1
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Zoughaib WS, Fry MJ, Singhal A, Coggan AR. Beetroot juice supplementation and exercise performance: is there more to the story than just nitrate? Front Nutr 2024; 11:1347242. [PMID: 38445207 PMCID: PMC10912565 DOI: 10.3389/fnut.2024.1347242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
This mini-review summarizes the comparative effects of different sources of dietary nitrate (NO3-), beetroot juice (BRJ) and nitrate salts (NIT), on physiological function and exercise capacity. Our objectives were to determine whether BRJ is superior to NIT in enhancing exercise-related outcomes, and to explore the potential contribution of other putatively beneficial compounds in BRJ beyond NO3-. We conducted a comparative analysis of recent studies focused on the impact of BRJ versus NIT on submaximal oxygen consumption (VO2), endurance performance, adaptations to training, and recovery from muscle-damaging exercise. While both NO3- sources provide benefits, there is some evidence that BRJ may offer additional advantages, specifically in reducing VO2 during high-intensity exercise, magnifying performance improvements with training, and improving recovery post-exercise. These reported differences could be due to the hypothesized antioxidant and/or anti-inflammatory properties of BRJ resulting from the rich spectrum of phytonutrients it contains. However, significant limitations to published studies directly comparing BRJ and NIT make it quite challenging to draw any firm conclusions. We provide recommendations to help guide further research into the important question of whether there is more to the story of BRJ than just NO3-.
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Affiliation(s)
- William S. Zoughaib
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Indianapolis, Indianapolis, IN, United States
| | - Madison J. Fry
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Indianapolis, Indianapolis, IN, United States
| | - Ahaan Singhal
- School of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Andrew R. Coggan
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Indianapolis, Indianapolis, IN, United States
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, United States
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2
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Seibert TA, Shi L, Althouse S, Hoffman R, Schneider BP, Russ KA, Altherr CA, Warden SJ, Guise TA, Coggan AR, Ballinger TJ. Molecular and clinical effects of aromatase inhibitor therapy on skeletal muscle function in early-stage breast cancer. Sci Rep 2024; 14:1029. [PMID: 38200207 PMCID: PMC10781701 DOI: 10.1038/s41598-024-51751-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/09/2024] [Indexed: 01/12/2024] Open
Abstract
We evaluated biochemical changes in skeletal muscle of women with breast cancer initiating aromatase inhibitors (AI), including oxidation of ryanodine receptor RyR1 and loss of stabilizing protein calstabin1, and detailed measures of muscle function. Fifteen postmenopausal women with stage I-III breast cancer planning to initiate AI enrolled. Quadriceps muscle biopsy, dual-energy x-ray absorptiometry, isokinetic dynamometry, Short Physical Performance Battery, grip strength, 6-min walk, patient-reported outcomes, and serologic measures of bone turnover were assessed before and after 6 months of AI. Post-AI exposure, oxidation of RyR1 significantly increased (0.23 ± 0.37 vs. 0.88 ± 0.80, p < 0.001) and RyR1-bound calstabin1 significantly decreased (1.69 ± 1.53 vs. 0.74 ± 0.85, p < 0.001), consistent with dysfunctional calcium channels in skeletal muscle. Grip strength significantly decreased at 6 months. No significant differences were seen in isokinetic dynamometry measures of muscle contractility, fatigue resistance, or muscle recovery post-AI exposure. However, there was significant correlation between oxidation of RyR1 with muscle power (r = 0.60, p = 0.02) and muscle fatigue (r = 0.57, p = 0.03). Estrogen deprivation therapy for breast cancer resulted in maladaptive changes in skeletal muscle, consistent with the biochemical signature of dysfunctional RyR1 calcium channels. Future studies will evaluate longer trajectories of muscle function change and include other high bone turnover states, such as bone metastases.
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Affiliation(s)
- Tara A Seibert
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Lei Shi
- Department of Endocrine Neoplasia and Hormonal Disorders, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sandra Althouse
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Richard Hoffman
- Department of Kinesiology, Indiana University School of Health & Human Sciences, Indianapolis, IN, 46202, USA
| | - Bryan P Schneider
- Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr. RT 472, Indianapolis, IN, 46202, USA
| | - Kristen A Russ
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Cody A Altherr
- Indiana Center for Musculoskeletal Health, Clinical Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Stuart J Warden
- Department of Physical Therapy, Indiana University School of Health & Human Sciences, Indianapolis, IN, 46202, USA
| | - Theresa A Guise
- Department of Kinesiology, Indiana University School of Health & Human Sciences, Indianapolis, IN, 46202, USA
| | - Andrew R Coggan
- Department of Kinesiology, Indiana University School of Health & Human Sciences, Indianapolis, IN, 46202, USA
| | - Tarah J Ballinger
- Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, 535 Barnhill Dr. RT 472, Indianapolis, IN, 46202, USA.
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3
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Coggan AR, Park LK, Racette SB, Davila-Roman VG, Lenzen P, Vehe K, Dore PM, Schechtman KB, Peterson LR. The inorganic NItrate and eXercise performance in Heart Failure (iNIX-HF) phase II clinical trial: Rationale and study design. Contemp Clin Trials Commun 2023; 36:101208. [PMID: 37842318 PMCID: PMC10568282 DOI: 10.1016/j.conctc.2023.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/16/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
Background Heart failure (HF) is a debilitating and often fatal disease that affects millions of people worldwide. Diminished nitric oxide synthesis, signaling, and bioavailability are believed to contribute to poor skeletal muscle function and aerobic capacity. The aim of this clinical trial (iNIX-HF) is to determine the acute and longer-term effectiveness of inorganic nitrate supplementation on exercise performance in patients with HF with reduced ejection fraction (HFrEF). Methods This clinical trial is a double-blind, placebo-controlled, randomized, parallel-arm design study in which patients with HFrEF (n = 75) are randomized to receive 10 mmol potassium nitrate (KNO3) or a placebo capsule daily for 6 wk. Primary outcome measures are muscle power determined by isokinetic dynamometry and peak aerobic capacity (VO2peak) determined during an incremental treadmill exercise test. Endpoints include the acute effects of a single dose of KNO3 and longer-term effects of 6 wk of KNO3. The study is adequately powered to detect expected increases in these outcomes at P < 0.05 with 1-β>0.80. Discussion The iNIX-HF phase II clinical trial will evaluate the effectiveness of inorganic nitrate supplements as a new treatment to ameliorate poor exercise capacity in HFrEF. This study also will provide critical preliminary data for a future 'pivotal', phase III, multi-center trial of the effectiveness of nitrate supplements not only for improving exercise performance, but also for improving symptoms and decreasing other major cardiovascular endpoints. The potential public health impact of identifying a new, relatively inexpensive, safe, and effective treatment that improves overall exercise performance in patients with HFrEF is significant.
