repeated measures analysis of variance/Friedman test, and Pearson correlations were used for data analysis. RESULTS In the diabetic group, Ktrans and rate constant (Kep) increased significantly at week 8 and then showed a decreasing trend. Extravascular extracellular space volume fraction (Ve) increased and plasma volume fraction (Vp) decreased significantly from the 8th week. Skewness began to decrease at the 4th week. Median Ktrans and entropy increased significantly, while inverse difference moment decreased from the 8th week. Energy decreased while contrast increased only at week 8. Muscle fibre cross-sectional area was negatively correlated with Ve. The capillary-to-fibre ratio was positively correlated with Vp (p < 0.05, all). CONCLUSIONS Quantitative DCE-MRI can be used to evaluate microvascular permeability and perfusion in diabetic skeletal muscle at an early stage; TA based on Ktrans map can identify microarchitectural modifications in diabetic muscles. KEY POINTS • Four quantitative parameters of DCE-MRI can be used to evaluate microvascular permeability and perfusion of skeletal muscle in diabetic models at early stages. • Texture analysis based on Ktrans map can identify subtle structural changes in diabetic muscles.
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Affiliation(s)
- Baiyu Liu
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Lei Hu
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Li Wang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Dong Xing
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Lin Peng
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Pianpian Chen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Feifei Zeng
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | | | - Huan Liu
- GE Healthcare, Shanghai, 201203, China
| | - Yunfei Zha
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Young GM, Krastins D, Chang D, Lam J, Quah J, Stanton T, Russell F, Greaves K, Kriel Y, Askew CD. Influence of cuff‐occlusion duration on contrast‐enhanced ultrasound assessments of calf muscle microvascular blood flow responsiveness in older adults. Exp Physiol 2020; 105:2238-2245. [DOI: 10.1113/ep089065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Grace Marie Young
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Sunshine Coast Hospital and Health Service Sunshine Coast Health Institute Birtinya Queensland Australia
| | - Digby Krastins
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Sunshine Coast Hospital and Health Service Sunshine Coast Health Institute Birtinya Queensland Australia
| | - David Chang
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Jeng Lam
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Jing Quah
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Tony Stanton
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Fraser Russell
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
| | - Kim Greaves
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
| | - Yuri Kriel
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
| | - Christopher David Askew
- VasoActive Research Group School of Health and Sport Sciences University of the Sunshine Coast Sippy Downs Queensland Australia
- Sunshine Coast Hospital and Health Service Sunshine Coast Health Institute Birtinya Queensland Australia
- Department of Cardiac Services Sunshine Coast Hospital and Health Service Birtinya Queensland Australia
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8
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Orlando G, Sacchetti M, D'Errico V, Haxhi J, Rapisarda G, Pugliese G, Balducci S. Muscle fatigability in patients with type 2 diabetes: relation with long-term complications. Diabetes Metab Res Rev 2020; 36:e3231. [PMID: 31670895 DOI: 10.1002/dmrr.3231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/27/2019] [Accepted: 10/13/2019] [Indexed: 12/20/2022]
Abstract
AIMS It is unclear whether long-term complications play a role in muscle fatigue characteristic of patients with type 2 diabetes mellitus (T2DM). The purpose of this study was to investigate the association between muscle fatigability and microvascular and macrovascular complications in patients with T2DM. METHODS One-hundred forty-six patients with T2DM (80 males, 66 females, aged 66.9 ± 7.9 years) were recruited. Maximal voluntary contraction (MCV) and endurance time (ET, 50% of the MVC) were assessed at the knee extensor muscles with an isometric dynamometer. Univariate and multivariate correlations of ET values with diabetic complications, a wide range of surrogate measures of these sequelae, and cardiovascular risk factors were examined. RESULTS A higher muscle fatigability was detected in patients with diabetic peripheral neuropathy (DPN, ET: -32.4%), cardiovascular disease (CVD, ET: -32.1%), retinopathy (ET: -35.8%), and nephropathy (ET: -30.4%). At univariate analysis, muscle fatigability was associated with age, physical activity level, diabetes duration, HbA1c , systolic blood pressure, albuminuria, eGFR, and several parameters of nervous and vascular function. Multivariate analysis showed that, after adjusting for covariates, ET was independently associated with sensory nerve conduction velocity, vibration perception threshold at malleolus, and ankle-brachial index. In addition, ET values were independently associated with the presence of DPN, CVD, and retinopathy. CONCLUSIONS In T2DM, muscle fatigability is associated with presence of DPN, CVD, and retinopathy. Such defect appears to be mediated predominantly by sensory nerve and peripheral vascular dysfunction.
