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Michel CP, Messonnier LA, Giannesini B, Vilmen C, Sourdon J, Le Fur Y, Bendahan D. Endurance training and hydroxyurea have synergistic effects on muscle function and energetics in sickle cell disease mice. Blood Cells Mol Dis 2024; 107:102853. [PMID: 38574498 DOI: 10.1016/j.bcmd.2024.102853] [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: 02/20/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
Sickle cell disease (SCD) is an hemoglobinopathy resulting in the production of an abnormal Hb (HbS) which can polymerize in deoxygenated conditions, leading to the sickling of red blood cells (RBC). These alterations can decrease the oxygen-carrying capacity leading to impaired function and energetics of skeletal muscle. Any strategy which could reverse the corresponding defects could be of interest. In SCD, endurance training is known to improve multiples muscle properties which restores patient's exercise capacity but present reduced effects in anemic patients. Hydroxyurea (HU) can increase fetal hemoglobin production which can reduce anemia in patients. The present study was conducted to determine whether HU can improve the effects of endurance training to improve muscle function and energetics. Twenty SCD Townes mice have been trained for 8 weeks with (n = 11) or without (n = 9) HU. SCD mice muscle function and energetics were analyzed during a standardized rest-exercise-recovery protocol, using Phosphorus-31 Magnetic resonance spectroscopy (31P-MRS) and transcutaneous stimulation. The combination of training and HU specifically decreased fatigue index and PCr consumption while muscle oxidative capacity was improved. These results illustrate the potential synergistic effects of endurance training and HU on muscle function and energetics in sickle cell disease.
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Affiliation(s)
| | - Laurent A Messonnier
- Université Savoie Mont Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité EA7424, Chambéry, France; Institut universitaire de France (IUF), France
| | | | | | - Joevin Sourdon
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France
| | - Yann Le Fur
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France
| | - David Bendahan
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France
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Ho S, Rock K, Marchese V. Diaphragm excursion correlates with performance and ventilation on the 6-min walk test in children with sickle cell disease. Pediatr Pulmonol 2023; 58:1665-1673. [PMID: 36843306 DOI: 10.1002/ppul.26373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Diaphragm function may be impaired in children with sickle cell disease (SCD). We hypothesized that diaphragm function is related to performance and ventilation on the 6-min walk test (6MWT). METHODS Respiratory muscle testing, diaphragm ultrasonography, and the 6MWT with portable gas analysis were performed on children with SCD and age- and sex-matched controls. RESULTS Fourteen children with SCD were enrolled. Comparisons were made between nine children with SCD (9.89 ± $\pm $ 2.93 years) and nine controls (10.33 ± $\pm $ 2.35 years). Diaphragm thickness at total lung capacity, thickening fraction, and excursion time during quiet breaths and deep breaths (DB), all normalized by forced vital capacity, were greater in children with SCD ( p < $p\lt $ 0.05 for all). 6MWT distance was shorter in children with SCD (450.87 ± $\pm $ 74.2 m vs. 579.22 ± $\pm $ 72.46 m, p = $p=$ 0.01). Tidal volume ( V T ${V}_{T}$ ), minute ventilation ( V ˙ E ${\dot{V}}_{E}$ ), and oxygen consumption ( V ˙ O 2 ${\dot{V}}_{{O}_{2}}$ ) were also lower ( p < $p\lt $ 0.05 for all). DB excursion correlated positively with 6MWT distance ( r = $r=$ 0.648, p = $p=$ 0.023) and negatively with rate of perceived exertion (RPE) ( r = $r=$ -0.759, p = $p=$ 0.003). RPE correlated negatively with distance ( r = $r=$ -0.680, p = $p=$ 0.015). DB excursion time correlated positively with distance ( r = $r=$ 0.611, p = $p=$ 0.035), V T ${V}_{T}$ ( r = $r=$ 0.770, p = $p=$ 0.009), V ˙ E ${\dot{V}}_{E}$ ( r = $r=$ 0.736, p = $p=$ 0.015), and V ˙ O 2 ${\dot{V}}_{{O}_{2}}$ ( r = $r=$ 0.751, p = $p=$ 0.012). CONCLUSIONS Increased diaphragm excursion may be a strategy used to relieve air hunger while longer excursion time may reflect compensations to increase lung recruitment. Further studies are needed to better understand how these mechanisms affect exercise tolerance in children with SCD.
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Affiliation(s)
- Simon Ho
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kelly Rock
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Michel CP, Bendahan D, Giannesini B, Vilmen C, Le Fur Y, Messonnier LA. Effects of hydroxyurea on skeletal muscle energetics and force production in a sickle cell disease murine model. J Appl Physiol (1985) 2023; 134:415-425. [PMID: 36603048 DOI: 10.1152/japplphysiol.00333.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Hydroxyurea (HU) is commonly used as a treatment for patients with sickle cell disease (SCD) to enhance fetal hemoglobin production. This increased production is expected to reduce anemia (which depresses oxygen transport) and abnormal Hb content alleviating clinical symptoms such as vaso-occlusive crisis and acute chest syndrome. The effects of HU on skeletal muscle bioenergetics in vivo are still unknown. Due to the beneficial effects of HU upon oxygen delivery, improved skeletal muscle energetics and function in response to a HU treatment have been hypothesized. Muscle energetics and function were analyzed during a standardized rest-exercise-recovery protocol, using 31P-magnetic resonance spectroscopy in Townes SCD mice. Measurements were performed in three groups of mice: one group of 2-mo-old mice (SCD2m, n = 8), another one of 4-mo-old mice (SCD4m, n = 8), and a last group of 4-mo-old mice that have been treated from 2 mo of age with HU at 50 mg/kg/day (SCD4m-HU, n = 8). As compared with SCD2m mice, SCD4m mice were heavier and displayed a lower acidosis. As lower specific forces were developed by SCD4m compared with SCD2m, greater force-normalized phosphocreatine consumption and oxidative and nonoxidative costs of contraction were also reported. HU-treated mice (SCD4m-HU) displayed a significantly higher specific force production as compared with untreated mice (SCD4m), whereas muscle energetics was unchanged. Overall, our results support a beneficial effect of HU on muscle function.NEW & NOTEWORTHY Our results highlighted that force production decreases between 2 and 4 mo of age in SCD mice thereby indicating a decrease of muscle function during this period. Of interest, HU treatment seemed to blunt the observed age effect given that SCD4m-HU mice displayed a higher specific force production as compared with SCD4m mice. In that respect, HU treatment would help to maintain a higher capacity of force production during aging in SCD.
