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Blow TA, Murthy A, Grover R, Schwitzer E, Nanus DM, Halpenny D, Plodkowski AJ, Jones LW, Goncalves MD. Profiling of Skeletal Muscle and Adipose Tissue Depots in Men with Advanced Prostate Cancer Receiving Different Forms of Androgen Deprivation Therapy. EUR UROL SUPPL 2023; 57:1-7. [PMID: 38020528 PMCID: PMC10658404 DOI: 10.1016/j.euros.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background Androgen deprivation therapy (ADT) is a common treatment modality for men with prostate cancer. Increases in adipose tissue mass and decreases in skeletal muscle mass are known on-target adverse effects of standard ADT. The effects of newer agents such as abiraterone acetate (ABI) and enzalutamide (ENZA) on body composition and how these compare with standard luteinizing hormone-releasing hormone agonists (aLHRHs) are unclear. Objective To assess the effects of different forms of androgen deprivation therapy on body composition in men with prostate cancer. Design setting and participants Using a retrospective design, 229 patients receiving aLHRHs alone (n = 120) or in combination with ABI (n = 53) or ENZA (n = 56) were studied. Outcome measurements and statistical analysis Muscle, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were assessed at baseline, 6 mo, and 18 mo after initiating therapy using a cross-sectional densitometry analysis performed on standard of care computed tomography images. Response trajectories for all treatment groups were calculated via a two-way analysis of variance post hoc test, for both within-group and between-group differences. Results and limitations Treatment with aLHRHs, ABI, and ENZA was associated with a median muscle volume loss of -1.4%, -4.8%, and -5.5% at 6 mo, and -7.1%, -8.1%, and -8.3% at 18 mo, respectively. Therapy with aLHRHs was associated with minimal changes in VAT (0.3% at 6 mo and -0.1% at 18 mo). ABI therapy was associated with significant increases in VAT at 6 mo (4.9%) but not at 18 mo (0.5%), and ENZA therapy was associated with significant decreases in VAT (-4.6% at 6 mo and -5.4% at 18 mo). With respect to SAT, treatment with aLHRHs was associated with increases over time (8.6% at 6 mo and 4.7% at 18 mo), ABI was associated with decreases over time (-3.6% at 6 mo and -6.8% at 18 mo), and ENZA had no clear effects (1.7% at 6 mo and 3.3% at 18 mo). Conclusions ADT regimens cause significant short-term losses in muscle mass, with the most rapid effects occurring with ABI and ENZA. The three regimens have disparate effects on SAT and VAT, suggesting distinct roles of androgens in these tissues. Patient summary Androgen deprivation therapy alters body composition in men with prostate cancer. Abiraterone and enzalutamide are associated with losses in muscle mass compared with luteinizing hormone-releasing hormone agonists. These treatments impact subcutaneous and visceral fat mass, suggesting distinct roles of androgens in these tissues.
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Affiliation(s)
| | | | | | | | | | | | | | - Lee W. Jones
- Weill Cornell Medicine, New York, NY, USA
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Andonian B, Ross LM, Zidek AM, Fos LB, Piner LW, Johnson JL, Belski KB, Counts JD, Pieper CF, Siegler IC, Bales CW, Porter Starr KN, Kraus WE, Huffman KM. Remotely Supervised Weight Loss and Exercise Training to Improve Rheumatoid Arthritis Cardiovascular Risk: Rationale and Design of the Supervised Weight Loss Plus Exercise Training-Rheumatoid Arthritis Trial. ACR Open Rheumatol 2023; 5:252-263. [PMID: 36992545 PMCID: PMC10184018 DOI: 10.1002/acr2.11536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 03/31/2023] Open
Abstract
Patients with rheumatoid arthritis (RA) remain at an increased risk for cardiovascular disease (CVD) and mortality. RA CVD results from a combination of traditional risk factors and RA-related systemic inflammation. One hypothetical means of improving overall RA CVD risk is through reduction of excess body weight and increased physical activity. Together, weight loss and physical activity can improve traditional cardiometabolic health through fat mass loss, while also improving skeletal muscle health. Additionally, disease-related CVD risk may improve as both fat mass loss and exercise reduce systemic inflammation. To explore this hypothesis, 26 older persons with RA and overweight/obesity will be randomized to 16 weeks of a usual care control arm or to a remotely Supervised Weight Loss Plus Exercise Training (SWET) program. A caloric restriction diet (targeting 7% weight loss) will occur via a dietitian-led intervention, with weekly weigh-ins and group support sessions. Exercise training will consist of both aerobic training (150 minutes/week moderate-to-vigorous exercise) and resistance training (twice weekly). The SWET remote program will be delivered via a combination of video conference, the study YouTube channel, and study mobile applications. The primary cardiometabolic outcome is the metabolic syndrome Z score, calculated from blood pressure, waist circumference, high-density lipoprotein cholesterol, triglycerides, and glucose. RA-specific CVD risk will be assessed with measures of systemic inflammation, disease activity, patient-reported outcomes, and immune cell function. The SWET-RA trial will be the first to assess whether a remotely supervised, combined lifestyle intervention improves cardiometabolic health in an at-risk population of older individuals with RA and overweight/obesity.