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Affiliation(s)
- Andrew R. Coggan
- Department of Kinesiology, School of Health & Human Sciences, And Indiana Center for Musculoskeletal Health, School of Medicine, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Lauren K. Park
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Susan B. Racette
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | | | - Pattie Lenzen
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Peter M. Dore
- Division of Biostatistics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Kenneth B. Schechtman
- Division of Biostatistics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Linda R. Peterson
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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4
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Zoughaib WS, Hoffman RL, Yates BA, Moorthi RN, Lim K, Coggan AR. Short-term beetroot juice supplementation improves muscle speed and power but does not reduce blood pressure or oxidative stress in 65-79 y old men and women. Nitric Oxide 2023; 138-139:34-41. [PMID: 37244392 PMCID: PMC10527284 DOI: 10.1016/j.niox.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023]
Abstract
We have previously demonstrated that acute ingestion of inorganic nitrate (NO3-)-rich beetroot juice (BRJ), a source of nitric oxide (NO) via the NO3- → nitrite (NO2-) → NO pathway, can improve muscle speed and power in older individuals. It is not known, however, whether this effect is maintained or perhaps even enhanced with repeated ingestion, or if tolerance develops as with organic nitrates, e.g., nitroglycerin. Using a double-blind, placebo-controlled, crossover design, we therefore studied 16 community-dwelling older (age 71 ± 5 y) individuals after both acute and short-term (i.e., daily for 2 wk) BRJ supplementation. Blood samples were drawn and blood pressure was measured periodically during each ∼3 h experiment, with muscle function determined using isokinetic dynamometry. Acute ingestion of BRJ containing 18.2 ± 6.2 mmol of NO3- increased plasma NO3- and NO2- concentrations 23 ± 11 and 2.7 ± 2.1-fold over placebo, respectively. This was accompanied by 5 ± 11% and 7 ± 13% increases in maximal knee extensor speed (Vmax) and power (Pmax), respectively. After daily supplementation for 2 wk, BRJ ingestion elevated NO3- and NO2- levels 24 ± 12 and 3.3 ± 4.0-fold, respectively, whereas Vmax and Pmax were 7 ± 9% and 9 ± 11% higher than baseline. No changes were observed in blood pressure or in plasma markers of oxidative stress with either acute or short-term NO3- supplementation. We conclude that both acute and short-term dietary NO3- supplementation result in similar improvements in muscle function in older individuals. The magnitudes of these improvements are sufficient to offset the decline resulting from a decade or more of aging and are therefore likely to be clinically significant.
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Affiliation(s)
- William S Zoughaib
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Purdue University, Indianapolis, USA
| | - Richard L Hoffman
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Purdue University, Indianapolis, USA
| | - Brandon A Yates
- Indiana Center for Musculoskeletal Health, School of Medicine, Indiana University School of Medicine, USA
| | - Ranjani N Moorthi
- Division of Nephrology & Hypertension, School of Medicine, Indiana University School of Medicine, USA
| | - Kenneth Lim
- Division of Nephrology & Hypertension, School of Medicine, Indiana University School of Medicine, USA
| | - Andrew R Coggan
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Purdue University, Indianapolis, USA; Indiana Center for Musculoskeletal Health, School of Medicine, Indiana University School of Medicine, USA.
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5
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Long GM, Coggan AR, Brown MB. Reply to Schulze and Musch. Am J Physiol Regul Integr Comp Physiol 2023; 325:R227. [PMID: 37467442 DOI: 10.1152/ajpregu.00151.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Gary Marshall Long
- Kinesiology, Health and Sport Sciences, University of Indianapolis, Indianapolis, Indiana, United States
| | - Andrew R Coggan
- Department of Kinesiology, Indiana University, Purdue University Indianapolis, Indianapolis, Indiana, United States
| | - Mary Beth Brown
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, United States
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6
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Zoughaib WS, Brault JJ, Coggan AR. Beeting atrophy: dietary nitrate to protect the powerhouse of the cell? J Physiol 2023:10.1113/JP285115. [PMID: 37519113 PMCID: PMC10828098 DOI: 10.1113/jp285115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Affiliation(s)
- William S. Zoughaib
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Purdue University Indianapolis
| | - Jeffrey J. Brault
- Department of Anatomy, Cell Biology & Physiology
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Andrew R. Coggan
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Purdue University Indianapolis
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN 46202
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7
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Zoughaib WS, Hoffman RL, Yates BA, Moorthi RN, Lim K, Coggan AR. The influence of acute dietary nitrate supplementation on skeletal muscle fatigue and recovery in older women. Physiol Rep 2023; 11:e15694. [PMID: 37226336 DOI: 10.14814/phy2.15694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/26/2023] Open
Abstract
Older individuals fatigue more rapidly during, and recover more slowly from, dynamic exercise. Women are particularly vulnerable to these deleterious effects of aging, which increases their risk of falling. We have shown that dietary nitrate (NO3 - ), a source of nitric oxide (NO) via the NO3 - → nitrite (NO2 - ) → NO pathway, enhances muscle speed and power in older individuals in the non-fatigued state; however, it is unclear if it reduces fatigability and/or improves recoverability in this population. Using a double-blind, placebo-controlled, crossover design, we studied 18 older (age 70 ± 4 years) women who were administered an acute dose of beetroot juice (BRJ) containing either 15.6 ± 3.6 or <0.05 mmol of NO3 - . Blood samples were drawn throughout each ~3 h visit for plasma NO3 - and NO2 - analysis. Peak torque was measured during, and periodically for 10 min after, 50 maximal knee extensions performed at 3.14 rad/s on an isokinetic dynamometer. Ingestion of NO3 - -containing BRJ increased plasma NO3 - and NO2 - concentrations by 21 ± 8 and 4 ± 4 fold, respectively. However, there were no differences in muscle fatigue or recovery. Dietary NO3 - increases plasma NO3 - and NO2 - concentrations but does not reduce fatigability during or enhance recoverability after high intensity exercise in older women.
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Affiliation(s)
- William S Zoughaib
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Richard L Hoffman
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Brandon A Yates
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ranjani N Moorthi
- Division of Nephrology and Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kenneth Lim
- Division of Nephrology and Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew R Coggan
- Department of Kinesiology, School of Health & Human Sciences, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
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8
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Zoughaib WS, Hoffman RL, Yates BA, Moorthi RN, Lim K, Coggan AR. The influence of acute dietary nitrate supplementation on skeletal muscle fatigue and recovery in older women. medRxiv 2023:2023.02.15.23285957. [PMID: 36824817 PMCID: PMC9949194 DOI: 10.1101/2023.02.15.23285957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Older individuals fatigue more rapidly during, and recover more slowly from, dynamic exercise. Women are particularly vulnerable to these deleterious effects of aging, which increases their risk of falling. We have shown that dietary nitrate (NO 3 - ), a source of nitric oxide (NO) via the NO 3 - → nitrite (NO 2 - ) → NO pathway, enhances muscle speed and power in older individuals in the non-fatigued state; however, it is unclear if it reduces fatigability and/or improves recoverability in this population. Using a double-blind, placebo-controlled, crossover design, we studied 18 older (age 70 ± 4 y) women who were administered an acute dose of beetroot juice (BRJ) containing either 15.6±3.6 or <0.05 mmol of NO 3 - . Blood samples were drawn throughout each ∼3 h visit for plasma NO 3 - and NO 2 - analysis. Peak torque was measured during, and periodically for 10 min after, 50 maximal knee extensions performed at 3.14 rad/s on an isokinetic dynamometer. Ingestion of NO 3 - -containing BRJ increased plasma NO 3 - and NO 2 - concentrations by 21±8 and 4±4 fold, respectively. However, there were no differences in muscle fatigue or recovery. Dietary NO 3 - increases plasma NO 3 - and NO 2 - concentrations but does not reduce fatigability during or enhance recoverability after high intensity exercise in older women.
