Intermittent claudication and muscle fiber fine structure: correlation between clinical and morphological data

Dysregulated Genes, MicroRNAs, Biological Pathways, and Gastrocnemius Muscle Fiber Types Associated With Progression of Peripheral Artery Disease: A Preliminary Analysis

Background Peripheral artery disease (PAD) is associated with gastrocnemius muscle abnormalities. However, the biological pathways associated with gastrocnemius muscle dysfunction and their associations with progression of PAD are largely unknown. This study characterized differential gene and microRNA (miRNA) expression in gastrocnemius biopsies from people without PAD compared with those with PAD. Participants with PAD included those with and without PAD progression. Methods and Results mRNA and miRNA sequencing were performed to identify differentially expressed genes, differentially expressed miRNAs, mRNA-miRNA interactions, and associated biological pathways for 3 sets of comparisons: (1) PAD progression (n=7) versus non-PAD (n=7); (2) PAD no progression (n=6) versus non-PAD; and (3) PAD progression versus PAD no progression. Immunohistochemistry was performed to determine gastrocnemius muscle fiber types and muscle fiber size. Differentially expressed genes and differentially expressed miRNAs were more abundant in the comparison of PAD progression versus non-PAD compared with PAD with versus without progression. Among the top significant cellular pathways in subjects with PAD progression were muscle contraction or development, transforming growth factor-beta, growth/differentiation factor, and activin signaling, inflammation, cellular senescence, and notch signaling. Subjects with PAD progression had increased frequency of smaller Type 2a gastrocnemius muscle fibers in exploratory analyses. Conclusions Humans with PAD progression exhibited greater differences in the number of gene and miRNA expression, biological pathways, and Type 2a muscle fiber size compared with those without PAD. Fewer differences were observed between people with PAD without progression and control patients without PAD. Further study is needed to confirm whether the identified transcripts may serve as potential biomarkers for diagnosis and progression of PAD.

Skeletal Muscle Pathology in Peripheral Artery Disease: A Brief Review

This brief review summarizes current evidence regarding lower extremity peripheral artery disease (PAD) and lower extremity skeletal muscle pathology. Lower extremity ischemia is associated with reduced calf skeletal muscle area and increased calf muscle fat infiltration and fibrosis on computed tomography or magnetic resonance imaging. Even within the same individual, the leg with more severe ischemia has more adverse calf muscle characteristics than the leg with less severe ischemia. More adverse computed tomography-measured calf muscle characteristics, such as reduced calf muscle density, are associated with higher rates of mobility loss in people with PAD. Calf muscle in people with PAD may also have reduced mitochondrial activity compared with those without PAD, although evidence is inconsistent. Muscle biopsy document increased oxidative stress in PAD. Reduced calf muscle perfusion, impaired mitochondrial activity, and smaller myofibers are associated with greater walking impairment in PAD. Preliminary evidence suggests that calf muscle pathology in PAD may be reversible. In a small uncontrolled trial, revascularization improved both the ankle-brachial index and mitochondrial activity, measured by calf muscle phosphocreatine recovery time. A pilot clinical trial showed that cocoa flavanols increased measures of myofiber health, mitochondrial activity, and capillary density while simultaneously improving 6-minute walk distance in PAD. Calf muscle pathological changes are associated with impaired walking performance in people with PAD, and interventions that both increase calf perfusion and improve calf muscle health are promising therapies to improve walking performance in PAD.

Regeneration of Mitochondrial Function in Gastrocnemius Muscle in Peripheral Arterial Disease After Successful Revascularisation

OBJECTIVE

Myopathy, characterised by altered mitochondrial function, is a central part of the pathophysiology of peripheral arterial disease and the aim of this study was to investigate the effect of revascularisation on mitochondrial function.