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Affiliation(s)
| | - David Bendahan
- CNRS, CRMBM, Aix-Marseille Université, Marseille, France
| | | | | | - Yann Le Fur
- CNRS, CRMBM, Aix-Marseille Université, Marseille, France
| | - Laurent A Messonnier
- Laboratoire Interuniversitaire de Biologie de la Motricité EA7424, Université Savoie Mont Blanc, Chambéry, France
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Exercise Capacity and Biomarkers Among Children and Adolescents With Sickle Cell Disease. Pediatr Exerc Sci 2022; 35:84-91. [PMID: 35894886 DOI: 10.1123/pes.2021-0188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/02/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sickle cell disease is the most common genetic hemoglobinopathy globally and systemically affects body functioning, decreasing exercise capacity. OBJECTIVE To assess exercise capacity through the 6-minute walk test (6MWT) and biomarkers in children and adolescents with sickle cell disease. MATERIALS AND METHODS Cross-sectional study involving 20 children and adolescents from Brazil. Demographic and socioeconomic data were obtained. Baseline measurements included biomarkers (red blood cells, hemoglobin, hematocrit, white blood cells, platelets, reticulocytes, lactate dehydrogenase, creatine phosphokinase, C-reactive protein, interleukin 6, and fetal hemoglobin). The following data were obtained before, during, and after the 6MWT: heart rate, blood pressure, and peripheral oxygen saturation. RESULTS Eighteen children and adolescents ages 5-14 years old were analyzed, 61.1% boys, 100% black or brown, and 61.1% in primary education, with low household income. The average distance walked in 6MWT was 463.8 (137.7) m, significantly less than the predicted value (P < .001). The distance of 6MWT was associated positively with age (P = .042) and inversely with reticulocyte count (P = .42) and interleukin 6 (P = .00). Age modified the effect of interleukin 6 in younger children (P = .038). CONCLUSION Our findings suggest increased baseline levels of biomarkers of hemolysis and inflammation impact on 6MWT performance.
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Stauffer E, Poutrel S, Gozal D, Germain M, Prudent M, Fort R, Gauthier A, Bertrand Y, Hot A, Connes P. Reduced Lung Diffusion Capacity Caused by Low Alveolar Volume and Restrictive Disease Are Common in Sickle Cell Disease. Arch Bronconeumol 2022; 58:572-574. [PMID: 35312609 DOI: 10.1016/j.arbres.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Emeric Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France; Centre de Médecine du Sommeil et des Maladies Respiratoires, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France; Service d'Explorations Fonctionnelles Respiratoires-Médecine du sport et de l'activité physique, France.
| | - Solène Poutrel
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France; Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - David Gozal
- Department of Child Health, Women and Children's Hospital, University of Missouri, Columbia, MO 65201, USA
| | - Michèle Germain
- Service d'Explorations Fonctionnelles Respiratoires-Médecine du sport et de l'activité physique, France
| | - Mélanie Prudent
- Service d'Explorations Fonctionnelles Respiratoires-Médecine du sport et de l'activité physique, France
| | - Romain Fort
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France; Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Alexandra Gauthier
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France; Institut d'Hématologique et d'Oncologique Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Yves Bertrand
- Institut d'Hématologique et d'Oncologique Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Service de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France; Service de Réanimation Médicale, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
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Oyedeji CI, Hall K, Luciano A, Morey MC, Strouse JJ. The Sickle Cell Disease Functional Assessment (SCD-FA) tool: a feasibility pilot study. Pilot Feasibility Stud 2022; 8:53. [PMID: 35246265 PMCID: PMC8895638 DOI: 10.1186/s40814-022-01005-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/16/2022] [Indexed: 01/15/2023] Open
Abstract
Background The life expectancy for individuals with sickle cell disease (SCD) has greatly increased over the last 50 years. Adults with SCD experience multiple complications such as cardiopulmonary disease, strokes, and avascular necrosis that lead to limitations that geriatric populations often experience. There are no dedicated instruments to measure functional decline and functional age to determine risk of future adverse outcomes in older adults with SCD. The objective of this study was to assess the feasibility of performing the Sickle Cell Disease Functional Assessment (SCD-FA). Methods We enrolled 40 adults with SCD (20 younger adults aged 18–49 years as a comparison group and 20 older adults aged 50 years and older) in a single-center prospective cohort study. Participants were recruited from a comprehensive sickle cell clinic in an academic center in the southeastern United States. We included measures validated in an oncology geriatric assessment enriched with additional physical performance measures: usual gait speed, seated grip strength, Timed Up and Go, six-minute walk test, and 30-second chair stand. We also included an additional cognitive measure, which was the Montreal Cognitive Assessment, and additional patient-reported measures at the intersection of sickle cell disease and geriatrics. The primary outcome was the proportion completing the assessment. Secondary outcomes were the proportion consenting, duration of the assessment, acceptability, and adverse events. Results Eighty percent (44/55) of individuals approached consented, 91% (40/44) completed the SCD-FA in its entirety, and the median duration was 89 min (IQR 80–98). There were no identified adverse events. On the acceptability survey, 95% (38/40) reported the length as appropriate, 2.5% (1/40) reported a question as upsetting, and 5% (2/40) reported portions as difficult. Exploratory analyses of physical function showed 63% (25/40) had a slow usual gait speed (< 1.2 m/s). Conclusion The SCD-FA is feasible, acceptable, and safe and physical performance tests identified functional impairments in adults with SCD. These findings will inform the next phase of the study where we will assess the validity of the SCD-FA to predict patient-important outcomes in a larger sample of adults with SCD.