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9
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Long GM, Troutman AD, Gray DA, Fisher AJ, Lahm T, Coggan AR, Brown MB. Skeletal muscle blood flow during exercise is reduced in a rat model of pulmonary hypertension. Am J Physiol Regul Integr Comp Physiol 2022; 323:R561-R570. [PMID: 36036455 PMCID: PMC9602702 DOI: 10.1152/ajpregu.00327.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022]
Abstract
Pulmonary arterial hypertension (PAH) is characterized by exercise intolerance. Muscle blood flow may be reduced during exercise in PAH; however, this has not been directly measured. Therefore, we investigated blood flow during exercise in a rat model of monocrotaline (MCT)-induced pulmonary hypertension (PH). Male Sprague-Dawley rats (∼200 g) were injected with 60 mg/kg MCT (MCT, n = 23) and vehicle control (saline; CON, n = 16). Maximal rate of oxygen consumption (V̇o2max) and voluntary running were measured before PH induction. Right ventricle (RV) morphology and function were assessed via echocardiography and invasive hemodynamic measures. Treadmill running at 50% V̇o2max was performed by a subgroup of rats (MCT, n = 8; CON, n = 7). Injection of fluorescent microspheres determined muscle blood flow via photo spectroscopy. MCT demonstrated a severe phenotype via RV hypertrophy (Fulton index, 0.61 vs. 0.31; P < 0.001), high RV systolic pressure (51.5 vs. 22.4 mmHg; P < 0.001), and lower V̇o2max (53.2 vs. 71.8 mL·min-1·kg-1; P < 0.0001) compared with CON. Two-way ANOVA revealed exercising skeletal muscle blood flow relative to power output was reduced in MCT compared with CON (P < 0.001), and plasma lactate was increased in MCT (10.8 vs. 4.5 mmol/L; P = 0.002). Significant relationships between skeletal blood flow and blood lactate during exercise were observed for individual muscles (r = -0.58 to -0.74; P < 0.05). No differences in capillarization were identified. Skeletal muscle blood flow is significantly reduced in experimental PH. Reduced blood flow during exercise may be, at least in part, consequent to reduced exercise intensity in PH. This adds further evidence of peripheral muscle dysfunction and exercise intolerance in PAH.
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Affiliation(s)
- Gary Marshall Long
- Department of Kinesiology, University of Indianapolis, Indianapolis, Indiana
| | - Ashley D Troutman
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Derrick A Gray
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Amanda J Fisher
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Tim Lahm
- Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Indiana University, Indianapolis, Indiana
- Richard L. Roudebush Veteran Affairs Medical Center, Indianapolis, Indiana
| | - Andrew R Coggan
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Mary Beth Brown
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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10
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Peterson LR, Coggan AR. Heart Failure With Reduced Ejection Fraction: “The Importance of Being Frail”. Circulation 2022; 146:91-93. [DOI: 10.1161/circulationaha.122.060467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Linda R. Peterson
- Washington University School of Medicine in Saint Louis, MO (L.R.P.)
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11
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Arroyo E, Umukoro PE, Burney HN, Li Y, Li X, Lane KA, Sher SJ, Lu T, Moe SM, Moorthi R, Coggan AR, McGregor G, Hiemstra TF, Zehnder D, Lim K. Initiation of Dialysis Is Associated With Impaired Cardiovascular Functional Capacity. J Am Heart Assoc 2022; 11:e025656. [PMID: 35861826 PMCID: PMC9707847 DOI: 10.1161/jaha.122.025656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
The transition to dialysis period carries a substantial increased cardiovascular risk in patients with chronic kidney disease. Despite this, alterations in cardiovascular functional capacity during this transition are largely unknown. The present study therefore sought to assess ventilatory exercise response measures in patients within 1 year of initiating dialysis.
Methods and Results
We conducted a cross‐sectional study of 241 patients with chronic kidney disease stage 5 from the CAPER (Cardiopulmonary Exercise Testing in Renal Failure) study and from the intradialytic low‐frequency electrical muscle stimulation pilot randomized controlled trial cohorts. Patients underwent cardiopulmonary exercise testing and echocardiography. Of the 241 patients (age, 48.9 [15.0] years; 154 [63.9%] men), 42 were predialytic (mean estimated glomerular filtration rate, 14 mL·min
−1
·1.73 m
−2
), 54 had a dialysis vintage ≤12 months, and 145 had a dialysis vintage >12 months. Dialysis vintage ≤12 months exhibited a significantly impaired cardiovascular functional capacity, as assessed by oxygen uptake at peak exercise (18.7 [5.8] mL·min
−1
·kg
−1
) compared with predialysis (22.7 [5.2] mL·min
−1
·kg
−1
;
P
<0.001). Dialysis vintage ≤12 months also exhibited reduced peak workload, impaired peak heart rate, reduced circulatory power, and increased left ventricular mass index (
P
<0.05 for all) compared with predialysis. After excluding those with prior kidney transplant, dialysis vintage >12 months exhibited a lower oxygen uptake at peak exercise (17.0 [4.9] mL·min
−1
·kg
−1
) compared with dialysis vintage ≤12 months (18.9 [5.9] mL·min
−1
·kg
−1
;
P
=0.033).
Conclusions
Initiating dialysis is associated with a significant impairment in oxygen uptake at peak exercise and overall decrements in ventilatory and hemodynamic exercise responses that predispose patients to functional dependence. The magnitude of these changes is comparable to the differences between low‐risk New York Heart Association class I and higher‐risk New York Heart Association class II to IV heart failure.