METHODS

High resolution respirometry was used to investigate mitochondrial respiration and the results were normalised to citrate synthase activity (CSA), a marker of mitochondrial content. Ten patients with symptomatic peripheral arterial disease (study group) and 10 subjects without ischaemia (control group) were included. Ankle brachial index and ultrasound imaging were performed before and after vascular intervention to confirm technically successful revascularisation. Within the study group, muscle biopsies from the gastrocnemius muscle were taken before vascular intervention and six weeks after revascularisation. Within the control group, tissue was harvested once.

RESULTS

There were no significant group differences regarding anthropometric data. CSA showed a significant increase after successful revascularisation (CSA pre-operative 281.4 (252.4-391.8) nmol/min/mg protein vs. CSA post-operative 438.5 (361.4-471.3) nmol/min/mg protein; p = .01) with post-operative return of values to the range of control subjects (CSA control 396.6 (308.2-435.9)). Mitochondrial respiration normalised to CSA in oxidative phosphorylation (P) as well as in electron transfer (E) capacity were significantly reduced post-operatively when compared with pre-operative values (P pre-operative 0.218 (0.196-0.266) pmol/(sec×mg) per CSA vs. post-operative 0.132 (0.116-0.150) pmol/(sec×mg) per CSA, p = .007; E pre-operative 0.230 (0.195-0.279) pmol/(sec×mg) per CSA vs. post-operative 0.129 (0.120-0.154) pmol/(sec×mg) per CSA, p = .005) meaning a post-operative return of values to within the range of control subjects (P control 0.124 (0.080-0.155) pmol/(sec×mg) per CSA; E control 0.121 (0.079-0.125) pmol/(sec×mg) per CSA).

CONCLUSION

With these results, it has been shown that the initially impaired mitochondrial function and content can normalise after revascularisation.

Relationships between pathology and pain severities: a review

The relationships between pathology severity and pain severity are reviewed using the literature available for humans. The aim is to help veterinary radiologists, physicians and pathologists recognise the disorders in which severity of a lesion is likely to be related to the severity of pain or to incipient pain. Specific features or lesions within the following conditions showed a relationship with pain score, which was usually assessed with a visual analogue scale: inflammation; pancreatitis; ileitis; mucositis; fasciitis; synovitis; arthritis; lower back pain; disc herniation; sciatica; scoliosis; myalgia; cancer; arteriosclerosis; skin ulcers; mastalgia; skin and oral neuropathies; endometriosis; hepatopathy and chronic pulp diseases of the teeth. As experience with magnetic resonance imaging grows, there will be further opportunities to look for quantitative relationships in humans between pathology and pain severities. This information will be useful to veterinarians and other people working with animals in evaluating pain in animals in their care.

Age-associated decrease of type IIA/B human skeletal muscle fibers

Elderly individuals often fall because of poor muscle strength and reduced balancing ability related to muscle aging. However, it is unclear whether changes in muscle fiber types contribute to poor strength or imbalance. We studied age- associated changes in human skeletal muscle fibers using muscle biopsy specimens taken from 65 male and female Chinese patients aged 17-96 years. The muscle specimens were cryosectioned with alkaline triphosphatase staining at pH 4.4, followed by image analysis. We analyzed morphologic observations and performed quantitative analyses of the number, size, and area percentage of different types of skeletal muscle fibers and connective tissues. Types IIA and IIB muscle fibers decreased with age in the area percentage, fiber number percentage, and mean fiber area, whereas Type I fibers increased in area and number but not in size. Morphologically, Type II fibers appeared smaller and flatter. Our findings suggest deterioration in muscle quality and balancing coordination in elderly patients. We provide data to help determine treatments for reversing muscle fiber changes and reducing the number of falls and related fractures in patients.

Morphological, histochemical, and interstitial pressure changes in the tibialis anterior muscle before and after aortofemoral bypass in patients with peripheral arterial occlusive disease

BACKGROUND

Morphological and electrophysiological studies of ischemic muscles in peripheral arterial disease disclosed evidence of denervation and fibre atrophy. The purpose of the present study is to describe morphological changes in ischemic muscles before and after reperfusion surgery in patients with peripheral occlusive arterial disease, and to provide an insight into the effect of reperfusion on the histochemistry of the reperfused muscle.