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Affiliation(s)
- Charity I Oyedeji
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, NC, USA. .,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA. .,Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, Durham, NC, USA.
| | - Katherine Hall
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Alison Luciano
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA
| | - Miriam C Morey
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - John J Strouse
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, NC, USA.,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.,Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, Durham, NC, USA.,Division of Pediatric Hematology-Oncology, Duke University, Durham, NC, USA
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Gouraud E, Connes P, Gauthier-Vasserot A, Faes C, Merazga S, Poutrel S, Renoux C, Boisson C, Joly P, Bertrand Y, Hot A, Cannas G, Hautier C. Is Skeletal Muscle Dysfunction a Limiting Factor of Exercise Functional Capacity in Patients with Sickle Cell Disease? J Clin Med 2021; 10:jcm10112250. [PMID: 34067352 PMCID: PMC8196873 DOI: 10.3390/jcm10112250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 02/02/2023] Open
Abstract
Patients with sickle cell disease (SCD) have reduced functional capacity due to anemia and cardio-respiratory abnormalities. Recent studies also suggest the presence of muscle dysfunction. However, the interaction between exercise capacity and muscle function is currently unknown in SCD. The aim of this study was to explore how muscle dysfunction may explain the reduced functional capacity. Nineteen African healthy subjects (AA), and 24 sickle cell anemia (SS) and 18 sickle cell hemoglobin C (SC) patients were recruited. Maximal isometric torque (Tmax) was measured before and after a self-paced 6-min walk test (6-MWT). Electromyographic activity of the Vastus Lateralis was recorded. The 6-MWT distance was reduced in SS (p < 0.05) and SC (p < 0.01) patients compared to AA subjects. However, Tmax and root mean square value were not modified by the 6-MWT, showing no skeletal muscle fatigue in all groups. In a multiple linear regression model, genotype, step frequency and hematocrit were independent predictors of the 6-MWT distance in SCD patients. Our results suggest that the 6-MWT performance might be primarily explained by anemia and the self-paced step frequency in SCD patients attempting to limit metabolic cost and fatigue, which could explain the absence of muscle fatigue.
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Affiliation(s)
- Etienne Gouraud
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Correspondence:
| | - Philippe Connes
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Institute of Universities of France, CEDEX 05, 75231 Paris, France
| | - Alexandra Gauthier-Vasserot
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Hematology and Oncology Pediatric Unit, University Hospital of Lyon, 69008 Lyon, France;
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
| | - Camille Faes
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
| | - Salima Merazga
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
| | - Solène Poutrel
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
- Internal Medicine Department, Edouard-Herriot Hospital, 69003 Lyon, France
| | - Céline Renoux
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Laboratory of Biochemistry of Erythrocyte Pathologies, Biology Centre East, 69500 Bron, France
| | - Camille Boisson
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
| | - Philippe Joly
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Laboratory of Biochemistry of Erythrocyte Pathologies, Biology Centre East, 69500 Bron, France
| | - Yves Bertrand
- Hematology and Oncology Pediatric Unit, University Hospital of Lyon, 69008 Lyon, France;
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
| | - Arnaud Hot
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
- Internal Medicine Department, Edouard-Herriot Hospital, 69003 Lyon, France
| | - Giovanna Cannas
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, 69003 Lyon, France; (S.M.); (S.P.); (A.H.)
- Internal Medicine Department, Edouard-Herriot Hospital, 69003 Lyon, France
| | - Christophe Hautier
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team “Vascular Biology and Red Blood Cell”, University Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.C.); (A.G.-V.); (C.F.); (C.R.); (C.B.); (P.J.); (G.C.); (C.H.)
- Laboratory of Excellence “GR-Ex”, 75015 Paris, France
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Gouraud E, Connes P, Gauthier-Vasserot A, Faes C, Merazga S, Poutrel S, Renoux C, Boisson C, Joly P, Bertrand Y, Hot A, Cannas G, Hautier C. Impact of a submaximal mono-articular exercise on the skeletal muscle function of patients with sickle cell disease. Eur J Appl Physiol 2021; 121:2459-2470. [PMID: 34023973 DOI: 10.1007/s00421-021-04716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Sickle cell disease (SCD) patients exhibit a limited exercise tolerance commonly attributed to anaemia, as well as hemorheological and cardio-respiratory abnormalities, but the functional status of skeletal muscle at exercise is unknown. Moreover, the effect of SCD genotype on exercise tolerance and skeletal muscle function has been poorly investigated. The aim of this study was to investigate skeletal muscle function and fatigue during a submaximal exercise in SCD patients. METHODS Nineteen healthy individuals (AA), 28 patients with sickle cell anaemia (SS) and 18 with sickle cell-haemoglobin C disease (SC) performed repeated knee extensions exercise (FAT). Maximal isometric torque (Tmax) was measured before and after the FAT to quantify muscle fatigability. Electromyographic activity and oxygenation by near-infrared spectroscopy of the Vastus Lateralis were recorded. RESULTS FAT caused a reduction in Tmax in SS (- 17.0 ± 12.1%, p < 0.001) and SC (- 21.5 ± 14.5%, p < 0.05) but not in AA (+ 0.58 ± 29.9%). Root-mean-squared value of EMG signal (RMS) decreased only in SS after FAT, while the median power frequency (MPF) was unchanged in all groups. Oxygenation kinetics were determined in SS and AA and were not different. CONCLUSION These results show skeletal muscle dysfunction during exercise in SCD patients, and suggest different fatigue aetiology between SS and SC. The changes in EMG signal and oxygenation kinetics during exercise suggest that the greater skeletal muscle fatigue occurring in SCD patients would be rather due to intramuscular alterations modifications than decreased tissue oxygenation. Moreover, SS patients exhibit greater muscle fatigability than SC.