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Affiliation(s)
- Eliott Arroyo
- Division of Nephrology and Hypertension Department of Medicine Indiana University School of Medicine Indianapolis IN
| | - Peter E. Umukoro
- Division of Nephrology and Hypertension Department of Medicine Indiana University School of Medicine Indianapolis IN
- Department of Nephrology Hendricks Regional Health Danville IN
| | - Heather N. Burney
- Department of Biostatistics and Health Data Science Indiana University School of Medicine Indianapolis IN
| | - Yang Li
- Department of Biostatistics and Health Data Science Indiana University School of Medicine Indianapolis IN
| | - Xiaochun Li
- Department of Biostatistics and Health Data Science Indiana University School of Medicine Indianapolis IN
| | - Kathleen A. Lane
- Department of Biostatistics and Health Data Science Indiana University School of Medicine Indianapolis IN
| | - S. Jawad Sher
- Division of Nephrology and Hypertension Department of Medicine Indiana University School of Medicine Indianapolis IN
| | - Tzong‐shi Lu
- Renal Division Department of Medicine Brigham and Women’s Hospital and Harvard Medical School Boston MA
| | - Sharon M. Moe
- Division of Nephrology and Hypertension Department of Medicine Indiana University School of Medicine Indianapolis IN
| | - Ranjani Moorthi
- Division of Nephrology and Hypertension Department of Medicine Indiana University School of Medicine Indianapolis IN
| | - Andrew R. Coggan
- Department of Kinesiology Indiana University–Purdue University Indianapolis Indianapolis IN
| | - Gordon McGregor
- Department of Nephrology University Hospital Coventry and Warwickshire National Health Service Trust Coventry United Kingdom
- Department of Cardiology University Hospital Coventry and Warwickshire National Health Service Trust Coventry United Kingdom
- Centre for Sport, Exercise, and Life Sciences Coventry University Coventry United Kingdom
- Warwick Clinical Trials Unit Warwick Medical School University of Warwick Coventry United Kingdom
| | - Thomas F. Hiemstra
- Cambridge Clinical Trials Unit Cambridge University Hospitals National Health Service Foundation Trust Cambridge United Kingdom
- School of Clinical Medicine University of Cambridge Cambridge United Kingdom
| | - Daniel Zehnder
- Department of Nephrology North Cumbria University Hospital National Health Service Trust Carlisle United Kingdom
- Department of Acute Medicine North Cumbria University Hospital National Health Service Trust Carlisle United Kingdom
| | - Kenneth Lim
- Division of Nephrology and Hypertension Department of Medicine Indiana University School of Medicine Indianapolis IN
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Park LK, Coggan AR, Peterson LR. Skeletal Muscle Contractile Function in Heart Failure With Reduced Ejection Fraction-A Focus on Nitric Oxide. Front Physiol 2022; 13:872719. [PMID: 35721565 PMCID: PMC9198547 DOI: 10.3389/fphys.2022.872719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Despite advances over the past few decades, heart failure with reduced ejection fraction (HFrEF) remains not only a mortal but a disabling disease. Indeed, the New York Heart Association classification of HFrEF severity is based on how much exercise a patient can perform. Moreover, exercise capacity-both aerobic exercise performance and muscle power-are intimately linked with survival in patients with HFrEF. This review will highlight the pathologic changes in skeletal muscle in HFrEF that are related to impaired exercise performance. Next, it will discuss the key role that impaired nitric oxide (NO) bioavailability plays in HFrEF skeletal muscle pathology. Lastly, it will discuss intriguing new data suggesting that the inorganic nitrate 'enterosalivary pathway' may be leveraged to increase NO bioavailability via ingestion of inorganic nitrate. This ingestion of inorganic nitrate has several advantages over organic nitrate (e.g., nitroglycerin) and the endogenous nitric oxide synthase pathway. Moreover, inorganic nitrate has been shown to improve exercise performance: both muscle power and aerobic capacity, in some recent small but well-controlled, cross-over studies in patients with HFrEF. Given the critical importance of better exercise performance for the amelioration of disability as well as its links with improved outcomes in patients with HFrEF, further studies of inorganic nitrate as a potential novel treatment is critical.
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Affiliation(s)
- Lauren K. Park
- Department of Medicine, Cardiology Division, Washington University School of Medicine, Saint Louis, MO, United States
| | - Andrew R. Coggan
- Department of Kinesiology, Indiana University Purdue University, Indianapolis, IN, United States
| | - Linda R. Peterson
- Department of Medicine, Cardiology Division, Washington University School of Medicine, Saint Louis, MO, United States,*Correspondence: Linda R. Peterson,
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Arroyo E, Troutman AD, Moorthi RN, Avin KG, Coggan AR, Lim K. Klotho: An Emerging Factor With Ergogenic Potential. Front Rehabil Sci 2022; 2:807123. [PMID: 36188832 PMCID: PMC9397700 DOI: 10.3389/fresc.2021.807123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022]
Abstract
Sarcopenia and impaired cardiorespiratory fitness are commonly observed in older individuals and patients with chronic kidney disease (CKD). Declines in skeletal muscle function and aerobic capacity can progress into impaired physical function and inability to perform activities of daily living. Physical function is highly associated with important clinical outcomes such as hospitalization, functional independence, quality of life, and mortality. While lifestyle modifications such as exercise and dietary interventions have been shown to prevent and reverse declines in physical function, the utility of these treatment strategies is limited by poor widespread adoption and adherence due to a wide variety of both perceived and actual barriers to exercise. Therefore, identifying novel treatment targets to manage physical function decline is critically important. Klotho, a remarkable protein with powerful anti-aging properties has recently been investigated for its role in musculoskeletal health and physical function. Klotho is involved in several key processes that regulate skeletal muscle function, such as muscle regeneration, mitochondrial biogenesis, endothelial function, oxidative stress, and inflammation. This is particularly important for older adults and patients with CKD, which are known states of Klotho deficiency. Emerging data support the existence of Klotho-related benefits to exercise and for potential Klotho-based therapeutic interventions for the treatment of sarcopenia and its progression to physical disability. However, significant gaps in our understanding of Klotho must first be overcome before we can consider its potential ergogenic benefits. These advances will be critical to establish the optimal approach to future Klotho-based interventional trials and to determine if Klotho can regulate physical dysfunction.
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Affiliation(s)
- Eliott Arroyo
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ashley D. Troutman
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, Indianapolis, IN, United States
| | - Ranjani N. Moorthi
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Keith G. Avin
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University Purdue University, Indianapolis, IN, United States
| | - Andrew R. Coggan
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis, Indianapolis, IN, United States
| | - Kenneth Lim
- Division of Nephrology & Hypertension, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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Coggan AR, Baranauskas MN, Hinrichs RJ, Liu Z, Carter SJ. Effect of dietary nitrate on human muscle power: a systematic review and individual participant data meta-analysis. J Int Soc Sports Nutr 2021; 18:66. [PMID: 34625064 PMCID: PMC8501726 DOI: 10.1186/s12970-021-00463-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/15/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Previous narrative reviews have concluded that dietary nitrate (NO3-) improves maximal neuromuscular power in humans. This conclusion, however, was based on a limited number of studies, and no attempt has been made to quantify the exact magnitude of this beneficial effect. Such information would help ensure adequate statistical power in future studies and could help place the effects of dietary NO3- on various aspects of exercise performance (i.e., endurance vs. strength vs. power) in better context. We therefore undertook a systematic review and individual participant data meta-analysis to quantify the effects of NO3- supplementation on human muscle power. METHODS The literature was searched using a strategy developed by a health sciences librarian. Data sources included Medline Ovid, Embase, SPORTDiscus, Scopus, Clinicaltrials.gov , and Google Scholar. Studies were included if they used a randomized, double-blind, placebo-controlled, crossover experimental design to measure the effects of dietary NO3- on maximal power during exercise in the non-fatigued state and the within-subject correlation could be determined from data in the published manuscript or obtained from the authors. RESULTS Nineteen studies of a total of 268 participants (218 men, 50 women) met the criteria for inclusion. The overall effect size (ES; Hedge's g) calculated using a fixed effects model was 0.42 (95% confidence interval (CI) 0.29, 0.56; p = 6.310 × 10- 11). There was limited heterogeneity between studies (i.e., I2 = 22.79%, H2 = 1.30, p = 0.3460). The ES estimated using a random effects model was therefore similar (i.e., 0.45, 95% CI 0.30, 0.61; p = 1.064 × 10- 9). Sub-group analyses revealed no significant differences due to subject age, sex, or test modality (i.e., small vs. large muscle mass exercise). However, the ES in studies using an acute dose (i.e., 0.54, 95% CI 0.37, 0.71; p = 6.774 × 10- 12) was greater (p = 0.0211) than in studies using a multiple dose regimen (i.e., 0.22, 95% CI 0.01, 0.43; p = 0.003630). CONCLUSIONS Acute or chronic dietary NO3- intake significantly increases maximal muscle power in humans. The magnitude of this effect-on average, ~ 5%-is likely to be of considerable practical and clinical importance.