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Affiliation(s)
| | | | | | - Liezl B. Fos
- Duke University School of MedicineDurhamNorth Carolina
| | - Lucy W. Piner
- Duke University School of MedicineDurhamNorth Carolina
| | | | | | | | | | | | - Connie W. Bales
- Duke University School of Medicine and Geriatric Research, Education, and Clinical Center, Durham VA Medical CenterDurhamNorth Carolina
| | - Kathryn N. Porter Starr
- Duke University School of Medicine and Geriatric Research, Education, and Clinical Center, Durham VA Medical CenterDurhamNorth Carolina
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Andonian BJ, Johannemann A, Hubal MJ, Pober DM, Koss A, Kraus WE, Bartlett DB, Huffman KM. Altered skeletal muscle metabolic pathways, age, systemic inflammation, and low cardiorespiratory fitness associate with improvements in disease activity following high-intensity interval training in persons with rheumatoid arthritis. Arthritis Res Ther 2021; 23:187. [PMID: 34246305 PMCID: PMC8272378 DOI: 10.1186/s13075-021-02570-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/29/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Exercise training, including high-intensity interval training (HIIT), improves rheumatoid arthritis (RA) inflammatory disease activity via unclear mechanisms. Because exercise requires skeletal muscle, skeletal muscle molecular pathways may contribute. The purpose of this study was to identify connections between skeletal muscle molecular pathways, RA disease activity, and RA disease activity improvements following HIIT. METHODS RA disease activity assessments and vastus lateralis skeletal muscle biopsies were performed in two separate cohorts of persons with established, seropositive, and/or erosive RA. Body composition and objective physical activity assessments were also performed in both the cross-sectional cohort and the longitudinal group before and after 10 weeks of HIIT. Baseline clinical assessments and muscle RNA gene expression were correlated with RA disease activity score in 28 joints (DAS-28) and DAS-28 improvements following HIIT. Skeletal muscle gene expression changes with HIIT were evaluated using analysis of covariance and biological pathway analysis. RESULTS RA inflammatory disease activity was associated with greater amounts of intramuscular adiposity and less vigorous aerobic exercise (both p < 0.05). HIIT-induced disease activity improvements were greatest in those with an older age, elevated erythrocyte sedimentation rate, low cardiorespiratory fitness, and a skeletal muscle molecular profile indicative of altered metabolic pathways (p < 0.05 for all). Specifically, disease activity improvements were linked to baseline expression of RA skeletal muscle genes with cellular functions to (1) increase amino acid catabolism and interconversion (GLDC, BCKDHB, AASS, PYCR, RPL15), (2) increase glycolytic lactate production (AGL, PDK2, LDHB, HIF1A), and (3) reduce oxidative metabolism via altered beta-oxidation (PXMP2, ACSS2), TCA cycle flux (OGDH, SUCLA2, MDH1B), and electron transport chain complex I function (NDUFV3). The muscle mitochondrial glycine cleavage system (GCS) was identified as critically involved in RA disease activity improvements given upregulation of multiple GCS genes at baseline, while GLDC was significantly downregulated following HIIT. CONCLUSION In the absence of physical activity, RA inflammatory disease activity is associated with transcriptional remodeling of skeletal muscle metabolism. Following exercise training, the greatest improvements in disease activity occur in older, more inflamed, and less fit persons with RA. These exercise training-induced immunomodulatory changes may occur via reprogramming muscle bioenergetic and amino acid/protein homeostatic pathways. TRIAL REGISTRATION ClinicalTrials.gov , NCT02528344 . Registered on 19 August 2015.
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Affiliation(s)
- Brian J Andonian
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Andrew Johannemann
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Monica J Hubal
- Department of Kinesiology, Indiana University-Purdue University Indianapolis School of Health & Human Sciences, Indianapolis, IN, USA
| | | | - Alec Koss
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - David B Bartlett
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kim M Huffman
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
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Skeletal muscle disease in rheumatoid arthritis: the center of cardiometabolic comorbidities? Curr Opin Rheumatol 2021; 32:297-306. [PMID: 32141950 DOI: 10.1097/bor.0000000000000697] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Despite its critical roles in body movement, structure, and metabolism, skeletal muscle remains underappreciated in the context of rheumatoid arthritis. In rheumatoid arthritis, chronic inflammation, physical inactivity, and medication toxicities impair skeletal muscle. These skeletal muscle alterations contribute to continued rheumatoid arthritis disparities in physical function and cardiometabolic health. RECENT FINDINGS In the prebiologic disease-modifying antirheumatic drug era, rheumatoid arthritis skeletal muscle atrophy was the central feature of 'rheumatoid cachexia,' a hypermetabolic state driven by chronic systemic inflammation and muscle protein degradation. In the current era, rheumatoid arthritis muscle deficits are less visible, yet persist as a key component of 'sarcopenic obesity.' In rheumatoid arthritis sarcopenic obesity, chronic inflammation, physical inactivity, and medication toxicities contribute to muscle contractile deficits, inflammation, altered metabolism, and intramuscular adiposity, a key predictor of rheumatoid arthritis disability and insulin resistance. SUMMARY Rheumatoid arthritis skeletal muscle disease in the current era is defined by impaired contractile function (poor strength and endurance) and sarcopenic obesity (decreased muscle mass, increased fat mass, and intramuscular adiposity). These muscle impairments contribute to disability and cardiometabolic disease in rheumatoid arthritis. Management should focus on monitoring of rheumatoid arthritis muscle function and body composition, limiting potentially myotoxic drugs, and prescription of exercise training.
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Khoja SS, Patterson CG, Goodpaster BH, Delitto A, Piva SR. Skeletal muscle fat in individuals with rheumatoid arthritis compared to healthy adults. Exp Gerontol 2019; 129:110768. [PMID: 31678218 PMCID: PMC10119702 DOI: 10.1016/j.exger.2019.110768] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/18/2019] [Accepted: 10/29/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To compare skeletal muscle fat (SMF), intermuscular adipose tissue (IMAT) and subcutaneous adipose tissue (SAT) between individuals with rheumatoid arthritis (RA), and healthy individuals of the same age, and healthy individuals at least 10 years older than those with RA. METHODS Two cross-sectional studies. In the first study, RA subjects were matched by age, sex, and BMI with healthy adults. In the second, RA subjects were matched by sex and BMI to adults 10-20 years older. SMF, IMAT and SAT were measured with Computed Tomography images of the mid-thigh region. We used parametric or non-parametric related-sample tests to compare fat accumulation between RA subjects and healthy adults. RESULTS In the first study SMF was significantly higher in the RA cohort compared to their age-matched healthy counterparts (mean difference = -3.5 HU (95% -6.2, -0.9), p = 0.011), but IMAT and SAT were similar between cohorts. In the second study, SMF, IMAT and SAT were not significantly different between the RA and matched older healthy cohorts. In both studies, there were no significant differences in mid-thigh muscle area between RA subjects and healthy adults. CONCLUSION SMF accumulation in RA was higher than in healthy individuals of similar age, sex, BMI. Accumulation of fat within and around the muscles in RA was not different compared to the matched healthy older individuals, indicating that muscle fat accumulation in RA might mimic a pattern not different from healthy aging.
