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Ravara B, Giuriati W, Zampieri S, Kern H, Pond AL. Translational mobility medicine and ugo carraro: a life of significant scientific contributions reviewed in celebration. Neurol Res 2024; 46:139-156. [PMID: 38043115 DOI: 10.1080/01616412.2023.2258041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 09/04/2023] [Indexed: 12/05/2023]
Abstract
Prof. Ugo Carraro reached 80 years of age on 23 February 2023, and we wish to celebrate him and his work by reviewing his lifetime of scientific achievements in Translational Myology. Currently, he is a Senior Scholar with the University of Padova, Italy, where, as a tenured faculty member, he founded the Interdepartmental Research Center of Myology. Prof. Carraro, a pioneer in skeletal muscle research, is a world-class expert in structural and molecular investigations of skeletal muscle biology, physiology, pathology, and care. An authority in bidimensional gel electrophoresis for myosin light chains, he was the first to separate mammalian muscle myosin heavy chain isoforms by SDS-gel electrophoresis. He has demonstrated that long-term denervated muscle can survive denervation by myofiber regeneration, and shown that an athletic lifestyle has beneficial impacts on muscle reinnervation. He has utilized his expertise in translational myology to develop and validate rehabilitative treatments for denervated and ageing skeletal muscle. He has authored more than 160 PubMed listed papers and numerous scholarly books, including his recent autobiography. Prof. Carraro founded and serves as Editor-in-Chief of the European Journal of Translational Myology and Mobility Medicine. He has organized more than 40 Padua Muscle Days Meetings and continues this, encouraging students and young scientists to participate. As he dreams endlessly, he is currently validating non-invasive analyses on saliva, a promising approach that will allow increased frequency sampling to analyze systemic factors during the transient effects of training and rehabilitation by his proposed Full-Body in- Bed Gym for bed-ridden elderly.
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Affiliation(s)
- Barbara Ravara
- Department of Biomedical Sciences (DSB), University of Padova, Padua, Italy
- CIR-Myo Interdepartmental Research Center of Myology, University of Padova, Padua, Italy
| | - Walter Giuriati
- Department of Biomedical Sciences (DSB), University of Padova, Padua, Italy
- CIR-Myo Interdepartmental Research Center of Myology, University of Padova, Padua, Italy
| | - Sandra Zampieri
- Department of Biomedical Sciences (DSB), University of Padova, Padua, Italy
- CIR-Myo Interdepartmental Research Center of Myology, University of Padova, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology Sciences, Padua University Hospital, Padua, Italy
| | - Helmut Kern
- Physiko- und Rheumatherapie, Ludwig Boltzmann Institute for Rehabilitation Research, Sankt Pölten, Austria
| | - Amber L Pond
- Anatomy Department, Southern Illinois University School of Medicine, Carbondale, IL 62901, USA
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Carraro U, Boncompagni S, Gobbo V, Rossini K, Zampieri S, Mosole S, Ravara B, Nori A, Stramare R, Ambrosio F, Piccione F, Masiero S, Vindigni V, Gargiulo P, Protasi F, Kern H, Pond A, Marcante A. Persistent Muscle Fiber Regeneration in Long Term Denervation. Past, Present, Future. Eur J Transl Myol 2015; 25:4832. [PMID: 26913148 PMCID: PMC4383182 DOI: 10.4081/ejtm.2015.4832] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/14/2015] [Accepted: 01/13/2015] [Indexed: 01/21/2023] Open
Abstract
Despite the ravages of long term denervation there is structural and ultrastructural evidence for survival of muscle fibers in mammals, with some fibers surviving at least ten months in rodents and 3-6 years in humans. Further, in rodents there is evidence that muscle fibers may regenerate even after repeated damage in the absence of the nerve, and that this potential is maintained for several months after denervation. While in animal models permanently denervated muscle sooner or later loses the ability to contract, the muscles may maintain their size and ability to function if electrically stimulated soon after denervation. Whether in mammals, humans included, this is a result of persistent de novo formation of muscle fibers is an open issue we would like to explore in this review. During the past decade, we have studied muscle biopsies from the quadriceps muscle of Spinal Cord Injury (SCI) patients suffering with Conus and Cauda Equina syndrome, a condition that fully and irreversibly disconnects skeletal muscle fibers from their damaged innervating motor neurons. We have demonstrated that human denervated muscle fibers survive years of denervation and can be rescued from severe atrophy by home-based Functional Electrical Stimulation (h-bFES). Using immunohistochemistry with both non-stimulated and the h-bFES stimulated human muscle biopsies, we have observed the persistent presence of muscle fibers which are positive to labeling by an antibody which specifically recognizes the embryonic myosin heavy chain (MHCemb). Relative to the total number of fibers present, only a small percentage of these MHCemb positive fibers are detected, suggesting that they are regenerating muscle fibers and not pre-existing myofibers re-expressing embryonic isoforms. Although embryonic isoforms of acetylcholine receptors are known to be re-expressed and to spread from the end-plate to the sarcolemma of muscle fibers in early phases of muscle denervation, we suggest that the MHCemb positive muscle fibers we observe result from the activation, proliferation and fusion of satellite cells, the myogenic precursors present under the basal