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Affiliation(s)
- Andrew R Coggan
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN, 46202, USA.
- Department of Kinesiology, Indiana University Purdue University Indianapolis, IF 101C, 250 University Boulevard, Indianapolis, IN, 46112, USA.
| | | | - Rachel J Hinrichs
- University Library, Indiana University Purdue University Indianapolis, Indianapolis, IN, 46202, USA
| | - Ziyue Liu
- Department of Biostatistics, Indiana University Purdue University Indianapolis, Indianapolis, IN, 46202, USA
| | - Stephen J Carter
- Department of Kinesiology, Indiana University, Bloomington, IN, 47405, USA
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University Purdue University Indianapolis, Indianapolis, IN, 46202, USA
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Baranauskas MN, Altherr CA, Coggan AR, Schlader ZJ, Carter SJ. ACUTE DIETARY NITRATE MAY IMPAIR CUTANEOUS VASCULAR CONDUCTANCE DURING LOCAL SKIN HEATING IN POSTMENOPAUSAL WOMEN. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000760040.09199.dc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Yates BA, Coggan AR. Gut Reaction: Habitual Dietary Nitrate Intake as a Modulator of Skeletal Muscle Contractile Function. J Nutr 2021; 151:1049-1050. [PMID: 33760918 PMCID: PMC8112769 DOI: 10.1093/jn/nxab023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brandon A Yates
- Indiana Center for Musculoskeletal Health, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Andrew R Coggan
- Indiana Center for Musculoskeletal Health, School of Medicine, Indiana University, Indianapolis, IN, USA
- Department of Kinesiology, School of Health and Human Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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17
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Gallardo EJ, Gray DA, Hoffman RL, Yates BA, Moorthi RN, Coggan AR. Dose-Response Effect of Dietary Nitrate on Muscle Contractility and Blood Pressure in Older Subjects: A Pilot Study. J Gerontol A Biol Sci Med Sci 2021; 76:591-598. [PMID: 33301009 DOI: 10.1093/gerona/glaa311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 02/06/2023] Open
Abstract
We have recently demonstrated that dietary nitrate, a source of nitric oxide (NO) via the nitrate → nitrite → NO enterosalivary pathway, can improve muscle contractility in healthy older men and women. Nitrate ingestion has also been shown to reduce blood pressure in some, but not all, studies of older individuals. However, the optimal dose for eliciting these beneficial effects is unknown. A pilot randomized, double-blind, placebo-controlled crossover study was therefore performed to determine the effects of ingesting 3.3 mL/kg of concentrated beetroot juice containing 0, 200, or 400 µmol/kg of nitrate in 9 healthy older subjects (mean age 70 ± 1 years). Maximal knee extensor power (Pmax) and speed (Vmax) were measured ~2.5 hours after nitrate ingestion using isokinetic dynamometry. Blood pressure was monitored periodically throughout each study. Pmax (in W/kg) was higher (p < .05) after the lower dose (3.9 ± 0.4) compared to the placebo (3.7 ± 0.4) or higher dose (3.7 ± 0.4). Vmax (in rad/s) also tended to be higher (p = .08) after the lower dose (11.9 ± 0.7) compared to the placebo (10.8 ± 0.8) or higher dose (11.2 ± 0.8). Eight out of 9 subjects achieved a higher Pmax and Vmax after the lower versus the higher dose. These dose-related changes in muscle contractility generally paralleled changes in breath NO levels. No significant changes were found in systolic, diastolic, or mean arterial blood pressure. A lower dose of nitrate increases muscle speed and power in healthy older individuals, but these improvements are lost at a higher dose. Blood pressure, on the other hand, is not reduced even with a higher dose.
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Affiliation(s)
- Edgar J Gallardo
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis
| | - Derrick A Gray
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis
| | - Richard L Hoffman
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis
| | - Brandon A Yates
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis
| | - Ranjani N Moorthi
- Department of Internal Medicine, School of Medicine, Indiana University Purdue University Indianapolis
| | - Andrew R Coggan
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis
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18
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Coggan AR, Hoffman RL, Gray DA, Moorthi RN, Thomas DP, Leibowitz JL, Thies D, Peterson LR. A Single Dose of Dietary Nitrate Increases Maximal Knee Extensor Angular Velocity and Power in Healthy Older Men and Women. J Gerontol A Biol Sci Med Sci 2021; 75:1154-1160. [PMID: 31231758 DOI: 10.1093/gerona/glz156] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Aging results in reductions in maximal muscular strength, speed, and power, which often lead to functional limitations highly predictive of disability, institutionalization, and mortality in elderly adults. This may be partially due to reduced nitric oxide (NO) bioavailability. We, therefore, hypothesized that dietary nitrate (NO3-), a source of NO via the NO3- → nitrite (NO2-) → NO enterosalivary pathway, could increase muscle contractile function in older subjects. METHODS Twelve healthy older (age 71 ± 5 years) men and women were studied using a randomized, double-blind, placebo-controlled, crossover design. After fasting overnight, subjects were tested 2 hours after ingesting beetroot juice containing or devoid of 13.4 ± 1.6 mmol NO3-. Plasma NO3- and NO2- and breath NO were measured periodically, and muscle function was determined using isokinetic dynamometry. RESULTS N O 3 - ingestion increased (p < .001) plasma NO3-, plasma NO2-, and breath NO by 1,051% ± 433%, 138% ± 149%, and 111% ± 115%, respectively. Maximal velocity of knee extension increased (p < .01) by 10.9% ± 12.1%. Maximal knee extensor power increased (p < .05) by 4.4% ± 7.8%. CONCLUSIONS Acute dietary NO3- intake improves maximal knee extensor angular velocity and power in older individuals. These findings may have important implications for this population, in whom diminished muscle function can lead to functional limitations, dependence, and even premature death.