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Affiliation(s)
- Samannaaz S Khoja
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Charity G Patterson
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Orlando, FL, United States
| | - Anthony Delitto
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sara R Piva
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, United States
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Andonian BJ, Chou CH, Ilkayeva OR, Koves TR, Connelly MA, Kraus WE, Kraus VB, Huffman KM. Plasma MicroRNAs in Established Rheumatoid Arthritis Relate to Adiposity and Altered Plasma and Skeletal Muscle Cytokine and Metabolic Profiles. Front Immunol 2019; 10:1475. [PMID: 31316517 PMCID: PMC6610455 DOI: 10.3389/fimmu.2019.01475] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
Background: MicroRNAs have been implicated in the pathogenesis of rheumatoid arthritis (RA), obesity, and altered metabolism. Although RA is associated with both obesity and altered metabolism, expression of RA-related microRNA in the setting of these cardiometabolic comorbidities is unclear. Our objective was to determine relationships between six RA-related microRNAs and RA disease activity, inflammation, body composition, and metabolic function. Methods: Expression of plasma miR-21, miR-23b, miR-27a, miR-143, miR-146a, and miR-223 was measured in 48 persons with seropositive and/or erosive RA (mean DAS-28-ESR 3.0, SD 1.4) and 23 age-, sex-, and BMI-matched healthy controls. Disease activity in RA was assessed by DAS-28-ESR. Plasma cytokine concentrations were determined by ELISA. Body composition was assessed using CT scan to determine central and muscle adipose and thigh muscle tissue size and tissue density. Plasma and skeletal muscle acylcarnitine, amino acid, and organic acid metabolites were measured via mass-spectroscopy. Plasma lipoproteins were measured via nuclear magnetic resonance (NMR) spectroscopy. Spearman correlations were used to assess relationships for microRNA with inflammation and cardiometabolic measures. RA and control associations were compared using Fisher transformations. Results: Among RA subjects, plasma miR-143 was associated with plasma IL-6 and IL-8. No other RA microRNA was positively associated with disease activity or inflammatory markers. In RA, microRNA expression was associated with adiposity, both visceral adiposity (miR-146a, miR-21, miR-23b, and miR-27a) and thigh intra-muscular adiposity (miR-146a and miR-223). RA miR-146a was associated with greater concentrations of cardiometabolic risk markers (plasma short-chain dicarboxyl/hydroxyl acylcarnitines, triglycerides, large VLDL particles, and small HDL particles) and lower concentrations of muscle energy substrates (long-chain acylcarnitines and pyruvate). Despite RA and controls having similar microRNA levels, RA, and controls differed in magnitude and direction for several associations with cytokines and plasma and skeletal muscle metabolic intermediates. Conclusion: Most microRNAs thought to be associated with RA disease activity and inflammation were more reflective of RA adiposity and impaired metabolism. These associations show that microRNAs in RA may serve as an epigenetic link between RA inflammation and cardiometabolic comorbidities.
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Affiliation(s)
- Brian J Andonian
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States.,Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Ching-Heng Chou
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Olga R Ilkayeva
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Timothy R Koves
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, United States
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Virginia B Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States.,Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States.,Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
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Summers G, Booth A, Brooke-Wavell K, Barami T, Clemes S. Physical activity and sedentary behavior in women with rheumatoid arthritis: a comparison of patients with low and high disease activity and healthy controls. Open Access Rheumatol 2019; 11:133-142. [PMID: 31417323 PMCID: PMC6592056 DOI: 10.2147/oarrr.s203511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: In rheumatoid arthritis (RA) patients, low levels of physical activity (PA) and high levels of sedentary behavior (SB) may play a role in enhancing cardiovascular risk. We do not know how long-term control of disease activity impacts upon daily PA levels and if treated patients attain PA levels seen in healthy controls. We therefore compared habitual levels of PA and SB between female RA patients with low disease activity achieved by anti-tumor necrosis factor (TNF) therapy, those with active arthritis (aRA) and non-RA controls. Methods: We carried out a cross-sectional comparison of 40 RA patients on anti-TNF therapy for >2 years with DAS28<3.2 (tRA), 32 patients on conventional disease modifying anti-rheumatic drugs with DAS28>3.2 (aRA) and 34 healthy controls (C) with the groups matched for age and body mass index. PA was assessed using the ActiGraph accelerometer to determine step count and time spent in moderate-to-vigorous physical activity (MVPA), light activity and sedentary time. Results: Daily step count was 72% higher in tRA and 40% higher in C in comparison to aRA (p<0.01). Sedentary time (as a proportion of wear time) was 10% less in tRA than aRA (p=0.03), while light activity time was 18% higher (p=0.014). Both RA groups had 40% lower MVPA time than C (p=0.001). Only half of either RA group fulfilled current WHO guidelines for PA compared with 82% of controls. Conclusion: RA patients who had long-term disease suppression were more physically active with less SB compared to RA patients with active disease. They had similar light PA and SB to controls although lower MVPA. Behavioral change interventions are likely to be needed in order to restore moderate exercise, further reduce SB and to meet guidelines for daily PA.
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Affiliation(s)
| | - Alison Booth
- Department of Rheumatology, Royal Derby Hospital, Derby, UK
| | | | - Tharaq Barami
- Department of Rheumatology, Royal Derby Hospital, Derby, UK.,Kettering General Hospital , Kettering, UK
| | - Stacy Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Serum retinol-binding protein 4 is associated with insulin resistance in patients with early and untreated rheumatoid arthritis. Joint Bone Spine 2019; 86:335-341. [DOI: 10.1016/j.jbspin.2018.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/01/2018] [Indexed: 01/07/2023]
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Hanaoka BY, Ithurburn MP, Rigsbee CA, Bridges SL, Moellering DR, Gower B, Bamman M. Chronic Inflammation in Rheumatoid Arthritis and Mediators of Skeletal Muscle Pathology and Physical Impairment: A Review. Arthritis Care Res (Hoboken) 2019; 71:173-177. [PMID: 30295435 DOI: 10.1002/acr.23775] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/02/2018] [Indexed: 12/13/2022]
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Andonian BJ, Bartlett DB, Huebner JL, Willis L, Hoselton A, Kraus VB, Kraus WE, Huffman KM. Effect of high-intensity interval training on muscle remodeling in rheumatoid arthritis compared to prediabetes. Arthritis Res Ther 2018; 20:283. [PMID: 30587230 PMCID: PMC6307310 DOI: 10.1186/s13075-018-1786-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/04/2018] [Indexed: 01/01/2023] Open
Abstract
Background Sarcopenic obesity, associated with greater risk of cardiovascular disease (CVD) and mortality in rheumatoid arthritis (RA), may be related to dysregulated muscle remodeling. To determine whether exercise training could improve remodeling, we measured changes in inter-relationships of plasma galectin-3, skeletal muscle cytokines, and muscle myostatin in patients with RA and prediabetes before and after a high-intensity interval training (HIIT) program. Methods Previously sedentary persons with either RA (n = 12) or prediabetes (n = 9) completed a 10-week supervised HIIT program. At baseline and after training, participants underwent body composition (Bod Pod®) and cardiopulmonary exercise testing, plasma collection, and vastus lateralis biopsies. Plasma galectin-3, muscle cytokines, muscle interleukin-1 beta (mIL-1β), mIL-6, mIL-8, muscle tumor necrosis factor-alpha (mTNF-α), mIL-10, and muscle myostatin were measured via enzyme-linked immunosorbent assays. An independent cohort of patients with RA (n = 47) and age-, gender-, and body mass index (BMI)-matched non-RA controls (n = 23) were used for additional analyses of galectin-3 inter-relationships. Results Exercise training did not reduce mean concentration of galectin-3, muscle cytokines, or muscle myostatin in persons with either RA or prediabetes. However, training-induced alterations varied among individuals and were associated with cardiorespiratory fitness and body composition changes. Improved cardiorespiratory fitness (increased absolute peak maximal oxygen consumption, or VO2) correlated with reductions in galectin-3 (r = −0.57, P = 0.05 in RA; r = −0.48, P = 0.23 in prediabetes). Training-induced improvements in body composition were related to reductions in muscle IL-6 and TNF-α (r < −0.60 and P <0.05 for all). However, the association between increased lean mass and decreased muscle IL-6 association was stronger in prediabetes compared with RA (Fisher r-to-z P = 0.0004); in prediabetes but not RA, lean mass increases occurred in conjunction with reductions in muscle myostatin (r = −0.92; P <0.05; Fisher r-to-z P = 0.026). Subjects who received TNF inhibitors (n = 4) or hydroxychloroquine (n = 4) did not improve body composition with exercise training. Conclusion Exercise responses in muscle myostatin, cytokines, and body composition were significantly greater in prediabetes than in RA, consistent with impaired muscle remodeling in RA. To maximize physiologic improvements with exercise training in RA, a better understanding is needed of skeletal muscle and physiologic responses to exercise training and their modulation by RA disease–specific features or pharmacologic agents or both. Trial registration ClinicalTrials.gov Identifier: NCT02528344. Registered on August 19, 2015.