lamina of the muscle fibers. Using morphological features and molecular biomarkers, we show that severely atrophic muscle fibers, with a peculiar cluster reorganization of myonuclei, are present in rodent muscle seven-months after neurectomy and in human muscles 30-months after complete Conus-Cauda Equina Syndrome and that these are structurally distinct from early myotubes. Beyond reviewing evidence from rodent and human studies, we add some ultrastructural evidence of muscle fiber regeneration in long-term denervated human muscles and discuss the options to substantially increase the regenerative potential of severely denervated human muscles not having been treated with h-bFES. Some of the mandatory procedures, are ready to be translated from animal experiments to clinical studies to meet the needs of persons with long-term irreversible muscle denervation. An European Project, the trial Rise4EU (Rise for You, a personalized treatment for recovery of function of denervated muscle in long-term stable SCI) will hopefully follow.
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Affiliation(s)
- Ugo Carraro
- Department of Neurorehabilitation, Foundation San Camillo Hospital, I.R.C.C.S., Venice, Italy
| | - Simona Boncompagni
- CeSI, Center for Research on Aging, Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti, Italy
| | - Valerio Gobbo
- C.N.R. Institute of Neuroscience, Department of Biomedical Science, University of Padova, Italy
| | - Katia Rossini
- Translational Myology, Interdepartmental Research Center of Myology of the University of Padova CIR-Myo, Department of Biomedical Science, Padova, Italy
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
| | - Sandra Zampieri
- Translational Myology, Interdepartmental Research Center of Myology of the University of Padova CIR-Myo, Department of Biomedical Science, Padova, Italy
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
| | - Simone Mosole
- Translational Myology, Interdepartmental Research Center of Myology of the University of Padova CIR-Myo, Department of Biomedical Science, Padova, Italy
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
| | - Barbara Ravara
- Translational Myology, Interdepartmental Research Center of Myology of the University of Padova CIR-Myo, Department of Biomedical Science, Padova, Italy
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
| | - Alessandra Nori
- Translational Myology, Interdepartmental Research Center of Myology of the University of Padova CIR-Myo, Department of Biomedical Science, Padova, Italy
| | - Roberto Stramare
- CIR-Myo, Department of Medicine, Radiology Unit, University of Padova, Italy
| | - Francesco Ambrosio
- Antalgic Laboratory, Department of Medicine, University of Padova, Italy
| | - Francesco Piccione
- Department of Neurorehabilitation, Foundation San Camillo Hospital, I.R.C.C.S., Venice, Italy
| | - Stefano Masiero
- CIR-Myo, Department of Neuroscience, Rehabilitation Unit, University of Padova, Italy
| | - Vincenzo Vindigni
- CIR-Myo, Department of Neuroscience, Plastic Surgery Unit, University of Padova, Italy
| | - Paolo Gargiulo
- Department of Science, Education, Innovation, Landspitali University Hospital, Reykjavik, Iceland
| | - Feliciano Protasi
- CeSI, Center for Research on Aging, Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti, Italy
| | - Helmut Kern
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
- Department of Physical Medicine, Wilhelminenspital, Vienna, Austria
| | - Amber Pond
- Anatomy Department, Southern Illinois University, School of Medicine, Carbondale, Illinois, USA
| | - Andrea Marcante
- Department of Neurorehabilitation, Foundation San Camillo Hospital, I.R.C.C.S., Venice, Italy
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Pond A, Marcante A, Zanato R, Martino L, Stramare R, Vindigni V, Zampieri S, Hofer C, Kern H, Masiero S, Piccione F. History, Mechanisms and Clinical Value of Fibrillation Analyses in Muscle Denervation and Reinnervation by Single Fiber Electromyography and Dynamic Echomyography. Eur J Transl Myol 2014; 24:3297. [PMID: 26913128 PMCID: PMC4749004 DOI: 10.4081/ejtm.2014.3297] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This work reviews history, current clinical relevance and future of fibrillation, a functional marker of skeletal muscle denervated fibers. Fibrillations, i.e., spontaneous contraction, in denervated muscle were first described during the nineteenth century. It is known that alterations in membrane potential are responsible for the phenomenon and that they are related to changes in electrophysiological factors, cellular metabolism, cell turnover and gene expression. They are known to inhibit muscle atrophy to some degree and are used to diagnose neural injury and reinnervation that are occurring in patients. Electromyography (EMG) is useful in determining progress, prognosis and efficacy of therapeutic interventions and their eventual change. For patients with peripheral nerve injury, and thus without the option of volitional contractions, electrical muscle stimulation may be helpful in preserving the contractility and extensibility of denervated muscle tissue and in retarding/counteracting muscle atrophy. It is obvious from the paucity of recent literature that research in this area has declined over the years. This is likely a consequence of the decrease in funding available for research and the fact that the fibrillations do not appear to cause serious health issues. Nonetheless, further exploration of them as diagnostic tools in long-term denervation is merited, in particular if Single Fiber EMG (SFEMG) is combined with Dynamic Echomyography (DyEM), an Ultra Sound muscle approach we recently designed and developed to explore denervated and reinnervating muscles.