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Affiliation(s)
- Giorgio Orlando
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, La Sapienza University, and Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Gianvito Rapisarda
- Department of Clinical and Molecular Medicine, La Sapienza University, and Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, La Sapienza University, and Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Stefano Balducci
- Department of Clinical and Molecular Medicine, La Sapienza University, and Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
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Irace C, Cutruzzolà A, Parise M, Fiorentino R, Frazzetto M, Gnasso C, Casciaro F, Gnasso A. Effect of empagliflozin on brachial artery shear stress and endothelial function in subjects with type 2 diabetes: Results from an exploratory study. Diab Vasc Dis Res 2020; 17:1479164119883540. [PMID: 31726866 PMCID: PMC7510381 DOI: 10.1177/1479164119883540] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Empagliflozin reduces the risk of cardiovascular mortality in subjects with type 2 diabetes. We demonstrated that empagliflozin increases blood viscosity and carotid shear stress and decreases carotid wall thickness. Shear stress is the force acting on the endothelial surface and modulates arterial function. The current study evaluates the influence of empagliflozin on brachial artery shear stress and endothelial function compared to incretin-based therapy. The study is a nonrandomized, open, prospective cohort study including 35 subjects with type 2 diabetes administered empagliflozin or incretin-based therapy. Shear stress was calculated with a validated formula, and endothelial function was evaluated using the flow-mediated dilation technique. Both treatments resulted in comparable reductions in blood glucose and glycated haemoglobin. Brachial artery shear stress significantly increased exclusively in the empagliflozin group (61 ± 20 vs 68 ± 25 dynes/cm2, p = 0.04), whereas no significant difference was detected in the incretin-based therapy group (60 ± 20 vs 55 ± 12 dynes/cm2, p = not significant). Flow-mediated dilation significantly increased in the empagliflozin group (4.8 ± 4.5% vs 8.5 ± 5.6%, p = 0.03). Again, no change was detected in the incretin-based therapy group (5.1 ± 4.5% vs 4.7 ± 4.7%, p = not significant). The present findings demonstrate the beneficial effect of empagliflozin on shear stress and endothelial function in subjects with type 2 diabetes independent of the hypoglycaemic effect.
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Affiliation(s)
- Concetta Irace
- Department of Health Science, Magna
Græcia University, Catanzaro, Italy
- Concetta Irace, Department of Health
Science, Magna Græcia University, 88100 Catanzaro, Italy.
| | | | - Martina Parise
- Department of Clinical and Experimental
Medicine, Magna Græcia University, Catanzaro, Italy
| | | | - Marco Frazzetto
- School of Medicine, Magna Græcia
University, Catanzaro, Italy
| | - Chiara Gnasso
- School of Medicine, Magna Græcia
University, Catanzaro, Italy
| | | | - Agostino Gnasso
- Department of Clinical and Experimental
Medicine, Magna Græcia University, Catanzaro, Italy
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Supplementary Nitric Oxide Donors and Exercise as Potential Means to Improve Vascular Health in People with Type 1 Diabetes: Yes to NO? Nutrients 2019; 11:nu11071571. [PMID: 31336832 PMCID: PMC6682901 DOI: 10.3390/nu11071571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/26/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022] Open
Abstract
Type 1 diabetes (T1D) is associated with a greater occurrence of cardiovascular pathologies. Vascular dysfunction has been shown at the level of the endothelial layers and failure to maintain a continuous pool of circulating nitric oxide (NO) has been implicated in the progression of poor vascular health. Biochemically, NO can be produced via two distinct yet inter-related pathways that involve an upregulation in the enzymatic activity of nitric oxide synthase (NOS). These pathways can be split into an endogenous oxygen-dependent pathway i.e., the catabolism of the amino acid L-arginine to L-citrulline concurrently yielding NO in the process, and an exogenous oxygen-independent one i.e., the conversion of exogenous inorganic nitrate to nitrite and subsequently NO in a stepwise fashion. Although a body of research has explored the vascular responses to exercise and/or compounds known to stimulate NOS and subsequently NO production, there is little research applying these findings to individuals with T1D, for whom preventative strategies that alleviate or at least temper vascular pathologies are critical foci for long-term risk mitigation. This review addresses the proposed mechanisms responsible for vascular dysfunction, before exploring the potential mechanisms by which exercise, and two supplementary NO donors may provide vascular benefits in T1D.