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Affiliation(s)
- Brian J Andonian
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA. .,Division of Rheumatology, Duke University School of Medicine, 40 Duke Medicine Circle Drive, Durham, NC, 27710, USA.
| | - David B Bartlett
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA
| | - Janet L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA
| | - Leslie Willis
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA
| | - Andrew Hoselton
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA
| | - Virginia B Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA.,Division of Rheumatology, Duke University School of Medicine, 40 Duke Medicine Circle Drive, Durham, NC, 27710, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA.,Division of Rheumatology, Duke University School of Medicine, 40 Duke Medicine Circle Drive, Durham, NC, 27710, USA
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Tejera-Segura B, López-Mejías R, de Vera-González AM, Jiménez-Sosa A, Olmos JM, Hernández JL, Llorca J, González-Gay MA, Ferraz-Amaro I. Relationship Between Insulin Sensitivity and β-Cell Secretion in Nondiabetic Subjects with Rheumatoid Arthritis. J Rheumatol 2018; 46:229-236. [PMID: 30275261 DOI: 10.3899/jrheum.180198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE In nondiabetic healthy individuals, insulin secretion and sensitivity are linked by a negative feedback loop characterized by a hyperbolic function. We aimed to study the association of traditional insulin resistance (IR) factors with insulin secretion and sensitivity, and to determine whether the hyperbolic equilibrium of this relation is preserved in patients with rheumatoid arthritis (RA). METHODS This was a cross-sectional study encompassing 361 nondiabetic individuals: 151 with RA and 210 controls. Insulin, C-peptide, and IR indices by homeostatic model (HOMA2) were assessed. A multivariable analysis was performed to evaluate the differences in the correlation of traditional IR-related factors with glucose homeostasis molecules, as well as IR indices between patients and controls. Nonlinear regression analysis was used to assess the hyperbolic relation of insulin sensitivity and secretion. RESULTS HOMA2-IR indices were higher in patients with RA than controls. Hepatic insulin extraction, as assessed by the insulin:C-peptide molar ratio, was lower in patients with RA after multivariable analysis (0.08 ± 0.02 vs 0.14 ± 0.07, p < 0.001). Traditional IR-related factors showed significantly lower adjusted correlation coefficients with IR indices in patients with RA. The association between insulin sensitivity and secretion showed a different hyperbolic relation in patients with RA: the variability explained by the curve was lower in RA (nonlinear r2 = 0.845 vs r2 = 0.928, p = 0.001) and β coefficients (-0.74, 95% CI -0.77 to -0.70 vs -1.09, 95% CI -1.17 to -1.02, ng/ml, p < 0.001) were different in RA. CONCLUSION The traditional factors associated with IR in healthy individuals are less related to IR in patients with RA. Insulin sensitivity and secretion yield a different hyperbolic equilibrium in RA.
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Affiliation(s)
- Beatriz Tejera-Segura
- From the Division of Rheumatology, and the Central Laboratory Division, and the Research Unit, Hospital Universitario de Canarias, Tenerife; the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, and the Division of Internal Medicine, and the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria; Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; the CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain; the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,B. Tejera-Segura, MD, Division of Rheumatology, Hospital Universitario de Canarias; R. López-Mejías, PhD, MD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario IDIVAL; A.M. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. Jiménez-Sosa, PhD, Research Unit, Hospital Universitario de Canarias; J.M. Olmos, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J.L. Hernández, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J. Llorca, PhD, MD, Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP; M.A. González-Gay, MD, PhD, Professor of Medicine, the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, and School of Medicine, University of Cantabria, Division of Rheumatology, IDIVAL, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, PhD, MD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Raquel López-Mejías
- From the Division of Rheumatology, and the Central Laboratory Division, and the Research Unit, Hospital Universitario de Canarias, Tenerife; the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, and the Division of Internal Medicine, and the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria; Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; the CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain; the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,B. Tejera-Segura, MD, Division of Rheumatology, Hospital Universitario de Canarias; R. López-Mejías, PhD, MD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario IDIVAL; A.M. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. Jiménez-Sosa, PhD, Research Unit, Hospital Universitario de Canarias; J.M. Olmos, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J.L. Hernández, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J. Llorca, PhD, MD, Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP; M.A. González-Gay, MD, PhD, Professor of Medicine, the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, and School of Medicine, University of Cantabria, Division of Rheumatology, IDIVAL, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, PhD, MD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Antonia M de Vera-González
- From the Division of Rheumatology, and the Central Laboratory Division, and the Research Unit, Hospital Universitario de Canarias, Tenerife; the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, and the Division of Internal Medicine, and the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria; Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; the CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain; the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,B. Tejera-Segura, MD, Division of Rheumatology, Hospital Universitario de Canarias; R. López-Mejías, PhD, MD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario IDIVAL; A.M. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. Jiménez-Sosa, PhD, Research Unit, Hospital Universitario de Canarias; J.M. Olmos, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J.L. Hernández, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J. Llorca, PhD, MD, Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP; M.A. González-Gay, MD, PhD, Professor of Medicine, the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, and School of Medicine, University of Cantabria, Division of Rheumatology, IDIVAL, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, PhD, MD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Alejandro Jiménez-Sosa
- From the Division of Rheumatology, and the Central Laboratory Division, and the Research Unit, Hospital Universitario de Canarias, Tenerife; the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, and the Division of Internal Medicine, and the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria; Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; the CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain; the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,B. Tejera-Segura, MD, Division of Rheumatology, Hospital Universitario de Canarias; R. López-Mejías, PhD, MD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario IDIVAL; A.M. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. Jiménez-Sosa, PhD, Research Unit, Hospital Universitario de Canarias; J.M. Olmos, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J.L. Hernández, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J. Llorca, PhD, MD, Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP; M.A. González-Gay, MD, PhD, Professor of Medicine, the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, and School of Medicine, University of Cantabria, Division of Rheumatology, IDIVAL, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, PhD, MD, Division of Rheumatology, Hospital Universitario de Canarias
| | - José M Olmos
- From the Division of Rheumatology, and the Central Laboratory Division, and the Research Unit, Hospital Universitario de Canarias, Tenerife; the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, and the Division of Internal Medicine, and the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria; Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; the CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain; the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,B. Tejera-Segura, MD, Division of Rheumatology, Hospital Universitario de Canarias; R. López-Mejías, PhD, MD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario IDIVAL; A.M. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. Jiménez-Sosa, PhD, Research Unit, Hospital Universitario de Canarias; J.M. Olmos, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J.L. Hernández, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J. Llorca, PhD, MD, Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP; M.A. González-Gay, MD, PhD, Professor of Medicine, the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, and School of Medicine, University of Cantabria, Division of Rheumatology, IDIVAL, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, PhD, MD, Division of Rheumatology, Hospital Universitario de Canarias