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Affiliation(s)
- Amber Pond
- Anatomy Department, Southern Illinois University School of Medicine, Carbondale, IL USA
| | - Andrea Marcante
- CIR-Myo, Rehabilitation and Physical Medicine Unit, Department of Neurosciences, University of Padova, Italy
| | - Riccardo Zanato
- CIR-Myo, Radiology, Department of Medicine, University of Padova, Italy
| | - Leonora Martino
- CIR-Myo, Radiology, Department of Medicine, University of Padova, Italy
| | - Roberto Stramare
- CIR-Myo, Radiology, Department of Medicine, University of Padova, Italy
| | - Vincenzo Vindigni
- CIR-Myo, Plastic Surgery, Department of Neuroscience, University of Padova, Italy
| | | | - Christian Hofer
- Ludwig Boltzmann Institute of Electrical Stimulation and Physical Rehabilitation, Vienna, Austria
| | | | - Stefano Masiero
- CIR-Myo, Rehabilitation and Physical Medicine Unit, Department of Neurosciences, University of Padova, Italy
| | - Francesco Piccione
- Clinical Neurophysiology, San Camillo Hospital I.R.C.C.S., Venezia-Lido, Italy
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Kern H, Carraro U. Home-Based Functional Electrical Stimulation for Long-Term Denervated Human Muscle: History, Basics, Results and Perspectives of the Vienna Rehabilitation Strategy. Eur J Transl Myol 2014; 24:3296. [PMID: 26913127 PMCID: PMC4749003 DOI: 10.4081/ejtm.2014.3296] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We will here discuss the following points related to Home-based Functional Electrical Stimulation (h-b FES) as treatment for patients with permanently denervated muscles in their legs: 1. Upper (UMN) and lower motor neuron (LMN) damage to the lower spinal cord; 2. Muscle atrophy/hypertrophy versus processes of degeneration, regeneration, and recovery; 3. Recovery of twitch- and tetanic-contractility by h-b FES; 4. Clinical effects of h-b FES using the protocol of the "Vienna School"; 5. Limitations and perspectives. Arguments in favor of using the Vienna protocol include: 1. Increased muscle size in both legs; 2. Improved tetanic force production after 3-5 months of percutaneous stimulation using long stimulus pulses (> 100 msec) of high amplitude (> 80 mAmp), tolerated only in patients with no pain sensibility; 3. Histological and electron microscopic evidence that two years of h-b FES return muscle fibers to a state typical of two weeks denervated muscles with respect to atrophy, disrupted myofibrillar structure, and disorganized Excitation-Contraction Coupling (E-CC) structures; 4. The excitability never recovers to that typical of normal or reinnervated muscles where pulses less than 1 msec in duration and 25 mAmp in intensity excite axons and thereby muscle fibres. It is important to motivate these patients for chronic stimulation throughout life, preferably standing up against the load of the body weight rather than sitting. Only younger and low weight patients can expect to be able to stand-up and do some steps more or less independently. Some patients like to maintain the h-b FES training for decades. Limitations of the procedure are obvious, in part related to the use of multiple, large surface electrodes and the amount of time patients are willing to use for such muscle training.
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Affiliation(s)
| | - Ugo Carraro
- CIR-Myo Translational Myology Lab, Department of Biomedical Sciences, University of Padova, Italy
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