METHODS

Muscle biopsies were obtained from the tibialis anterior of 9 patients with chronic peripheral arterial occlusive disease of the lower extremities, before and after aortofemoral bypass, in order to evaluate the extent and type of muscle fibre changes during ischemia and after revascularization. Fibre type content and muscle fibre areas were quantified using standard histological and histochemical methods and morphometric analysis. Each patient underwent concentric needle electromyography, nerve conduction velocity studies, and interstitial pressure measurements.

RESULTS

Preoperatively all patients showed muscle fibre atrophy of both types, type II fibre area being more affected. The mean fibre cross sectional area of type I was 3,745 microm2 and of type II 4,654 microm2. Fibre-type grouping, great variation in fibre size and angular fibres were indicative of chronic dennervation-reinnervation, in the absence of any clinical evidence of a neuropathic process. Seven days after the reperfusion the areas of both fibre types were even more reduced, being 3,086 microm2 for type I and 4,009 microm2 for type II, the proportion of type I fibres, and the interstitial pressure of tibialis anterior were increased.

CONCLUSIONS

The findings suggest that chronic ischemia of the leg muscles causes compensatory histochemical changes in muscle fibres resulting from muscle hypoxia, and chronic dennervation-reinnervation changes, resulting possibly from ischemic neuropathy. Reperfusion seems to bring the oxidative capacity of the previously ischemic muscle closer to normal.

Altered surface myoelectric signals in peripheral vascular disease: correlations with muscle fiber composition

Conduction velocity (CV) and median frequency (MDF) during tetanic electrical stimulation of the tibialis anterior muscle were evaluated in patients with uncomplicated peripheral arterial occlusive disease. Results were analyzed with respect to biopsy determination of diameter and proportion of types 1 and 2 muscles fibers. Initial MDF and CV correlated positively with type 2, but not type 1 fiber diameter. Initial MDF was reduced bilaterally in patients with unilateral peripheral arterial occlusive disease as compared to normal subjects, indicating that chronic ischemia alone cannot explain the altered myoelectric signal. Physical training increased pain-free walking distance and raised initial MDF, though CV remained unchanged. Fatigue indices were highly interrelated, but showed no correlation with any of the other evaluation variables. Thus, initial MDF, a correlate of type 2 muscle fiber distribution in chronically ischemic tibialis anterior muscles, is altered in peripheral vascular disease. However, muscle ischemia alone cannot explain all aspects of this abnormality.

Progression of neuropathy in peripheral arterial disease

Atherosclerotic peripheral arterial disease (PAD) can cause muscle denervation, but whether it is associated with more severe peripheral nerve disease is not clear. Equally unclear is the effect of exercise training on the neuromuscular aspects of this disease. We performed serial electrophysiologic studies (nerve conduction studies and quantitative electromyography) and muscle strength assessment on 16 patients with moderately severe PAD. Seven of the patients were assigned to a natural history (control) group and 9 to an exercise training group. Over study periods ranging from 3 to 23 months, 6 of 7 patients in the control group and 8 of 9 patients in the exercise training group showed progression of multifocal neuropathic disease in their ischemic legs. For equivalent lengths of time, the degree of neuropathic progression was not significantly different between the control and exercise training groups. There was a significant decline in muscle strength for the control group but not for the exercise training group. These results demonstrate that PAD can be associated with the development of a multifocal predominantly motor neuropathy, which is most likely ischemic in etiology. Furthermore, exercise training does not pose an additional risk for the development of neuropathy in patients with moderately severe PAD.