| | - José L Hernández
- From the Division of Rheumatology, and the Central Laboratory Division, and the Research Unit, Hospital Universitario de Canarias, Tenerife; the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, and the Division of Internal Medicine, and the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria; Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; the CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain; the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,B. Tejera-Segura, MD, Division of Rheumatology, Hospital Universitario de Canarias; R. López-Mejías, PhD, MD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario IDIVAL; A.M. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. Jiménez-Sosa, PhD, Research Unit, Hospital Universitario de Canarias; J.M. Olmos, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J.L. Hernández, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J. Llorca, PhD, MD, Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP; M.A. González-Gay, MD, PhD, Professor of Medicine, the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, and School of Medicine, University of Cantabria, Division of Rheumatology, IDIVAL, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, PhD, MD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Javier Llorca
- From the Division of Rheumatology, and the Central Laboratory Division, and the Research Unit, Hospital Universitario de Canarias, Tenerife; the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, and the Division of Internal Medicine, and the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria; Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; the CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain; the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,B. Tejera-Segura, MD, Division of Rheumatology, Hospital Universitario de Canarias; R. López-Mejías, PhD, MD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario IDIVAL; A.M. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. Jiménez-Sosa, PhD, Research Unit, Hospital Universitario de Canarias; J.M. Olmos, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J.L. Hernández, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J. Llorca, PhD, MD, Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP; M.A. González-Gay, MD, PhD, Professor of Medicine, the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, and School of Medicine, University of Cantabria, Division of Rheumatology, IDIVAL, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, PhD, MD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Miguel A González-Gay
- From the Division of Rheumatology, and the Central Laboratory Division, and the Research Unit, Hospital Universitario de Canarias, Tenerife; the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, and the Division of Internal Medicine, and the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria; Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; the CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain; the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,B. Tejera-Segura, MD, Division of Rheumatology, Hospital Universitario de Canarias; R. López-Mejías, PhD, MD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario IDIVAL; A.M. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. Jiménez-Sosa, PhD, Research Unit, Hospital Universitario de Canarias; J.M. Olmos, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J.L. Hernández, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J. Llorca, PhD, MD, Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP; M.A. González-Gay, MD, PhD, Professor of Medicine, the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, and School of Medicine, University of Cantabria, Division of Rheumatology, IDIVAL, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, PhD, MD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Iván Ferraz-Amaro
- From the Division of Rheumatology, and the Central Laboratory Division, and the Research Unit, Hospital Universitario de Canarias, Tenerife; the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, and the Division of Internal Medicine, and the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla (IDIVAL), University of Cantabria; Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; the CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain; the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,B. Tejera-Segura, MD, Division of Rheumatology, Hospital Universitario de Canarias; R. López-Mejías, PhD, MD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario IDIVAL; A.M. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. Jiménez-Sosa, PhD, Research Unit, Hospital Universitario de Canarias; J.M. Olmos, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J.L. Hernández, PhD, MD, Division of Internal Medicine, IDIVAL, Universidad de Cantabria; J. Llorca, PhD, MD, Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP; M.A. González-Gay, MD, PhD, Professor of Medicine, the Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, and School of Medicine, University of Cantabria, Division of Rheumatology, IDIVAL, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, PhD, MD, Division of Rheumatology, Hospital Universitario de Canarias.
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12
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Bartlett DB, Willis LH, Slentz CA, Hoselton A, Kelly L, Huebner JL, Kraus VB, Moss J, Muehlbauer MJ, Spielmann G, Kraus WE, Lord JM, Huffman KM. Ten weeks of high-intensity interval walk training is associated with reduced disease activity and improved innate immune function in older adults with rheumatoid arthritis: a pilot study. Arthritis Res Ther 2018; 20:127. [PMID: 29898765 PMCID: PMC6001166 DOI: 10.1186/s13075-018-1624-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is a chronic inflammatory disease in which adults have significant joint issues leading to poor health. Poor health is compounded by many factors, including exercise avoidance and increased risk of opportunistic infection. Exercise training can improve the health of patients with RA and potentially improve immune function; however, information on the effects of high-intensity interval training (HIIT) in RA is limited. We sought to determine whether 10 weeks of a walking-based HIIT program would be associated with health improvements as measured by disease activity and aerobic fitness. Further, we assessed whether HIIT was associated with improved immune function, specifically antimicrobial/bacterial functions of neutrophils and monocytes. Methods Twelve physically inactive adults aged 64 ± 7 years with either seropositive or radiographically proven (bone erosions) RA completed 10 weeks of high-intensity interval walking. Training consisted of 3 × 30-minute sessions/week of ten ≥ 60-second intervals of high intensity (80–90% VO2reserve) separated by similar bouts of lower-intensity intervals (50–60% VO2reserve). Pre- and postintervention assessments included aerobic and physical function; disease activity as measured by Disease Activity score in 28 joints (DAS28), self-perceived health, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR); plasma interleukin (IL)-1β, IL-6, chemokine (C-X-C motif) ligand (CXCL)-8, IL-10, and tumor necrosis factor (TNF)-α concentrations; and neutrophil and monocyte phenotypes and functions. Results Despite minimal body composition change, cardiorespiratory fitness increased by 9% (change in both relative and absolute aerobic capacity; p < 0.001), and resting blood pressure and heart rate were both reduced (both p < 0.05). Postintervention disease activity was reduced by 38% (DAS28; p = 0.001) with significant reductions in ESR and swollen joints as well as improved self-perceived health. Neutrophil migration toward CXCL-8 (p = 0.003), phagocytosis of Escherichia coli (p = 0.03), and ROS production (p < 0.001) all increased following training. The frequency of cluster of differentiation 14-positive (CD14+)/CD16+ monocytes was reduced (p = 0.002), with both nonclassical (CD14dim/CD16bright) and intermediate (CD14bright/CD16positive) monocytes being reduced (both p < 0.05). Following training, the cell surface expression of intermediate monocyte Toll-like receptor 2 (TLR2), TLR4, and HLA-DR was reduced (all p < 0.05), and monocyte phagocytosis of E. coli increased (p = 0.02). No changes were observed for inflammatory markers IL-1β, IL-6, CXCL-8, IL-10, CRP, or TNF-α. Conclusions We report for the first time, to our knowledge, that a high-intensity interval walking protocol in older adults with stable RA is associated with reduced disease activity, improved cardiovascular fitness, and improved innate immune functions, indicative of reduced infection risk and inflammatory potential. Importantly, the exercise program was well tolerated by these patients. Trial registration ClinicalTrials.gov, NCT02528344. Registered on 19 August 2015.