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Affiliation(s)
- Etienne Gouraud
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence "GR-Ex", Paris, France
| | - Philippe Connes
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence "GR-Ex", Paris, France.,Institute of Universities of France, Paris, France
| | - Alexandra Gauthier-Vasserot
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence "GR-Ex", Paris, France.,Hematology and Oncology Pediatric Unit, University Hospital of Lyon, Lyon, France.,Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, Lyon, France
| | - Camille Faes
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence "GR-Ex", Paris, France
| | - Salima Merazga
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, Lyon, France
| | - Solène Poutrel
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, Lyon, France.,Internal Medicine Department, Edouard-Herriot Hospital, Lyon, France
| | - Céline Renoux
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence "GR-Ex", Paris, France.,Laboratory of Biochemistry of Erythrocyte Pathologies, Biology Centre East, Bron, France
| | - Camille Boisson
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence "GR-Ex", Paris, France
| | - Philippe Joly
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence "GR-Ex", Paris, France.,Laboratory of Biochemistry of Erythrocyte Pathologies, Biology Centre East, Bron, France
| | - Yves Bertrand
- Hematology and Oncology Pediatric Unit, University Hospital of Lyon, Lyon, France.,Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, Lyon, France.,Internal Medicine Department, Edouard-Herriot Hospital, Lyon, France
| | - Giovanna Cannas
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratory of Excellence "GR-Ex", Paris, France.,Reference Centre in Sickle Cell Disease, Thalassemia and Rare Red Blood Cell and Erythropoiesis Diseases, Hospices Civils de Lyon, Lyon, France.,Internal Medicine Department, Edouard-Herriot Hospital, Lyon, France
| | - Christophe Hautier
- Inter-University Laboratory of Human Movement Sciences (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", University Claude Bernard Lyon 1, Villeurbanne, France. .,Laboratory of Excellence "GR-Ex", Paris, France.
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9
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Zeitoune R, Mogami R, Koifman ACB, Lopes AJ, Soares AR, Martins RAG, Maioli MCP. Diaphragm ultrasonography in adults with sickle cell anemia: evaluation of morphological and functional aspects. ACTA ACUST UNITED AC 2020; 25:372-382. [PMID: 33095119 DOI: 10.1080/16078454.2020.1833506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess morphological and functional aspects of the diaphragm by ultrasonography (US) in adults with sickle cell anemia (SCA) and evaluate if the diaphragmatic musculature can play a role in changes found in pulmonary function tests (PFTs) of these patients. METHODS This is a cross-sectional observational and single-center study involving 40 adults with SCA who underwent diaphragm US and PFTs with a maximum of 1 month between the two tests. Diaphragm US was performed in B and M modes, and echogenicity, thickness and movement of the muscle was assessed in different respiratory maneuvers. RESULTS Diaphragms had preserved echogenicity and the thickness was not significantly different between the groups. The SCA group exhibited significantly higher movement of the right hemidiaphragm during deep breathing (p = 0.004) and the sniff test (p = 0.0008) and lower movement of the left hemidiaphragm during quiet breathing (p = 0.009). There was a predominance of restrictive pattern (65%) and a global reduction in respiratory muscle strength (RMS) (70%). CONCLUSIONS This study shows that adults with SCA had normal morphostructural aspects and absence of diaphragm dysfunction. Otherwise, they presented greater movement of the right hemidiaphragm during deep breathing and sniff test maneuvers. Despite the restrictive pattern and the reduction in RMS found in PFTs, the diaphragm of young adults with SCA did not have weakness or paralysis.
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Affiliation(s)
- Rachel Zeitoune
- Marinha do Brasil, São Paulo, Brazil.,Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Roberto Mogami
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Ana Celia Baptista Koifman
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Agnaldo Jose Lopes
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
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10
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Oyedeji CI, Hall K, Luciano A, Morey MC, Strouse JJ. Geriatric assessment for older adults with sickle cell disease: protocol for a prospective cohort pilot study. Pilot Feasibility Stud 2020; 6:131. [PMID: 32974042 PMCID: PMC7495855 DOI: 10.1186/s40814-020-00673-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background The life expectancy for people with sickle cell disease (SCD) has improved tremendously over the last 50 years. This population experiences hemolysis and vaso-occlusion in multiple organs that lead to complications such as cardiopulmonary disease, strokes, and avascular necrosis. These complications can limit mobility and aerobic endurance, similar to limitations that often occur in geriatric populations. These sickle-cell and age-related events lead to frequent hospitalization, which further increases the risk of functional decline. We have few tools to measure functional decline in people with SCD. The purpose of this paper is to describe a protocol to evaluate the feasibility of sickle cell disease geriatric assessment (SCD-GA). Methods/design We will enroll 40 adults with SCD (20 age 18–49.99 years and 20 age ≥ 50 years) in a prospective cohort study to assess the feasibility of SCD-GA. The SCD-GA includes validated measures from the oncology geriatric assessment enriched with additional physical and cognitive measures. The SCD-GA will be performed at the first study visit, at 10 to 20 days after hospitalization, and at 12 months (exit visit). With input from a multidisciplinary team of sickle cell specialists, geriatricians, and experts in physical function and physical activity, we selected assessments across 7 domains: functional status (11 measures), comorbid medical conditions (1 measure), psychological state (1 measure), social support (2 measures), weight status (2 measures), cognition (3 measures), and medications (1 measure). We will measure the proportion completing the assessment with feasibility as the primary outcome. Secondary outcomes include the proportion consenting and completing all study visits, duration of the assessment, acceptability, and adverse events. Discussion We present the protocol and rationale for selection of the measures included in SCD-GA. We also outline the methods to determine feasibility and subsequently to optimize the SCD-GA in preparation for a larger multicenter validation study of the SCD-GA.