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11
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Chen LL, Zhai JX, Kang J, Li YS. Utility of Contrast-Enhanced Ultrasound for the Assessment of Skeletal Muscle Perfusion in Diabetes Mellitus: A Meta-Analysis. Med Sci Monit 2019; 25:4535-4543. [PMID: 31211767 PMCID: PMC6597144 DOI: 10.12659/msm.915252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study evaluated the effectiveness of contrast-enhanced ultrasonography for the assessment of skeletal muscle perfusion in diabetes mellites. MATERIAL AND METHODS Electronic databases (Embase, Google Scholar, Ovid, and PubMed) were searched for required articles, and studies were selected by following pre-determined eligibility criteria. Meta-analyses of mean differences or standardized mean differences (SMD) were performed to evaluate the significance of difference in contrast-enhanced ultrasonography measured muscle perfusion indices between patients with diabetes and healthy individuals or between basal and final values of perfusion indices after insulin manipulation or physical exercise in patients with diabetes or healthy individuals. RESULTS There were 15 studies included, with 279 patients with diabetes and 230 healthy individuals in total. The age of the study patients with diabetes mellitus was 55.8 years (95% CI: 49.6 years, 61.9 years) and these patients had disease for 11.4 years (95% CI: 7.7 years, 15.1 years). The percentage of males in group of patients with diabetes was 66% (95% CI: 49%, 84%), body mass index was 29.4 kg/m² (95% CI: 26.5 kg/m², 32.3 kg/m²), hemoglobin A1c was 7.3% (95% CI: 6.7%, 7.9%), and fasting plasma glucose was 149 kg/m² (95% CI: 118 kg/m², 179 kg/m²). Time to peak intensity after provocation was significantly higher in patients with diabetes than in healthy individuals (SMD 1.18 [95% CI: 0.60, 1.76]; P<0.00001). In patients with diabetes, insulin administration did not improve contrast-enhanced ultrasonography measured muscle perfusion indices but exercise improved muscle perfusion but at a level that was statistically non-significant (SMD between basal and post-exercise values (1.03 [95% CI: -0.14, 2.20]; P=0.08). In healthy individuals, lipids in addition to insulin administration was associated with significantly reduced blood volume and blood flow. CONCLUSIONS Our review showed that the use of contrast-enhanced ultrasonography showed that diabetes mellitus was associated with altered muscle perfusion in which insulin-mediated metabolic changes played an important role.
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Affiliation(s)
- Lin-Lin Chen
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Jun-Xiu Zhai
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - Jie Kang
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
| | - You-Shan Li
- Department of Ultrasound, Dong Zhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (mainland)
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Ichinose M, Nakabayashi M, Ono Y. Sympathoexcitation constrains vasodilation in the human skeletal muscle microvasculature during postocclusive reactive hyperemia. Am J Physiol Heart Circ Physiol 2018; 315:H242-H253. [DOI: 10.1152/ajpheart.00010.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We used diffuse correlation spectroscopy to investigate sympathetic vasoconstriction, local vasodilation, and integration of these two responses in the skeletal muscle microvasculature of 20 healthy volunteers. Diffuse correlation spectroscopy probes were placed on the flexor carpi radialis muscle or vastus lateralis muscle, and a blood flow index was derived continuously. We measured hemodynamic responses during sympathoexcitation induced by forehead cooling, after which the effects of the increased sympathetic tone on vasodilatory responses during postocclusive reactive hyperemia (PORH) were examined. PORH was induced by releasing arterial occlusion (3 min) in an arm or leg. To increase sympathetic tone during PORH, forehead cooling was begun 60 s before the occlusion release and ended 60 s after the release. During forehead cooling, mean arterial pressure rose significantly and was sustained at an elevated level. Significant vasoconstriction and decreases in blood flow index followed by gradual blunting of the vasoconstriction also occurred. The time course of these responses is in good agreement with previous observations in animals. The acute sympathoexcitation diminished the peak vasodilation during PORH only in the vastus lateralis muscle, but it hastened the decline in vasodilation after the peak in both the flexor carpi radialis muscle and vastus lateralis muscle. Consequently, the total vasodilatory response assessed as the area of the vascular conductance during the first minute of PORH was significantly diminished in both regions. We conclude that, in humans, the integrated effects of sympathetic vasoconstriction and local vasodilation have an important role in vascular regulation and control of perfusion in the skeletal muscle microcirculation. NEW & NOTEWORTHY We used diffuse correlation spectroscopy to demonstrate that acute sympathoexcitation constrains local vasodilation in the human skeletal muscle microvasculature during postocclusive reactive hyperemia. This finding indicates that integration of sympathetic vasoconstriction and local vasodilation is importantly involved in vascular regulation and the control of perfusion of the skeletal muscle microcirculation in humans.
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Affiliation(s)
- Masashi Ichinose
- Human Integrative Physiology Laboratory, School of Business Administration, Meiji University, Tokyo, Japan
| | - Mikie Nakabayashi
- Graduate School of Science and Technology, Meiji University, Kanagawa, Japan
| | - Yumie Ono
- Department of Electronics and Bioinformatics, School of Science and Technology, Meiji University, Kanagawa, Japan
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