Increased technetium uptake is not equivalent to muscle necrosis: scintigraphic, morphological and intramuscular pressure analyses of sore muscles after exercise

A scintigraphic technique employing technetium pyrophosphate uptake was used to identify the area of skeletal muscle damage in the lower leg of four runners 24 h after an ultramarathon footrace (160 km). Most of the race had been run downhill which incorporated an extensive amount of eccentric work. Soreness was diffuse throughout the posterior region of the lower leg. In order to interpret what increased technetium uptake reflects and to express extreme endurance related damages, a biopsy was taken from the 3-D position of abnormal uptake. In addition, intramuscular pressures were determined in the deep posterior compartment. Scintigraphs revealed increased technetium pyrophosphate uptake in the medial portion of the gastrocnemius muscle. For 3698 fibres analysed, 33 fibres (1%) were necrotic, while a few other fibres were either atrophic or irregular shaped. A cluster of necrotic fibres occurred at the fascicular periphery for one subject and fibre type grouping occurred for another. Ultrastructural analysis revealed Z-line streaming near many capillaries and variously altered subsarcolemmal mitochondria including some with paracrystalline inclusions. The majority of the capillaries included thickened and irregular shaped endothelial cells. Intramuscular pressures of the deep posterior compartment were slightly elevated (12-15 mmHg) for three of the four subjects. Increased technetium uptake following extreme endurance running does not just reflect muscle necrosis but also subtle fibre abnormalities. Collectively, these pathological findings are attributed to relative ischaemia occurring during the race and during pre-race training, whereas, intramuscular pressure elevations associated with muscle soreness are attributed to mechanical stress caused by extensive eccentric work during the race.

Skeletal muscle metabolism during exercise and recovery in patients with respiratory failure

BACKGROUND

Patients with respiratory failure have early fatiguability which may be due to limitation of oxygen supply for oxidative (mitochondrial) ATP synthesis. Skeletal muscle in exercise and recovery was studied to examine the effect of chronic hypoxia on mitochondrial activity in vivo.

METHODS

The skeletal muscle of five patients with respiratory failure (PaO2 < 9 kPa) was studied by phosphorus-31 magnetic resonance spectroscopy and compared with 10 age and sex matched controls. Patients lay in a 1.9 Tesla superconducting magnet with the gastrocnemius muscle overlying a six cm surface coil. Spectra were acquired at rest, during plantar flexion exercise, and during recovery from exercise. Relative concentrations of inorganic phosphate (Pi), phosphocreatine (PCr) and ATP were measured from peak areas, and pH and free ADP concentration were calculated. For the start of exercise, the rates of PCr depletion and estimated lactic acid production were calculated. For the post exercise recovery period, the initial rate of PCr recovery (a quantitative measure of mitochondrial ATP synthesis), the apparent Vmax for mitochondrial ATP synthesis (calculated from initial PCr resynthesis and the end exercise ADP concentration which drives this process), and the recovery half times of PCr, Pi, and ADP (also measures of mitochondrial function) were determined.

RESULTS

Considerably greater and faster PCr depletion and intracellular acidosis were found during exercise. This is consistent with limitation of oxygen supply to the muscle and might explain the early fatiguability of these patients. There was no abnormality in recovery from exercise, however, suggesting that mitochondria function normally after exercise.

CONCLUSIONS

These results are consistent with one or more of the following: (a) decreased level of activity of these patients; (b) changes in the fibre type of the muscle; (c) decreased oxygen supply to the muscle during exercise but not during recovery. They are not consistent with an intrinsic defect of mitochondrial ATP synthesis in skeletal muscle in respiratory failure.

Chronic changes in skeletal muscle histology and function in peripheral arterial disease

BACKGROUND

Peripheral arterial disease (PAD) is associated with an impairment in exercise performance and muscle function that is not fully explained by the reduced leg blood flow during exercise. This study characterized the effects of PAD on muscle function, histology, and metabolism.