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Affiliation(s)
- David B Bartlett
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA. .,Division of Medical Oncology, Duke University School of Medicine, Durham, NC, 27701, USA. .,MRC-ARUK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
| | - Leslie H Willis
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Cris A Slentz
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Hoselton
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Leslie Kelly
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Janet L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Virginia B Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer Moss
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Michael J Muehlbauer
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Janet M Lord
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre in Inflammation, University Hospital Birmingham, Birmingham, UK
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
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13
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Khoja SS, Moore CG, Goodpaster BH, Delitto A, Piva SR. Skeletal Muscle Fat and Its Association With Physical Function in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2018; 70:333-342. [PMID: 28482146 DOI: 10.1002/acr.23278] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/02/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To characterize skeletal muscle fat (SMF), intermuscular adipose tissue (IMAT), and subcutaneous adipose tissue (SAT) in individuals with rheumatoid arthritis (RA), and assess the associations between these fat depots and physical function and physical activity. METHODS In a cross-sectional analysis from an RA cohort, SMF, IMAT, and SAT were measured using computed tomography imaging of the midthigh cross-sectional region. Physical function was measured using the Health Assessment Questionnaire (HAQ) and a battery of performance-based tests that included quadriceps muscle strength, gait speed, repeated chair-stands, stair ascent, and single-leg stance. Physical activity was assessed using an activity monitor. Associations between SMF, IMAT, and SAT and physical function and activity were assessed by multiple linear regression models adjusted for potential confounders such as age, sex, body mass index (BMI), muscle area, and muscle strength. RESULTS Sixty subjects with RA (82% female, mean ± SD age 59 ± 10 years, mean ± SD BMI 31.79 ± 7.16 kg/m2 ) were included. In the adjusted models, lower SMF was associated with greater gait speed, single-leg stance, quadriceps strength, and physical activity, and less disability (R2 Δ range 0.06-0.25; P < 0.05), whereas IMAT was not associated with physical function or physical activity and SAT was negatively associated with disability (HAQ) (R2 Δ = 0.13; P < 0.05) and weakly but positively associated with muscle strength (R2 Δ = 0.023; P < 0.05). CONCLUSION Fat infiltration within the muscle seems to independently contribute to low physical function and physical activity, contrary to IMAT or SAT accumulation. Longitudinal studies are necessary to confirm the impact of SMF on disability and health promotion in persons with RA.
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Affiliation(s)
| | - Charity G Moore
- Center for Outcomes Research and Evaluation, Carolinas Health Care System, Charlotte, North Carolina
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Orlando, Florida
| | | | - Sara R Piva
- University of Pittsburgh, Pittsburgh, Pennsylvania
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14
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Li J, Xu B, Wu C, Yan X, Zhang L, Chang X. TXNDC5 contributes to rheumatoid arthritis by down-regulating IGFBP1 expression. Clin Exp Immunol 2017; 192:82-94. [PMID: 29131315 DOI: 10.1111/cei.13080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/18/2022] Open
Abstract
The thioredoxin domain-containing 5 (TXNDC5) gene is associated with susceptibility to rheumatoid arthritis (RA) and exhibits increased expression in the synovial tissues. TXNDC5 is also associated strongly with diabetes, a metabolic disease characterized by interrupted insulin signalling. This study investigated whether TXNDC5 contributes to RA via the insulin signalling pathway. In this study, RA synovial fibroblast-like cells (RASFs) transfected with an anti-TXNDC5 small interfering RNA (siRNA) were analysed with an insulin signaling pathway RT2 profiler polymerase chain reaction (PCR) array and an insulin resistance RT2 profiler PCR array. The PCR arrays detected significantly increased expression of insulin-like growth factor binding protein 1 (IGFBP1) in RASFs with suppressed TXNDC5 expression. The result was verified using real-time PCR and Western blot analyses. Significantly elevated IGFBP1 expression and decreased interleukin (IL)-6 secretion were also detected in culture medium of transfected RASFs. Furthermore, decreased IGFBP1 mRNA and protein expression levels were detected in RA synovial tissues. Additionally, significantly increased apoptosis and decreased cell proliferation and cell migration were observed in RASFs transfected with the anti-TXNDC5 siRNA, whereas transfection with the anti-IGFBP1 siRNA or a mixture of the anti-IGFBP1 and anti-TXNDC5 siRNAs restored normal cell proliferation, migration and IL-6 level in RASFs. Insulin-like growth factor (IGF) has potent prosurvival and anti-apoptotic functions, and IGFBP1 can suppress IGF activity. Based on the results of the present study, we suggest that TXNDC5 contributes to abnormal RASF proliferation, migration and IL-6 production by inhibiting IGFBP1 expression.
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Affiliation(s)
- J Li
- Medical Research Center of Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan.,Affiliated Hospital of Jining Medical University, Jining
| | - B Xu
- Medical Research Center of Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan
| | - C Wu
- Department of Bone and Joint Surgery of Shandong Provincial Hospital
| | - X Yan
- Medical Research Center of Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan.,Department of Bone and Joint Surgery of Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, P. R. China
| | - L Zhang
- Medical Research Center of Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan.,Department of Bone and Joint Surgery of Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, P. R. China
| | - X Chang
- Medical Research Center of Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan
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15
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Müller R, Kull M, Lember M, Põlluste K, Valner A, Kallikorm R. Insulin Resistance in Early Rheumatoid Arthritis Is Associated with Low Appendicular Lean Mass. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9584720. [PMID: 28932748 PMCID: PMC5592389 DOI: 10.1155/2017/9584720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/05/2017] [Accepted: 07/25/2017] [Indexed: 02/08/2023]
Abstract
In established rheumatoid arthritis (RA), the presence of insulin resistance (IR) is well proven but, in the early stage of the disease, data are inconclusive. We evaluated the presence of IR and associations with body composition (BC) parameters among early RA (ERA) and control subjects. The study group consisted of 92 ERA and 321 control subjects. Using homeostatic model assessment of IR (HOMA-IR), the cut-off value for IR was 2.15. 56% of the ERA patients and 25% of the controls had IR. Of the BC parameters, patients with early RA had less fat-free mass and appendicular lean mass (ALM). In multivariable model, ERA group (b-Coefficient) (4.8, CI: 2.6-8.8), male gender (7.7, CI: 2.7-22.1), and fat mass index (1.2, CI: 1.1-1.4) were associated with IR. Insulin-resistant ERA patients had higher inflammatory markers and higher disease activity. In the multivariable model in the ERA group, IR was associated with male gender (b-Coefficient) (7.4, CI: 153-34.9), high disease activity (6.2, CI: 1.7-22.2), and lower ALM (0.03, CI: 0.001-0.97). IR develops in the early stage of RA in the majority of patients. IR is more common among males and is associated with RA disease activity and lower ALM.