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Affiliation(s)
- Andrew R Coggan
- Department of Kinesiology, Indiana University-Purdue University Indianapolis.,Department of Cellular and Integrative Physiology, Indiana University-Purdue University Indianapolis
| | - Richard L Hoffman
- Department of Kinesiology, Indiana University-Purdue University Indianapolis
| | - Derrick A Gray
- Department of Kinesiology, Indiana University-Purdue University Indianapolis
| | - Ranjani N Moorthi
- Department of Internal Medicine, Indiana University-Purdue University Indianapolis
| | - Deepak P Thomas
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua L Leibowitz
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Dakkota Thies
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Linda R Peterson
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Baranauskas MN, Altherr CA, Gruber AH, Coggan AR, Raglin JS, Gupta SK, Carter SJ. Beetroot supplementation in women enjoying exercise together (BEE SWEET): Rationale, design and methods. Contemp Clin Trials Commun 2021; 21:100693. [PMID: 33392416 PMCID: PMC7773568 DOI: 10.1016/j.conctc.2020.100693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/11/2020] [Accepted: 12/16/2020] [Indexed: 01/22/2023] Open
Abstract
Background Postmenopausal women exhibit higher rates of disability and cardiovascular disease (CVD) with aging compared to men. Whereas habitual exercise training is a known strategy to enhance physiologic function in men and premenopausal women, exercise-related adaptations are often modest in postmenopausal women. We propose dietary nitrate (beetroot juice) administered prior to exercise training may be a feasible approach to improve mobility and cardio-metabolic health outcomes in postmenopausal women. Methods Our randomized, placebo-controlled study aims to determine preliminary effects sizes for changes in functional mobility and endothelium-dependent vasodilation across three study arms: exercise only (EX), exercise + placebo (EX + PL), and exercise + beetroot (EX + BR). Thirty-six postmenopausal women are recruited in small cohorts wherein group exercise is implemented to facilitate social support and adherence to an 8-week training progression. Participants are randomized to one of three study arms (n = 12 per group) following baseline assessments. Post-intervention assessments are used to determine pre-post changes in outcome measures including distance covered during a 6 min walk test, walking economy, muscle speed and power, and endothelial-dependent vasodilation as determined by flow-mediated dilation. Measures of feasibility include recruitment, retention, adherence to exercise prescription, perceived exercise session difficulty, and adverse event rates. Discussion Evidence-based, translational strategies are needed to optimize exercise training-related adaptations in postmenopausal women. Findings will inform larger randomized clinical trials to determine if pre-exercise consumption of beetroot juice is an efficacious strategy to promote mobility and attenuate CVD disease risk.
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Affiliation(s)
- Marissa N. Baranauskas
- Department of Kinesiology, School of Public Health, Bloomington, Indiana University, 47405, USA
| | - Cody A. Altherr
- Department of Kinesiology, School of Public Health, Bloomington, Indiana University, 47405, USA
| | - Allison H. Gruber
- Department of Kinesiology, School of Public Health, Bloomington, Indiana University, 47405, USA
| | - Andrew R. Coggan
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis, Indianapolis, IN, 46202, USA
| | - John S. Raglin
- Department of Kinesiology, School of Public Health, Bloomington, Indiana University, 47405, USA
| | - Samir K. Gupta
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, 46203, USA
| | - Stephen J. Carter
- Department of Kinesiology, School of Public Health, Bloomington, Indiana University, 47405, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, 46202, USA
- Corresponding author. Department of Kinesiology School of Public Health – Bloomington Indiana University Bloomington, IN, 47405-7109, USA.
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20
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Lim K, McGregor G, Coggan AR, Lewis GD, Moe SM. Cardiovascular Functional Changes in Chronic Kidney Disease: Integrative Physiology, Pathophysiology and Applications of Cardiopulmonary Exercise Testing. Front Physiol 2020; 11:572355. [PMID: 33041870 PMCID: PMC7522507 DOI: 10.3389/fphys.2020.572355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022] Open
Abstract
The development of cardiovascular disease during renal impairment involves striking multi-tiered, multi-dimensional complex alterations encompassing the entire oxygen transport system. Complex interactions between target organ systems involving alterations of the heart, vascular, musculoskeletal and respiratory systems occur in Chronic Kidney Disease (CKD) and collectively contribute to impairment of cardiovascular function. These systemic changes have challenged our diagnostic and therapeutic efforts, particularly given that imaging cardiac structure at rest, rather than ascertainment under the stress of exercise, may not accurately reflect the risk of premature death in CKD. The multi-systemic nature of cardiovascular disease in CKD patients provides strong rationale for an integrated approach to the assessment of cardiovascular alterations in this population. State-of-the-art cardiopulmonary exercise testing (CPET) is a powerful, dynamic technology that enables the global assessment of cardiovascular functional alterations and reflects the integrative exercise response and complex machinery that form the oxygen transport system. CPET provides a wealth of data from a single assessment with mechanistic, physiological and prognostic utility. It is an underutilized technology in the care of patients with kidney disease with the potential to help advance the field of cardio-nephrology. This article reviews the integrative physiology and pathophysiology of cardio-renal impairment, critical new insights derived from CPET technology, and contemporary evidence for potential applications of CPET technology in patients with kidney disease.
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Affiliation(s)
- Kenneth Lim
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Gordon McGregor
- Coventry University Hospital, Coventry and Warwickshire NHS Trust, Coventry, United Kingdom.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Andrew R Coggan
- Department of Kinesiology, Indiana University - Purdue University, Indianapolis, IN, United States
| | - Gregory D Lewis
- Division of Cardiology, The Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sharon M Moe
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
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21
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Carter SJ, Gruber AH, Raglin JS, Baranauskas MN, Coggan AR. Potential health effects of dietary nitrate supplementation in aging and chronic degenerative disease. Med Hypotheses 2020; 141:109732. [PMID: 32294579 PMCID: PMC7313402 DOI: 10.1016/j.mehy.2020.109732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022]
Abstract
In the United States, latest projections indicate the number of adults 65 years of age and older is expected to double by 2050. Given that increased oxidative stress is a hallmark of aging, it is understandable that waning nitric oxide and chronic degenerative disease arise in tandem. To this end, translational evidence-based strategies are needed to mitigate the impending toll on personal and public health. Dietary nitrate supplementation, particularly in the form of beetroot juice, is an active area of inquiry that has gained considerable attention in recent years. Compelling evidence has revealed beetroot juice can elicit potent physiological responses that may offer associated health benefits for multiple clinical disorders including hypertension, dementia, and sarcopenia. Even in the absence of overt disease, age-related impairments in cardiovascular and skeletal muscle function may uniquely benefit from beetroot juice supplementation as evidence has shown blood pressure lowering effects and improved muscle function/contractility - presumably from increased nitric oxide bioavailability. This, in turn, presents a practical opportunity for susceptible populations to support ease of movement and exercise tolerance, both of which may promote free-living physical activity. A theoretical rationale details the potential health effects of dietary nitrate supplementation, wherein a working framework hypothesizes beetroot juice consumption prior to structured exercise training may offer synergistic benefits to aid healthy aging and independent-living among older adults.
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Affiliation(s)
- Stephen J Carter
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, Bloomington, IN 47405, USA.