METHODS AND RESULTS

Twenty-six patients with PAD and six age-matched control subjects were studied. Ten of the PAD patients had unilateral disease, which permitted paired comparisons between their diseased and nonsymptomatic legs. All PAD patients had a lower peak treadmill walking time and peak oxygen consumption than controls. Vascular disease (diseased leg in unilateral patients and the most severely diseased leg in bilateral patients) was associated with decreased calf muscle strength compared with control values. In patients with unilateral disease, the diseased legs had a greater percentage of angular fibers (indicating chronic denervation) and a decreased type II fiber cross-sectional area (expressed as percent of total fiber area) compared with the nonsymptomatic, or control, legs. In diseased legs, gastrocnemius muscle strength was correlated with the total calf cross-sectional area (r = 0.78, p < 0.05) and type II fiber cross-sectional area (r = 0.63, p < 0.05). Activities of citrate synthase, phosphofructokinase, and lactate dehydrogenase in all 26 PAD patients (most diseased leg) did not differ from control values. Despite a wide range in citrate synthase activity in PAD patients, activity of this enzyme was not correlated with muscle strength or treadmill exercise performance.

CONCLUSIONS

In patients with PAD, gastrocnemius muscle weakness is associated with muscle fiber denervation and a decreased type II fiber cross-sectional area. In contrast, the PAD patients displayed substantial heterogeneity in muscle enzyme activities that was not associated with exercise performance. Denervation and type II fiber atrophy may contribute to the muscle dysfunction in patients with PAD and further confirm that the pathophysiology of chronic PAD extends beyond arterial obstruction.

Assessment of muscular metabolism in peripheral arterial occlusive disease using 31P nuclear magnetic resonance spectroscopy. Comparison with metabolite concentrations in femoral blood

The behaviour of muscular metabolism was investigated in 10 patients with peripheral arterial occlusive disease stage II at rest and after maximum ergometric calf exercise. The intracellular concentrations of phosphocreatine, inorganic phosphate and adenosine triphosphate as well as muscle pH were measured by means of 31P magnetic resonance spectroscopy and compared with those from a control group. In addition, arteriovenous differences in concentrations of lactate, pyruvate, ammonia, hypoxanthine and alanine in the femoral blood were determined. The fall in intracellular phosphocreatine concentration during exercise was significantly greater in the calf muscles of patients with arterial occlusion than in controls and correlated linearly with the increase in femoral arteriovenous differences in lactate, ammonia and alanine. A significant fall in intracellular pH occurred during muscular activity only in the patient group, but not in the identically exercised control group. The fall in pH correlated closely with the rise in arteriovenous lactate difference in the femoral blood. The intramuscular ATP concentration remained constant throughout the exercise procedure. The behaviour of both the directly and indirectly measured metabolites permits the deduction of activation of the creatine kinase reaction, glycolysis, myokinase reaction and the purine nucleotide cycle during exercise-induced hypoxia in the presence of arterial occlusive disease. The anaerobic production of energy is sufficient to maintain the ATP concentration even during claudication pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Fibre loss and distribution in skeletal muscle from patients with severe peripheral arterial insufficiency

Cross-sections of whole calf muscles (m soleus and m gastrocnemius) were obtained from five previously clinically health individuals who had died accidentally (controls) and from amputated legs of five patients of similar age with severe peripheral arterial insufficiency. In the controls, but not in the patients, a characteristic distribution of different fibre types over the entire cross-sections was found, with a relative increase in number of (slow twitch) type 1 fibres in the central parts of both m soleus and m gastrocnemius. A pronounced neuromuscular pathomorphology was found in the patients, especially in m gastrocnemius. The findings suggested widespread damage to the fibres. There was also a lower total number of fibres in these ischaemic muscles; about 50% of the fibres of m gastrocnemius seemed to have disappeared. The results suggested that the relative inactivity as such may be responsible for some of the structural changes, above all the dedifferentiated distribution of different fibres over the cross-section. However, repeated acute and chronic subacute ischaemia may also cause, in the long term, irreparable damage and loss of many individual fibres. This may explain why muscles of patients with peripheral arterial insufficiency are also weaker, during single contractions. The lack of corresponding muscular atrophy in these patients seems to a large extent to be explained by an increase in connective tissue.

Muscle pathomorphology in m. quadriceps of marathon runners. Early signs of strain disease or functional adaptation?