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Affiliation(s)
- Raili Müller
- Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
- Internal Medicine Clinic, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia
| | - Mart Kull
- Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
- Internal Medicine Clinic, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia
| | - Margus Lember
- Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
- Internal Medicine Clinic, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia
| | - Kaja Põlluste
- Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
| | - Annika Valner
- Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
- Internal Medicine Clinic, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia
| | - Riina Kallikorm
- Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
- Internal Medicine Clinic, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia
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AbouAssi H, Connelly MA, Bateman LA, Tune KN, Huebner JL, Kraus VB, Winegar DA, Otvos JD, Kraus WE, Huffman KM. Does a lack of physical activity explain the rheumatoid arthritis lipid profile? Lipids Health Dis 2017; 16:39. [PMID: 28187765 PMCID: PMC5303308 DOI: 10.1186/s12944-017-0427-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/31/2017] [Indexed: 12/12/2022] Open
Abstract
Background In rheumatoid arthritis (RA), cardiovascular risk is associated with paradoxical reductions in total cholesterol, low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein-cholesterol (HDL-C). Concentrations of small LDL (LDL-P) and HDL (HDL-P) particles are also reduced with increased inflammation and disease activity in RA patients. Here we sought to identify which measure(s) of inflammation, disease activity and cardiometabolic risk contribute most to the RA-associated lipoprotein profile. Methods NMR lipoprotein measurements were obtained for individuals with RA (n = 50) and age-, gender-, and body mass index (BMI)-matched controls (n = 39). Groups were compared using 39 matched pairs with 11 additional subjects used in RA only analyses. Among RA patients, relationships were determined for lipoprotein parameters with measures of disease activity, disability, pain, inflammation, body composition, insulin sensitivity and exercise. Percentage of time spent in basal activity (<1 metabolic equivalent) and exercise (≥3 metabolic equivalents) were objectively-determined. Results Subjects with RA had fewer total and small LDL-P as well as larger LDL and HDL size (P < 0.05). Among RA patients, pain and disability were associated with fewer small HDL-P (P < 0.05), while interleukin (IL)-6, IL-18, and TNF-α were associated with LDL size (P < 0.05). BMI, waist circumference, abdominal visceral adiposity and insulin resistance were associated with more total and small LDL-P, fewer large HDL-P, and a reduction in HDL size (P < 0.05). Most similar to the RA lipoprotein profile, more basal activity (minimal physical activity) and less exercise time were associated with fewer small LDL-P and total and small HDL-P (P < 0.05). Conclusions The RA-associated lipoprotein profile is associated with a lack of physical activity. As this was a cross-sectional investigation and not an intervention and was performed from 2008–13, this study was not registered in clinicaltrials.gov.
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Affiliation(s)
- Hiba AbouAssi
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Margery A Connelly
- LipoScience, Inc., Laboratory Corporation of America® Holdings, Raleigh, NC, USA
| | | | | | - Janet L Huebner
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Virginia B Kraus
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Deborah A Winegar
- LipoScience, Inc., Laboratory Corporation of America® Holdings, Raleigh, NC, USA
| | - James D Otvos
- LipoScience, Inc., Laboratory Corporation of America® Holdings, Raleigh, NC, USA
| | - William E Kraus
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Kim M Huffman
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA.
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Huffman KM, Jessee R, Andonian B, Davis BN, Narowski R, Huebner JL, Kraus VB, McCracken J, Gilmore BF, Tune KN, Campbell M, Koves TR, Muoio DM, Hubal MJ, Kraus WE. Molecular alterations in skeletal muscle in rheumatoid arthritis are related to disease activity, physical inactivity, and disability. Arthritis Res Ther 2017; 19:12. [PMID: 28114971 PMCID: PMC5260091 DOI: 10.1186/s13075-016-1215-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/30/2016] [Indexed: 01/04/2023] Open
Abstract
Background To identify molecular alterations in skeletal muscle in rheumatoid arthritis (RA) that may contribute to ongoing disability in RA. Methods Persons with seropositive or erosive RA (n = 51) and control subjects matched for age, gender, race, body mass index (BMI), and physical activity (n = 51) underwent assessment of disease activity, disability, pain, physical activity and thigh muscle biopsies. Muscle tissue was used for measurement of pro-inflammatory markers, transcriptomics, and comprehensive profiling of metabolic intermediates. Groups were compared using mixed models. Bivariate associations were assessed with Spearman correlation. Results Compared to controls, patients with RA had 75% greater muscle concentrations of IL-6 protein (p = 0.006). In patients with RA, muscle concentrations of inflammatory markers were positively associated (p < 0.05 for all) with disease activity (IL-1β, IL-8), disability (IL-1β, IL-6), pain (IL-1β, TNF-α, toll-like receptor (TLR)-4), and physical inactivity (IL-1β, IL-6). Muscle cytokines were not related to corresponding systemic cytokines. Prominent among the gene sets differentially expressed in muscles in RA versus controls were those involved in skeletal muscle repair processes and glycolytic metabolism. Metabolic profiling revealed 46% higher concentrations of pyruvate in muscle in RA (p < 0.05), and strong positive correlation between levels of amino acids involved in fibrosis (arginine, ornithine, proline, and glycine) and disability (p < 0.05). Conclusion RA is accompanied by broad-ranging molecular alterations in skeletal muscle. Analysis of inflammatory markers, gene expression, and metabolic intermediates linked disease-related disruptions in muscle inflammatory signaling, remodeling, and metabolic programming to physical inactivity and disability. Thus, skeletal muscle dysfunction might contribute to a viscous cycle of RA disease activity, physical inactivity, and disability. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1215-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim M Huffman
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA.