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Affiliation(s)
- Charity I Oyedeji
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 315 Trent Dr. Suite 261, DUMC Box 3939, Durham, NC 27710 USA.,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA
| | - Katherine Hall
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC USA
| | - Alison Luciano
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA
| | - Miriam C Morey
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC USA
| | - John J Strouse
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 315 Trent Dr. Suite 261, DUMC Box 3939, Durham, NC 27710 USA.,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, Durham, NC USA.,Division of Pediatric Hematology-Oncology, Duke University, Durham, NC USA
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11
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Padkao T, Boonla O. Relationships between respiratory muscle strength, chest wall expansion, and functional capacity in healthy nonsmokers. J Exerc Rehabil 2020; 16:189-196. [PMID: 32509705 PMCID: PMC7248446 DOI: 10.12965/jer.2040080.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/29/2020] [Indexed: 12/31/2022] Open
Abstract
Chest wall expansion determines lung volume and functional capacity. Factors determining chest wall expansion include respiratory muscle strength. Accordingly, there may be association among respiratory muscle strength, chest wall expansion, and functional capacity. Thusly, this cross-sectional study identified the relationship between respirato-ry muscle strength, chest wall expansion, and functional capacity. Seventy-six healthy male and female participants aged between 20 to 59 years exhibiting a body mass index of 18.5 to 22.9 kg/m2 were enrolled. Inspiratory and expiratory muscle strength were evaluated via maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), respectively. Chest wall expansion was measured through thoracic circumferences at three different levels; upper, middle, and lower levels with diaphragmatic movement also measured utilizing the circumference of the lower edge of the 10th rib. Functional capacity was evaluated through distance obtained from a 6-min walk test. Results showed that both MIP and MEP were significantly correlated with chest wall expansion at the middle (P=0.005 and P=0.006) and lower (P=0.012 and P=0.020) thoracic levels as well as diaphragmatic movement (both P<0.001). Moreover, both MIP and MEP were significantly related amid the 6-min walk distance (P=0.025 and P<0.001). In conclusion, respiratory muscle strength is positively associated with chest wall expansion, diaphragmatic movement, and functional capacity in healthy participants.
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Affiliation(s)
- Tadsawiya Padkao
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand.,Exercise and Nutrition Sciences and Innovation Research Unit, Burapha University, Chonburi, Thailand
| | - Orachorn Boonla
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand.,Exercise and Nutrition Sciences and Innovation Research Unit, Burapha University, Chonburi, Thailand
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12
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Merlet AN, Chatel B, Hourdé C, Ravelojaona M, Bendahan D, Féasson L, Messonnier LA. How Sickle Cell Disease Impairs Skeletal Muscle Function: Implications in Daily Life. Med Sci Sports Exerc 2019; 51:4-11. [PMID: 30095751 DOI: 10.1249/mss.0000000000001757] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sickle cell disease (SCD) is the most frequent life-threatening genetic hemoglobinopathy in the world and occurs due to the synthesis of abnormal hemoglobin S (HbS). hemoglobin S-containing red blood cells (RBC) are fragile, leading to hemolysis and anemia, and adhere to the endothelium, leading to hemorheological and hemodynamical disturbances. In its deoxygenated form, HbS may polymerize, leading to sickling of red blood cells and potentially to vasoocclusive crises. Recent findings observed that SCD patients demonstrate significant skeletal muscle remodeling and display reduced muscle functional capacities, contributing to exercise intolerance and poor quality of life. Although acute high-intensity exercise is not recommended for SCD patients because it may increase the risk of sickling, regular moderate-intensity physical activity could have beneficial effects on skeletal muscle and more generally on the well-being of SCD patients. This article reviews the literature regarding the impact of the disease on muscular tissue characteristics and function, as well as the corresponding implications for SCD patients' quality of life.
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Affiliation(s)
- Angèle N Merlet
- Inter-university Laboratory of Human Movement Sciences, University of Lyon, UJM Saint-Etienne, Saint-Etienne, FRANCE
| | - Benjamin Chatel
- Inter-university Laboratory of Human Movement Sciences, University of Savoie Mont Blanc, Chambéry, FRANCE.,Aix-Marseille University, Marseille, FRANCE
| | - Christophe Hourdé
- Inter-university Laboratory of Human Movement Sciences, University of Savoie Mont Blanc, Chambéry, FRANCE
| | - Marion Ravelojaona
- Inter-university Laboratory of Human Movement Sciences, University of Lyon, UJM Saint-Etienne, Saint-Etienne, FRANCE.,Myology Unit, Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, FRANCE
| | | | - Léonard Féasson
- Inter-university Laboratory of Human Movement Sciences, University of Lyon, UJM Saint-Etienne, Saint-Etienne, FRANCE.,Inter-university Laboratory of Human Movement Sciences, University of Savoie Mont Blanc, Chambéry, FRANCE.,Aix-Marseille University, Marseille, FRANCE.,Myology Unit, Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, FRANCE
| | - Laurent A Messonnier
- Inter-university Laboratory of Human Movement Sciences, University of Savoie Mont Blanc, Chambéry, FRANCE
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13
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Gonçalves CEA, Silva PO, Soares MS, Bunn PS, Lima CMA, Lopes AJ. Muscle dysfunction is associated with poorer health-related quality of life in adults with sickle cell anaemia. J Back Musculoskelet Rehabil 2019; 32:43-53. [PMID: 30056413 DOI: 10.3233/bmr-171027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND It is known that episodes of microvascular obstruction and oxidative stress in sickle cell anaemia (SCA) can damage muscle tissue. As a consequence, deterioration in muscle function may potentially contribute to poor health-related quality of life (HRQoL) in subjects with SCA, particularly those who do not use long-term treatment. OBJECTIVES To evaluate muscle function in adults with SCA, to study the correlations between muscle function and HRQoL and to analyse the impact of hydroxyurea treatment. METHODS Twenty-two adults with SCA and 20 matched controls were subjected to Short Form-36 (SF-36), respiratory muscle strength measurement, isometric hand grip strength (iHGS) measurement and knee isokinetic dynamometry. RESULTS In relation to their healthy peers, adults with SCA had lower SF-36 scores, respiratory muscle strength and iHGS. Regarding the isokinetic test, adults with SCA showed lower values, especially in the variables measured in flexion and with an angular velocity of 240∘/s. There was a significant correlation between the peak torque (PT) at 240∘/s and the physical component summary (SF-36PCS) in both extension (r= 0.77; p< 0.001) and flexion (r= 0.82; p< 0.001). Significant correlations were also observed between the agonist/antagonist ratio at 240∘/s and the SF-36PCS (r= 0.50; p< 0.001). The use of hydroxyurea led to higher scores on the SF-36 and higher values in knee isokinetic dynamometry. CONCLUSIONS Adults with SCA have muscle dysfunction, especially with regard to endurance of the knee flexor muscles. In these patients, there is a significant association between muscle function and HRQoL. Moreover, the use of hydroxyurea is associated with better HRQoL and less muscle dysfunction.