Muscle biopsies were obtained from m. vastus lateralis of five male marathon runners and five sprinters. The athletes performed their last competition at least 2 weeks prior to the investigation. No clinical signs of discomfort or injury were observed in the runners. The biopsy specimens from the sprinters showed an ordinary overall morphology, although fibre sizes varied considerably within and between the individuals. In contrast, in the marathon runners, structural deviations of pathologic value appeared in four out of five subjects. The fibre shapes were irregular, irrespective of fibre type, and internal architectural changes were common. An increased amount of connective tissue was found. A majority of fibres showed one or more central nuclei. A few fibres were flat and there were also evidence of fibre type grouping. The divergent picture might be an expression of repeated fibre injury with subsequent processes. If so, a peripheral, relative, arterial insufficiency is suggested as a possible aetiology. However, it cannot be ruled out that the deviations express a functional adaptation to the extreme endurance demands.

Endurance, what is it? Muscle morphology after an extremely long distance run

Biopsies of m. vastus lateralis of a well-trained 46-year-old man were analysed before and after an extremely long distance run (3529 km in 7 weeks). After the period of running, both a decrease of fibre size and a neuromuscular pathology were found. Muscle fibre degeneration and regeneration, especially of type 2 (fast-twitch) fibres, was seen as well as signs of damage to the peripheral nerves. The relative amount of type 1 (slow-twitch) fibres was higher after the run. The relationships between light and electron microscopical characteristics normally present could not be found in the specimens of this man. The changes in fibre size as well as the other microscopical characteristics may express an adaptation through more or less complete fibre transformation. However, we could not rule out that a selective elimination of fibres also contributed to the observed changes. In that case, the underlying pathophysiology might have been a peripheral arterial insufficiency which was related to the extreme functional demands. These disturbances may have affected type 2 fibres more than type 1 fibres. Endurance may, on this basis, express an adaptation of the muscle through elimination of weak fibres, that is, fibres related to limited functional capacities.

Skeletal muscle morphology, metabolism and function in smokers and non-smokers. A study on smoking-discordant monozygous twins

Differences in skeletal muscle characteristics between smokers and non-smokers have been demonstrated in a previous study ( Orlander , J. et al. 1979, Acta Physiol Scand 107:39-46). In order to decide whether these differences had a genetical background, six pairs of smoking-discordant monozygous twins were studied with respect to muscle (vastus lateralis) morphology, metabolism and function. The percentage type I fibres was lower in the smokers, who also had smaller diameters of this fibre type. Cytochrome oxidase activity was decreased in the smokers. No differences were seen for other enzymes of energy metabolism, capillary density, isometric or dynamic strength, or short-term muscular endurance. The non-smokers tended to be more physically active. In four ex-smoker/non-smoker pairs, no significant differences were found for the investigated parameters. It was concluded, that the difference in fibre type distribution is not due to a hereditary predisposition to take up smoking. Furthermore, the small difference in physical activity level is an unlikely cause. Thus, smoking per se appears to be the most plausible explanation for the difference in fibre type distribution and associated muscle characteristics. No definitive conclusion regarding the reversibility of the smoking-related differences can be drawn from the present results.

Hemiplegic atrophy. Morphological findings in the anterior tibial muscle of patients with cerebral vascular accidents

Anterior tibial muscle biopsies of the hemiplegic side of 16 patients with a cerebrovascular accident in the middle cerebral artery region were analyzed qualitatively and quantitatively by enzyme histochemistry and electron microscopy. Patients grouped according to the time lapsed as from the occurrence of the accident (1-17 months) demonstrated a progressive decrease in the fiber diameter and changes in fiber type distribution with predominant type II atrophy and type I predominance. Nuclear internalization, myopathic alterations, and perifascicular fatty infiltrations were observed constantly. In the affected fibers the ultrastructural findings were myofibrillar alterations with the formation of rods and cytoplasmic bodies. There was accumulation of lipofuscin, glycogen, and lipid droplets. Microvascular changes were observed frequently. Biopsies from the asymptomatic legs were either normal or showed age-related muscle alterations. Correlation was noted between the clinical and functional status of the patients and the morphological aspects seen in muscle biopsies.