| | - Allison H Gruber
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, Bloomington, IN 47405, USA
| | - John S Raglin
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, Bloomington, IN 47405, USA
| | - Marissa N Baranauskas
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, Bloomington, IN 47405, USA
| | - Andrew R Coggan
- Department of Kinesiology, Indiana University Purdue University, Indianapolis, IN 46202, USA
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Long GM, Frump A, Troutman A, Mailand M, Ellis KA, Fisher A, Avin K, Lahm T, Coggan AR, Brown MB. Dietary Nitrate Does Not Increase Exercising Muscle Blood Flow In Rat With Pulmonary Arterial Hypertension. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675992.64423.dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Coggan AR, Gallardo E, Gray DA, Hoffman R, Moorthi R. DIFFERENTIAL EFFECTS OF VARYING DOSES OF DIETARY NITRATE ON MUSCLE FUNCTION AND BLOOD PRESSURE IN OLDER SUBJECTS. Innov Aging 2019. [PMCID: PMC6844768 DOI: 10.1093/geroni/igz038.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We have recently demonstrated that dietary nitrate, a source of nitric oxide via the enterosalivary pathway, can improve muscle contractile function in healthy older men and women. Nitrate ingestion has also been shown to reduce blood pressure in older individuals. However, the optimal dose for eliciting these beneficial effects is unknown. We therefore performed a randomized, double-blind, crossover study to determine the effects of ingesting 3.3 mL/kg of beetroot juice (BRJ) containing 0, 212, or 425 µmol/kg of nitrate in six healthy older (age 69±3 y) subjects. Maximal knee extensor speed (Vmax) and power (Pmax) were measured 2 h after BRJ ingestion using isokinetic dynamometry; blood pressure was monitored periodically throughout each study. Mean arterial pressure (in mmHg) was lower (P<0.05) after the high (80±4) vs. the low (84±3) or placebo (88±2) doses. Vmax (in rad/s), however, was higher (P<0.05) after the low dose (11.7±0.8), but not the high dose (10.8±1.0), compared to the placebo (10.5±1.0). Pmax (in W/kg) also tended to be higher (P=0.11) in the low (3.9±0.5) compared to the placebo (3.7±0.5) or high (3.7±0.5) trials. Five out of six subjects achieved a higher Vmax and Pmax after the low vs. the high dose. We conclude that dietary nitrate has differential effects on muscle function and blood pressure in older individuals. A high dose of nitrate intake further lowers blood pressure but does not enhance muscle contractility as much as a lower dose. Supported by Indiana University Purdue University Indianapolis and by the NIA (R21 AG053606)
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Affiliation(s)
- Andrew R Coggan
- Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States
| | - Edgar Gallardo
- Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States
| | - Derrick A Gray
- Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States
| | - Richard Hoffman
- Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States
| | - Ranjani Moorthi
- Indiana University Purdue University Indianapolis, Indianapolis, Indiana, United States
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Madigan MJ, Racette SB, Coggan AR, Stein RI, McCue LM, Gropler RJ, Peterson LR. Weight Loss Affects Intramyocardial Glucose Metabolism in Obese Humans. Circ Cardiovasc Imaging 2019; 12:e009241. [PMID: 31352791 DOI: 10.1161/circimaging.119.009241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Michael J Madigan
- Department of Medicine (S.B.R., M.J.M., R.I.S., R.J.G., L.R.P.), Washington University School of Medicine (WUSM), St. Louis, MO
| | - Susan B Racette
- Department of Medicine (S.B.R., M.J.M., R.I.S., R.J.G., L.R.P.), Washington University School of Medicine (WUSM), St. Louis, MO.,Program in Physical Therapy (S.B.R.), Washington University School of Medicine (WUSM), St. Louis, MO
| | - Andrew R Coggan
- Department of Kinesiology, Indiana University Purdue University, Indianapolis (A.R.C.)
| | - Richard I Stein
- Department of Medicine (S.B.R., M.J.M., R.I.S., R.J.G., L.R.P.), Washington University School of Medicine (WUSM), St. Louis, MO
| | - Lena M McCue
- Division of Biostatistics (L.M.M.), Washington University School of Medicine (WUSM), St. Louis, MO
| | - Robert J Gropler
- Department of Medicine (S.B.R., M.J.M., R.I.S., R.J.G., L.R.P.), Washington University School of Medicine (WUSM), St. Louis, MO.,Department of Radiology (R.J.G., L.R.P.), Washington University School of Medicine (WUSM), St. Louis, MO
| | - Linda R Peterson
- Department of Medicine (S.B.R., M.J.M., R.I.S., R.J.G., L.R.P.), Washington University School of Medicine (WUSM), St. Louis, MO.,Department of Radiology (R.J.G., L.R.P.), Washington University School of Medicine (WUSM), St. Louis, MO
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Abstract
Consumption of beetroot juice (BRJ) supplements has become popular among athletes, because beets tend to be rich in nitrate (NO3-), which can enhance exercise performance by increasing nitric oxide production. The NO3- content of beets can vary significantly, however, making it difficult to know how much NO3- any product actually contains. Samples from 45 different lots of 24 different BRJ products from 21 different companies were therefore analyzed for NO3- (and nitrite; NO2-) concentration using high performance liquid chromatography. The NO3- and NO2- content, i.e., amount per serving, was then calculated based on either 1) the manufacturer's recommended serving size (for prepackaged/single dose products) or 2) as used in previous studies, a volume of 500 mL (for BRJ sold in bulk containers). There was moderate-to-large variability in NO3- content between samples of the same product, with a mean coefficient of variation of 30±26% (range 2 to 83%). There was even greater variability between products, with a ~50-fold range in NO3- content between the lowest and highest. Only five products consistently provided ≥5 mmol of NO3- per serving, which seems to be the minimal dose required to enhance exercise performance in most individuals. NO2- contents were generally low (i.e., ≤0.5% compared to NO3-), although two products contained 10 and 14%. The present results may be useful to athletes and their support staff contemplating which (if any) BRJ product to utilize. These data may also offer insight into variability in the literature with respect to the effects of BRJ on exercise performance.
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Affiliation(s)
| | - Andrew R Coggan
- 1 Departments of Kinesiology
- 2 Cellular and Integrative Physiology, Indiana University Purdue University Indianapolis, Indianapolis, IN
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Long GM, Frump A, Troutman A, Mailand M, Ellis KA, Fisher A, Avin K, Coggan AR, Lahm T, Brown MB. Exercising Skeletal Muscle Blood Flow is Diminished in a Rat Model of Pulmonary Arterial Hypertension. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562337.85607.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Coggan AR, Gray D, Racette SB, Todd Cade W, Thies D, Schechtman KB, Peterson LR. The Inorganic NItrate For eXercise In Heart Failure (INIX-HF) Trial: Rationale, Design, And Preliminary Data. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561749.14622.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Coggan AR, Peterson LR. [Reply to Notarius]. J Card Fail 2019; 25:223. [DOI: 10.1016/j.cardfail.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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Coggan AR, Broadstreet SR, Mikhalkova D, Bole I, Leibowitz JL, Kadkhodayan A, Park S, Thomas DP, Thies D, Peterson LR. Dietary nitrate-induced increases in human muscle power: high versus low responders. Physiol Rep 2019; 6. [PMID: 29368802 PMCID: PMC5789728 DOI: 10.14814/phy2.13575] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 01/26/2023] Open
Abstract
Maximal neuromuscular power is an important determinant of athletic performance and also quality of life, independence, and perhaps even mortality in patient populations. We have shown that dietary nitrate (NO3−), a source of nitric oxide (NO), improves muscle power in some, but not all, subjects. The present investigation was designed to identify factors contributing to this interindividual variability. Healthy men (n = 13) and women (n = 7) 22–79 year of age and weighing 52.1–114.9 kg were studied using a randomized, double‐blind, placebo‐controlled, crossover design. Subjects were tested 2 h after ingesting beetroot juice (BRJ) either containing or devoid of 12.3 ± 0.8 mmol of NO3−. Plasma NO3− and nitrite (NO2−) were measured as indicators of NO bioavailability and maximal knee extensor speed (Vmax), power (Pmax), and fatigability were determined via isokinetic dynamometry. On average, dietary NO3− increased (P < 0.05) Pmax by 4.4 ± 8.1%. Individual changes, however, ranged from −9.6 to +26.8%. This interindividual variability was not significantly correlated with age, body mass (inverse of NO3− dose per kg), body mass index (surrogate for body composition) or placebo trial Vmax or fatigue index (in vivo indicators of muscle fiber type distribution). In contrast, the relative increase in Pmax was significantly correlated (r = 0.60; P < 0.01) with the relative increase in plasma NO2− concentration. In multivariable analysis female sex also tended (P = 0.08) to be associated with a greater increase in Pmax. We conclude that the magnitude of the dietary NO3−‐induced increase in muscle power is dependent upon the magnitude of the resulting increase in plasma NO2− and possibly female sex.