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Affiliation(s)
| | - Priscila Oliveira Silva
- Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University, Rio de Janeiro, Brazil
| | - Mauricio Santos Soares
- Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | - Priscila Santos Bunn
- Admiral Adalberto Nunes Physical Education Center (Brazilian Navy), Rio de Janeiro, Brazil
| | | | - Agnaldo José Lopes
- Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University, Rio de Janeiro, Brazil.,Medical Sciences Post-Graduation Programme, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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14
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Silva PO, Ferreira AS, Lima CMDA, Guimarães FS, Lopes AJ. Balance control is impaired in adults with sickle cell anaemia. Somatosens Mot Res 2018; 35:109-118. [PMID: 30010483 DOI: 10.1080/08990220.2018.1481829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Musculoskeletal involvement and cerebrovascular disease are common in sickle cell anaemia (SCA). These changes are potentially important factors that modify the control of balance in this population. OBJECTIVE To assess balance control in adults with SCA and investigate the associations among balance, posture and muscle function. METHODS Twenty neurologically intact (i.e. without previous episodes of overt stroke or transient ischaemic attack) adults with SCA and 18 controls were evaluated. All participants underwent static balance measurement through stabilometry, postural evaluation through photogrammetry and assessment of muscle function through handgrip and respiratory muscle strength. RESULTS Compared to the controls, the adults with SCA exhibited greater displacement of the centre of mass, particularly in the mediolateral direction. Moreover, the adults with SCA exhibited greater postural deviations for the following variables: angles of the right and left hip, horizontal asymmetry of the scapula in relation to T3, angles of the right and left leg-heel and horizontal alignment of the pelvis. Handgrip strength, respiratory muscle strength and haemoglobin (Hb) levels were significantly correlated with postural balance measurements. Significant correlations between balance and posture were only observed between the variables of balance and the postural parameters that involved the angulations calculated from the vertical alignment of the pelvis, hip and ankle. CONCLUSIONS Neurologically intact adults with SCA exhibit damage in static balance, particularly in the mediolateral direction. These patients present postural deviations due to changes in the hip and ankle joints. In addition, balance control is related to posture, Hb level and muscle function.
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Affiliation(s)
- Priscila Oliveira Silva
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil
| | - Arthur Sá Ferreira
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil
| | | | - Fernando Silva Guimarães
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil
| | - Agnaldo José Lopes
- a Rehabilitation Sciences Master's Programme , Augusto Motta University Center , Rio de Janeiro , Brazil.,b Postgraduate Programme in Medical Sciences , State University of Rio de Janeiro , Rio de Janeiro , Brazil
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15
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Marinho CDL, Maioli MCP, do Amaral JLM, Lopes AJ, de Melo PL. Respiratory resistance and reactance in adults with sickle cell anemia: Correlation with functional exercise capacity and diagnostic use. PLoS One 2017; 12:e0187833. [PMID: 29220407 PMCID: PMC5722327 DOI: 10.1371/journal.pone.0187833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/26/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The improvement in sickle cell anemia (SCA) care resulted in the emergence of a large population of adults living with this disease. The mechanisms of lung injury in this new population are largely unknown. The forced oscillation technique (FOT) represents the current state-of-the-art in the assessment of lung function. The present work uses the FOT to improve our knowledge about the respiratory abnormalities in SCA, evaluates the associations of FOT with the functional exercise capacity and investigates the early detection of respiratory abnormalities. METHODOLOGY/PRINCIPAL FINDINGS Spirometric classification of restrictive abnormalities resulted in three categories: controls (n = 23), patients with a normal exam (n = 21) and presenting pulmonary restriction (n = 24). FOT analysis showed that, besides restrictive changes (reduced compliance; p<0.001), there is also an increase in respiratory resistance (p<0.001) and ventilation heterogeneity (p<0.01). FOT parameters are associated with functional exercise capacity (R = -0.38), pulmonary diffusion (R = 0.66), respiratory muscle performance (R = 0.41), pulmonary volumes (R = 0.56) and airway obstruction (R = 0.54). The diagnostic accuracy was evaluated by investigating the area under the receiver operating characteristic curve (AUC). A combination of FOT and machine learning (ML) classifiers showed adequate diagnostic accuracy in the detection of early respiratory abnormalities (AUC = 0.82). CONCLUSIONS In this study, the use of FOT showed that adults with SCA develop a mixed pattern of respiratory disease. Changes in FOT parameters are associated with functional exercise capacity decline, abnormal pulmonary mechanics and diffusion. FOT associated with ML methods accurately diagnosed early respiratory abnormalities. This suggested the potential utility of the FOT and ML clinical decision support systems in the identification of respiratory abnormalities in patients with SCA.