Autophagic response to strenuous exercise in mouse skeletal muscle fibers

Strenuous physical exercise induces necrosis of skeletal muscle fibers and increases lysosomal enzyme activities in surviving muscle fibers. This study examines the ultrastructural basis of the stimulation of the lysosomal system in mouse vastus medialis muscle during the appearance and repair of exercise-induced (9 h of running) injuries. Necrotic fibers appeared the day after exercise and an inflammatory response with the replacement of necrotic fibers by phagocytes was highest 2-3 days after exertion. Ultrastructural study of surviving muscle fibers revealed numerous autophagic vacuoles, residual bodies, and spheromembranous structures at the periphery of myofibers, especially in fibers adjacent to necrotic fibers. The autophagic response was most prominent between 2 and 7 days after exertion. Autophagic vacuoles with double or single limiting membranes contained mitochondria at various stages of degradation. Vacuolar and multilamellar structures were also observed in regenerating muscle fibers. The structure of injured skeletal muscle fibers returned to normal within 2 weeks. It is proposed that increased autophagic activity could be related to the breakdown of cellular constituents of surviving muscle fibers to provide structural elements for regenerating muscle fibers.

Distribution of different fiber types in human skeletal muscles: effects of aging studied in whole muscle cross sections

The effects of aging on the total number and size of fibers, and the proportion and distribution of type 1 (slow twitch) and type 2 (fast twitch) fibers were studied in cross sections (15 mu thick) of autopsied whole m. vastus lateralis from two age groups. Each group consisted of six, previously physically healthy males (mean age 72 +/- 1 years and 30 +/- 6 years, respectively). The size of the muscles of the older individuals was 18% smaller (P less than 0.01) and the total number of fibers was 25% lower (P less than 0.01) than those of the young individuals (mean number 364,000 +/- 50,000 vs 478,000 +/- 56,000). There was, however, no significant difference in the mean fiber size (indirectly determined) or the proportion of the two fiber types, though a preferential reduction in type 2 fiber number in the aged individuals was seen. The relative occurrence of the fiber types at various depths in the aged muscles was found to be more even than in muscles from the young individuals. The results suggest that the aging atrophy in m. vastus lateralis, at least up to the age of 70, is primarily the result of a loss of fibers.

Distribution of different fibre types in human skeletal muscles. I. Method for the preparation and analysis of cross-sections of whole tibialis anterior

The aim of this study was to examine whether small biopsy specimens are representative of the whole human skeletal muscle or whether the different fibre types are unevenly distributed at different depths of the muscle. Ten micrometre thick cross-sections of whole human tibialis anterior were prepared using LKB PMV Cryo-Microtomes with a stroke length of 160 to 480 mm and the sections were stained for myofibrillar ATPase according to a modified procedure. The total and relative number of different fibres (Types 1 and 2) was determined in every 9th mm2 of the section. The data obtained were analysed by means of a computer program, which allowed assessment of bivariate data in the form of contour plots. The total number of fibres varied greatly between individuals (from 96 000 to 162 000; five individuals). The relative number of different fibres varied systematically in all individuals as a function of depth in the muscle. There was a gradual, often dramatic, relative increase in Type 2 fibre occurrence from the surface of the muscle (about 10--25%) towards the deeper regions (30--50%), the maximum being approximately along a line slightly posterior to the middle of the muscle. Additionally, superficial peaks were seen in places. In conclusion, the fibre type distribution in the tibialis anterior is not random. These results point to the importance of defining biopsy depth.