| | - Ryan Jessee
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Brian Andonian
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | | | | | - Janet L Huebner
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Virginia B Kraus
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Julie McCracken
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Brian F Gilmore
- Department of Surgery, Duke School of Medicine, Durham, NC, USA
| | - K Noelle Tune
- Department of Emergency Medicine, Indiana University, Indianapolis, IN, USA
| | - Milton Campbell
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Timothy R Koves
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Deborah M Muoio
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | | | - William E Kraus
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
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18
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Bartlett DB, Connelly MA, AbouAssi H, Bateman LA, Tune KN, Huebner JL, Kraus VB, Winegar DA, Otvos JD, Kraus WE, Huffman KM. A novel inflammatory biomarker, GlycA, associates with disease activity in rheumatoid arthritis and cardio-metabolic risk in BMI-matched controls. Arthritis Res Ther 2016; 18:86. [PMID: 27067270 PMCID: PMC4828830 DOI: 10.1186/s13075-016-0982-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/23/2016] [Indexed: 12/31/2022] Open
Abstract
Background RA and CVD both have inflammation as part of the underlying biology. Our objective was to explore the relationships of GlycA, a measure of glycosylated acute phase proteins, with inflammation and cardiometabolic risk in RA, and explore whether these relationships were similar to those for persons without RA. Methods Plasma GlycA was determined for 50 individuals with mild-moderate RA disease activity and 39 controls matched for age, gender, and body mass index (BMI). Regression analyses were performed to assess relationships between GlycA and important markers of traditional inflammation and cardio-metabolic health: inflammatory cytokines, disease activity, measures of adiposity and insulin resistance. Results On average, RA activity was low (DAS-28 = 3.0 ± 1.4). Traditional inflammatory markers, ESR, hsCRP, IL-1β, IL-6, IL-18 and TNF-α were greater in RA versus controls (P < 0.05 for all). GlycA concentrations were significantly elevated in RA versus controls (P = 0.036). In RA, greater GlycA associated with disease activity (DAS-28; RDAS-28 = 0.5) and inflammation (RESR = 0.7, RhsCRP = 0.7, RIL-6 = 0.3: P < 0.05 for all); in BMI-matched controls, these inflammatory associations were absent or weaker (hsCRP), but GlycA was related to IL-18 (RhsCRP = 0.3, RIL-18 = 0.4: P < 0.05). In RA, greater GlycA associated with more total abdominal adiposity and less muscle density (Rabdominal-adiposity = 0.3, Rmuscle-density = −0.3, P < 0.05 for both). In BMI-matched controls, GlycA associated with more cardio-metabolic markers: BMI, waist circumference, adiposity measures and insulin resistance (R = 0.3-0.6, P < 0.05 for all). Conclusions GlycA provides an integrated measure of inflammation with contributions from traditional inflammatory markers and cardio-metabolic sources, dominated by inflammatory markers in persons with RA and cardio-metabolic factors in those without.
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Affiliation(s)
- David B Bartlett
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Margery A Connelly
- LipoScience, Laboratory Corporation of America® Holdings, Raleigh, NC, USA
| | - Hiba AbouAssi
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Lori A Bateman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K Noelle Tune
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Janet L Huebner
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Virginia B Kraus
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Deborah A Winegar
- LipoScience, Laboratory Corporation of America® Holdings, Raleigh, NC, USA
| | - James D Otvos
- LipoScience, Laboratory Corporation of America® Holdings, Raleigh, NC, USA
| | - William E Kraus
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Kim M Huffman
- Department of Medicine and Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA.
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Manrique-Arija S, Ureña I, Valdivielso P, Rioja J, Jiménez-Núñez FG, Irigoyen MV, Fernández-Nebro A. Insulin resistance and levels of adipokines in patients with untreated early rheumatoid arthritis. Clin Rheumatol 2015; 35:43-53. [PMID: 26526677 PMCID: PMC4710654 DOI: 10.1007/s10067-015-3106-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 10/03/2015] [Accepted: 10/21/2015] [Indexed: 01/02/2023]
Abstract
The aim of this study is to investigate the presence of insulin resistance (IR) in patients with untreated early rheumatoid arthritis (ERA) and its relationship with adipokines, inflammatory cytokines, and treatment. In this prospective study, we enrolled 46 ERA patients with a disease duration of <1 year, and 45 sex-, age-, race-, and body mass index (BMI)-matched controls. Patients and controls with diabetes or a history of glucocorticoid (GC) or disease-modifying antirheumatic drugs (DMARDs) use were excluded. Patients were assessed at the time of diagnosis (visit 1) and after 6 months of treatment (visit 2). The main outcomes were homeostatic model assessment of IR (HOMA-IR) and β-cell function (HOMA-β) and quantitative insulin sensitivity check index (QUICKI). A multivariate regression analysis was performed to analyze IR adjusting according to lipids, body composition, physical activity, nutrition, and inflammatory cytokine and adipokine levels. The baseline HOMA-IR, HOMA-β, and QUICKI values were similar in both groups. However, patients showed lower levels of physical activity, total cholesterol, and high-density lipoprotein. Moreover, the inflammatory cytokines and resistin concentrations were higher in patients than controls. Multivariate analysis indicated that BMI and baseline rheumatoid factor levels were positively associated with HOMA-IR and HOMA-β, and negatively with QUICKI. After DMARD treatment, patients showed improvements in inflammatory parameters and lipids whereas IR remained stable. Furthermore, adiponectin and resistin concentrations decreased slightly. Our data suggest that IR is not present in ERA patients either at diagnosis or at 6 months after treatment. However, symptom duration and fat mass appear to be related.
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Affiliation(s)
- Sara Manrique-Arija
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Inmaculada Ureña
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Pedro Valdivielso
- UGC de Medicina Interna, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - José Rioja
- Departamento de Medicina y Dermatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Francisco G Jiménez-Núñez
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - María V Irigoyen
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Antonio Fernández-Nebro
- UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain.
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Cachexia and adiposity in rheumatoid arthritis. Relevance for disease management and clinical outcomes. Joint Bone Spine 2015; 83:127-33. [PMID: 26184539 DOI: 10.1016/j.jbspin.2015.04.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/19/2015] [Indexed: 12/18/2022]
Abstract
Altered body composition is a frequent finding in rheumatoid arthritis and is associated with the two major outcomes of the disease: disability and cardiovascular mortality. It is estimated that up to two thirds of patients may be affected by loss of lean mass, the so-called rheumatoid cachexia. Hence, body weight being equal, the relative amount of lean mass is lower and that of body fat is higher in rheumatoid arthritis patients vs. healthy controls. Both disease-related factors and other factors, like drug treatments, physical activity and nutrition contribute to modify body composition in rheumatoid arthritis. The effect of pharmacological treatments, and notably of anti-TNF drugs, on body composition is controversial. Conversely, training programs to stimulate muscle growth can restore lean mass and reduce adiposity. There is good evidence that amelioration of body composition ameliorates function and reduces disability. Currently, there is no evidence that interventions that modify body composition can reduce cardiovascular morbidity and mortality in rheumatoid arthritis.
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Ormseth MJ, Stein CM. Is visceral fat the missing link in the relationship between inflammation and insulin resistance in RA? J Rheumatol 2014; 41:1906-9. [PMID: 25275092 DOI: 10.3899/jrheum.140780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - C Michael Stein
- Division of Rheumatology, Department of Medicine and Division of Clinical Pharmacology, Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
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