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Affiliation(s)
- Cirlene de Lima Marinho
- Biomedical Instrumentation Laboratory—Institute of Biology and Faculty of Engineering, and BioVasc Research Laboratory—Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro—Brazil
| | | | - Jorge Luis Machado do Amaral
- Department of Electronics and Telecommunications Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- School of Medical Sciences, Pulmonary Function Testing Laboratory, Rio de Janeiro/RJ, State University of Rio de Janeiro, Rio de Janeiro–Brazil
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Biomedical Instrumentation Laboratory—Institute of Biology and Faculty of Engineering, and BioVasc Research Laboratory—Institute of Biology, State University of Rio de Janeiro, Rio de Janeiro—Brazil
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16
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Vieira AK, Alvim CG, Carneiro MCM, Ibiapina CDC. Pulmonary function in children and adolescents with sickle cell disease: have we paid proper attention to this problem? J Bras Pneumol 2017; 42:409-415. [PMID: 28117470 PMCID: PMC5474345 DOI: 10.1590/s1806-37562016000000057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 10/31/2016] [Indexed: 01/26/2023] Open
Abstract
Objective: To evaluate pulmonary function and functional capacity in children and adolescents with sickle cell disease. Methods: This was a cross-sectional study involving 70 children and adolescents (8-15 years of age) with sickle cell disease who underwent pulmonary function tests (spirometry) and functional capacity testing (six-minute walk test). The results of the pulmonary function tests were compared with variables related to the severity of sickle cell disease and history of asthma and of acute chest syndrome. Results: Of the 64 patients who underwent spirometry, 15 (23.4%) showed abnormal results: restrictive lung disease, in 8 (12.5%); and obstructive lung disease, in 7 (10.9%). Of the 69 patients who underwent the six-minute walk test, 18 (26.1%) showed abnormal results regarding the six-minute walk distance as a percentage of the predicted value for age, and there was a ≥ 3% decrease in SpO2 in 36 patients (52.2%). Abnormal pulmonary function was not significantly associated with any of the other variables studied, except for hypoxemia and restrictive lung disease. Conclusions: In this sample of children and adolescents with sickle cell disease, there was a significant prevalence of abnormal pulmonary function. The high prevalence of respiratory disorders suggests the need for a closer look at the lung function of this population, in childhood and thereafter.
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Affiliation(s)
| | - Cristina Gonçalves Alvim
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
| | | | - Cássio da Cunha Ibiapina
- . Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG) Brasil
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17
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Lopes AJ, Marinho CL, Alves UD, Gonçalves CEA, Silva PO, Botelho EC, Bedirian R, Soares AR, Maioli MCP. Relationship between ventilation heterogeneity and exercise intolerance in adults with sickle cell anemia. ACTA ACUST UNITED AC 2017; 50:e6512. [PMID: 28746470 PMCID: PMC5520223 DOI: 10.1590/1414-431x20176512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022]
Abstract
Sickle cell anemia (SCA) causes dysfunction of multiple organs, with pulmonary involvement as a major cause of mortality. Recently, there has been growing interest in the nitrogen single-breath washout (N2SBW) test, which is able to detect ventilation heterogeneity and small airway disease when the results of other pulmonary function tests (PFTs) are still normal. Thus, the objectives of the present study were to assess the heterogeneity in the ventilation distribution in adults with SCA and to determine the association between the ventilation distribution and the clinical, cardiovascular, and radiological findings. This cross-sectional study included 38 adults with SCA who underwent PFTs, echocardiography, computed tomography (CT), and 6-min walk test. To evaluate the ventilation heterogeneity, the patients were categorized according to the phase III slope of the N2SBW (SIIIN2). Compared with adults with lower SIIIN2 values, adults with higher SIIIN2 values showed lower hemoglobin levels (P=0.048), a history of acute chest syndrome (P=0.001), an elevated tricuspid regurgitation velocity (P=0.039), predominance of a reticular pattern in the CT (P=0.002), a shorter 6-min walking distance (6MWD) (P=0.002), and lower peripheral oxygen saturation (SpO2) after exercise (P=0.03). SIIIN2 values correlated significantly with hemoglobin (rs=-0.344; P=0.034), forced vital capacity (rs=-0.671; P<0.0001), diffusing capacity for carbon monoxide (rs=-0.376; P=0.019), 6MWD (rs=-0.554; P=0.0003), and SpO2 after exercise (P=0.040). Heterogeneity in the ventilation distribution is one of the most common pulmonary dysfunctions in adults with SCA. Moreover, relationships exist between ventilation heterogeneity, worsening of pulmonary structural damage, and reduced tolerance for exercise.
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Affiliation(s)
- A J Lopes
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil.,Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - C L Marinho
- Programa de Pós-Graduação em Fisiopatologia Clínica e Experimental, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - U D Alves
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - C E A Gonçalves
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - P O Silva
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - E C Botelho
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - R Bedirian
- Disciplina de Clínica Médica, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - A R Soares
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Disciplina de Hematologia e Hemoterapia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - M C P Maioli
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.,Disciplina de Hematologia e Hemoterapia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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18
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Melo HN, Stoots SJM, Pool MA, Carvalho VO, Almeida LOC, Aragão MLDC, Agyemang C, Cipolotti R. Physical activity level and performance in the six-minute walk test of children and adolescents with sickle cell anemia. Rev Bras Hematol Hemoter 2017; 39:133-139. [PMID: 28577650 PMCID: PMC5457483 DOI: 10.1016/j.bjhh.2017.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To establish determinants of maximum walking distance in the 6-minute walk test of children and adolescents with sickle cell anemia, and to compare the performance in this test with physical activity level between patients and healthy controls. METHODS A cross-sectional study was performed in which the participants answered the Physical Activity Questionnaire for Older Children and Adolescents, and completed the 6-minute walk test. MAIN RESULTS Fifty-seven patients and 58 controls were studied. By univariate analysis of the patients, age (p<0.0001) and indirect bilirubin (p=0.008) were associated with maximum walking distance in the 6-minute walk test. In multivariate analysis, age was positively associated (p<0.0001; beta: 0.75), while body mass index was inversely associated with distance walked (p=0.047; beta: -0.32). This yields the following equation: maximum distance walked=487.7 (age×18.3)-(12×body mass index) meters. Patients reported a lower physical activity level however there was no significant difference in the distance walked in six minutes between patients (500.6±88.7m) and controls (536.3±94m). CONCLUSION The determinants for the 6-minute walk test in children and adolescents with sickle cell anemia were age and body mass index. There was no significant difference in the 6-minute walk test but patients with sickle cell anemia had a lower physical activity level compared to healthy controls.