Distribution of different fibre types in human skeletal muscles. 2. A study of cross-sections of whole m. vastus lateralis

In order to determine the total number of fibres and the extent to which the relative occurrence of different fibre types varies within m. vastus lateralis, 15 micrometers thick cross-sections of whole muscles were prepared. The total number of type 1 and type 2 fibres was determined in every 48th square millimetre of the section, and the results thus obtained were analysed using a computer program allowing an assessment of bivariate data in the form of contour plots. The total number of fibres varied both in proximal to distal direction in the same muscle and between individuals. No obvious correlation existed between the mean fibre area and the muscle cross-sectional area. The proportion of type 1 fibres in the whole muscle varied between individuals (from 44% to 57%) with a mean value for all five of 52%. The distribution of different fibre types varied within the muscle, mainly as a function of depth, with a predominance to type 2 fibres at the surface and type 1 fibres in deeper regions of the muscle. Thus, the fibre type distribution in m. vastus lateralis is not random. This must be taken into consideration when data on fibre type composition are compared with functional variables.

Human skeletal muscle metabolism and morphology after temporary incomplete ischaemia

Incomplete ischaemia was caused by clamping the aorta during reconstructive vascular surgery. After restoration of the blood flow extensive metabolic and morphological changes in the muscle tissue were observed. The adenylate (ATP + ADP + AMP) and the creatine (PCr + Cr) pools declined 30-40% and the energy charge of the adenine nucleotides dropped significantly. The metabolic pool changes were closely related to the changes in the lactate/pyruvate ratios. Morphological signs of membrane disturbances, such as fibre oedema and swelling of mitochondria, were seen in many muscle fibres 30 min after declamping. 5 days postoperatively, a number of mitochondrial abnormalities were observed and fibre regeneration was seen in places. The relative number of Type 2 fibres and the width of the capillary lumen were both related to the decrease of the metabolic parameters. Thus, the metabolic state and the fine structure of the incompletely ischaemic muscle were closely related to each other. The amount of Type 2 fibres seemed to be of special importance for the patho-physiological events in intermittently ischaemic muscle fibres.

Is muscle structure influenced by genetical or functional factors? A study of three forearm muscles

Relative fibre type composition and weights of 3 forearm muscles; the m. extensor carpi radialis longus (ECRL), m. extensor carpi radialis brevis (ECRB) and the m. brachioradialis (BR) from both the left and right arm were determined. Fibre type 1 muscle weight of the ECRB, which co-contracts posturally during gripping, was significantly greater in the right than the left forearm. Weights of type 2 fibres in this muscle were, however, similar in the left and right arm. Fibre type weights of both ECRL and BR were also similar in both arms. For all these muscles, intra-individual co-variation in relative fibre type occurrence was found. It is proposed that genetic factors may play a role in determining the relative fibre type composition at least as far as the upper extremities are concerned. However, functional demands are also important determining factors for development of muscle structure.

Intermittent claudication and muscle fiber fine structure: morphometric data on mitochondrial volumes

The mitochondrial volume densities (Vmit) of the different fiber types (type 1, type 2A, type 2B) were estimated in bilaterally obtained biopsies from 22 patients with unilateral intermittent claudication. These data, which were obtained from structurally intact fibers, were compared with clinical data from the same subject. In both the asymptomatic and symptomatic legs, Vmit 1 greater than Vmit 2A greater than Vmit 2B. Furthermore, Vmit 1 covariated with Vmit 2A and Vmit 2A with Vmit 2B in the asymptomatic legs (as in healthy subjects) but not in the symptomatic legs. Vmit 2 (mainly Vmit 2A) covariated with the age of the subjects in both legs. Vmit Tot was higher in the symptomatic legs than in the asymptomatic legs. This was mainly due to increase in the oxidative fibers, type 1 and type 2A. Usually, Vmit in the asymptomatic legs covariated significantly with the results of the functional tests (initial pain and maximum walking tolerance), while only Vmit 2A in the symptomatic legs showed such a correlation. However, the difference between the two legs concerning Vmit 1 was also correlated to the walking tolerance. Patients with high stenosis or occlusion showed higher Vmit Tot than did those with low obstacles. The results conclusively show that a fiber type-specific adaptation to ischemia occurs through an increase of mitochondrial content of oxidative fibers, which suggests that hypoxia may influence the control of synthesis or degradation of mitochondrial proteins.