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Impaired muscle force production and higher fatigability in a mouse model of sickle cell disease. Blood Cells Mol Dis 2017; 63:37-44. [PMID: 28110136 DOI: 10.1016/j.bcmd.2017.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/09/2017] [Indexed: 12/28/2022]
Abstract
Skeletal muscle function has been scarcely investigated in sickle cell disease (SCD) so that the corresponding impact of sickle hemoglobin is still a matter of debate. The purpose of this study was to investigate muscle force production and fatigability in SCD and to identify whether exercise intensity could have a modulatory effect. Ten homozygous sickle cell (HbSS), ten control (HbAA) and ten heterozygous (HbAS) mice were submitted to two stimulation protocols (moderate and intense) to assess force production and fatigability. We showed that specific maximal tetanic force was lower in HbSS mice as compared to other groups. At the onset of the stimulation period, peak force was reduced in HbSS and HbAS mice as compared to HbAA mice. Contrary to the moderate protocol, the intense stimulation protocol was associated with a larger decrease in peak force and rate of force development in HbSS mice as compared to HbAA and HbAS mice. These findings provide in vivo evidence of impaired muscle force production and resistance to fatigue in SCD. These changes are independent of muscle mass. Moreover, SCD is associated with muscle fatigability when exercise intensity is high.
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Marinho CDL, Maioli MCP, Soares AR, Bedirian R, Melo PLD, Guimarães FS, Ferreira ADS, Lopes AJ. Predictive models of six-minute walking distance in adults with sickle cell anemia: Implications for rehabilitation. J Bodyw Mov Ther 2016; 20:824-831. [PMID: 27814863 DOI: 10.1016/j.jbmt.2016.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 12/14/2015] [Accepted: 02/06/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sickle cell anemia (SCA) is characterized by a broad spectrum of abnormalities that affect most body organs and systems. To date, there is few data on the influence of these patients' clinical characteristics on the functional exercise capacity. AIM To investigate the effect of the clinical complications on the functional exercise capacity of adult SCA patients. METHOD Cross-sectional study, where 45 SCA patients underwent clinical evaluations, echocardiography, pulmonary function testing, and determination of six-minute walking distance (6MWD). RESULTS A significant correlation (P < 0.001) was found between 6MWD and hemoglobin (Hb) level, tricuspid regurgitation velocity, forced vital capacity, acute chest syndrome, and diffusing capacity for carbon monoxide. The prediction model for 6MWD explained 67% of the 6MWD variability (P < 0.001). CONCLUSIONS Hemodynamics, cardiovascular function, pulmonary function, and episodes of acute lung injury seem to impact the 6MWD in adults with SCA.
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Affiliation(s)
- Cirlene de Lima Marinho
- Post-graduate Program in Clinical and Experimental Physiopathology, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Christina Paixão Maioli
- Hematology Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Post-graduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea Ribeiro Soares
- Hematology Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Post-graduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Bedirian
- Post-graduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Lopes de Melo
- Post-graduate Program in Clinical and Experimental Physiopathology, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Post-graduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Biomedical Instrumentation Laboratory, Institute of Biology and Faculty of Engineering, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando Silva Guimarães
- Rehabilitation Sciences Post-graduate Program, Augusto Motta University Center, Rio de Janeiro, Brazil
| | - Arthur de Sá Ferreira
- Rehabilitation Sciences Post-graduate Program, Augusto Motta University Center, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Post-graduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Rehabilitation Sciences Post-graduate Program, Augusto Motta University Center, Rio de Janeiro, Brazil.
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Maioli MCP, Soares AR, Bedirian R, Alves UD, de Lima Marinho C, Lopes AJ. Relationship between pulmonary and cardiac abnormalities in sickle cell disease: implications for the management of patients. Rev Bras Hematol Hemoter 2015; 38:21-7. [PMID: 26969771 PMCID: PMC4786771 DOI: 10.1016/j.bjhh.2015.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 10/23/2015] [Accepted: 11/07/2015] [Indexed: 12/20/2022] Open
Abstract
Objective To evaluate the association between clinical, pulmonary, and cardiovascular findings in patients with sickle cell disease and, secondarily, to compare these findings between sickle cell anemia patients and those with other sickle cell diseases. Methods Fifty-nine adults were included in this cross-sectional study; 47 had sickle cell anemia, and 12 had other sickle cell diseases. All patients underwent pulmonary function tests, chest computed tomography, and echocardiography. Results Abnormalities on computed tomography, echocardiography, and pulmonary function tests were observed in 93.5%, 75.0%; and 70.2% of patients, respectively. A higher frequency of restrictive abnormalities was observed in patients with a history of acute chest syndrome (85% vs. 21.6%; p-value < 0.0001) and among patients with increased left ventricle size (48.2% vs. 22.2%; p-value = 0.036), and a higher frequency of reduced respiratory muscle strength was observed in patients with a ground-glass pattern (33.3% vs. 4.3%; p-value = 0.016). Moreover, a higher frequency of mosaic attenuation was observed in patients with elevated tricuspid regurgitation velocity (61.1% vs. 24%; p-value = 0.014). Compared to patients with other sickle cell diseases, sickle cell anemia patients had suffered increased frequencies of acute pain episodes, and acute chest syndrome, and exhibited mosaic attenuation on computed tomography, and abnormalities on echocardiography. Conclusion A significant interrelation between abnormalities of the pulmonary and cardiovascular systems was observed in sickle cell disease patients. Furthermore, the severity of the cardiopulmonary parameters among patients with sickle cell anemia was greater than that of patients with other sickle cell diseases.
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Affiliation(s)
| | | | - Ricardo Bedirian
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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