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Affiliation(s)
- Andrew R Coggan
- Departments of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana.,Cellular and Integrative Physiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana.,Departments of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Seth R Broadstreet
- Departments of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Deana Mikhalkova
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Indra Bole
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua L Leibowitz
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ana Kadkhodayan
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Soo Park
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Deepak P Thomas
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Dakkota Thies
- Departments of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Linda R Peterson
- Departments of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Abstract
Studies of rats have indicated that skeletal muscle plays a central role in whole-body nitrate ( NO3- )/nitrite ( NO2- )/nitric oxide (NO) metabolism. Extending these results to humans, however, is challenging due to the small size of needle biopsy samples. We therefore developed a method to precisely and accurately quantify NO3- and NO2- in biopsy-sized muscle samples. NO3- and NO2- were extracted from rat soleus samples using methanol combined with mechanical homogenization + ultrasound, bead beating, pulverization at liquid N2 temperature or pulverization + 0.5% Triton X-100. After centrifugation to remove proteins, NO3- and NO2- were measured using HPLC. Mechanical homogenization + ultrasound resulted in the lowest NO3- content (62 ± 20 pmol/mg), with high variability [coefficient of variation (CV) >50%] across samples from the same muscle. The NO2- / NO3- ratio (0.019 ± 0.006) was also elevated, suggestive of NO3- reduction during tissue processing. Bead beating or pulverization yielded lower NO2- and slightly higher NO3- levels, but reproducibility was still poor. Pulverization + 0.5% Triton X-100 provided the highest NO3- content (124 ± 12 pmol/mg) and lowest NO2- / NO3- ratio (0.008 ± 0.001), with the least variability between duplicate samples (CV ~15%). These values are consistent with literature data from larger rat muscle samples analyzed using chemiluminescence. Samples were stable for at least 5 wk at -80°C, provided residual xanthine oxidoreductase activity was blocked using 0.1 mmol/l oxypurinol. We have developed a method capable of measuring NO3- and NO2- in <1 mg of muscle. This method should prove highly useful in investigating the role of skeletal muscle in NO3- / NO2- /NO metabolism in human health and disease. NEW & NOTEWORTHY Measurement of nitrate and especially nitrite in small, i.e., biopsy-sized, muscle samples is analytically challenging. We have developed a precise, accurate, and convenient method for doing so using an affordable commercial HPLC system.
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Affiliation(s)
- Ashley D Troutman
- Department of Kinesiology, Indiana University-Purdue University Indianapolis , Indianapolis, Indiana.,Department of Physical Therapy, Indiana University-Purdue University Indianapolis , Indianapolis, Indiana
| | - Edgar J Gallardo
- Department of Kinesiology, Indiana University-Purdue University Indianapolis , Indianapolis, Indiana
| | - Mary Beth Brown
- Department of Physical Therapy, Indiana University-Purdue University Indianapolis , Indianapolis, Indiana
| | - Andrew R Coggan
- Department of Kinesiology, Indiana University-Purdue University Indianapolis , Indianapolis, Indiana.,Department of Cellular and Integrative Physiology, Indiana-University Purdue University Indianapolis , Indianapolis, Indiana
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Abstract
We review recent studies of the effects of dietary nitrate on human muscle contractile function and discuss possible underlying mechanisms. Dietary nitrate, a source of nitric oxide (NO), improves the contractile properties of human muscle. We present the hypothesis that this is due to nitrosylation of the ryanodine receptor and increased NO signaling via the soluble guanyl cyclase-cyclic guanosine monophosphate-protein kinase G pathway, which together increase the free intracellular Ca2+ concentration along with the Ca2+ sensitivity of the myofilaments themselves.
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Affiliation(s)
- Andrew R Coggan
- Departments of Kinesiology and.,Cellular and Integrative Physiology, Indiana University Purdue University Indianapolis, Indianapolis, IN
| | - Linda R Peterson
- Medicine and.,Radiology, Washington University School of Medicine, St. Louis, MO
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Mulkareddy V, Racette SB, Coggan AR, Peterson LR. Dietary nitrate's effects on exercise performance in heart failure with reduced ejection fraction (HFrEF). Biochim Biophys Acta Mol Basis Dis 2018; 1865:735-740. [PMID: 30261290 DOI: 10.1016/j.bbadis.2018.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 01/09/2023]
Abstract
Heart failure with reduced ejection fraction (HFrEF) is a deadly and disabling disease. A key derangement contributing to impaired exercise performance in HFrEF is decreased nitric oxide (NO) bioavailability. Scientists recently discovered the inorganic nitrate pathway for increasing NO. This has advantages over organic nitrates and NO synthase production of NO. Small studies using beetroot juice as a source of inorganic nitrate demonstrate its power to improve exercise performance in HFrEF. A larger-scale trial is now underway to determine if inorganic nitrate may be a new arrow for physicians' quiver of HFrEF treatments.
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Affiliation(s)
- Vinaya Mulkareddy
- The Department of Medicine, 4960 Children's Place, Campus Box 8066, St. Louis, MO 63110, USA.
| | - Susan B Racette
- The Department of Medicine, 4960 Children's Place, Campus Box 8066, St. Louis, MO 63110, USA; Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Ave., St. Louis, MO 63108-2212, USA.
| | - Andrew R Coggan
- Department of Kinesiology, Indiana University Purdue University Indianapolis, 901 West New York Street, Indianapolis, IN 46202, USA; Department of Cellular and Integrative Physiology, Indiana University Purdue University Indianapolis, 901 West New York Street, Indianapolis, IN 46202, USA.
| | - Linda R Peterson
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA.
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Gallardo EJ, Coggan AR. Nitrate and Nitrite Content of Beet Juice Products Marketed to Athletes. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000537045.93218.dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Coggan AR, Troutman AD, Brown MB. Measurement Of Nitrate And Nitrite In Biopsy-Sized Muscle Samples. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536481.32666.fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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35
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Coggan AR. Dietary Nitrate and Muscle Function in Humans. Med Sci Sports Exerc 2018; 50:874. [DOI: 10.1249/mss.0000000000001489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mikhalkova D, Holman SR, Jiang H, Saghir M, Novak E, Coggan AR, O'Connor R, Bashir A, Jamal A, Ory DS, Schaffer JE, Eagon JC, Peterson LR. Bariatric Surgery-Induced Cardiac and Lipidomic Changes in Obesity-Related Heart Failure with Preserved Ejection Fraction. Obesity (Silver Spring) 2018; 26:284-290. [PMID: 29243396 PMCID: PMC5783730 DOI: 10.1002/oby.22038] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/24/2017] [Accepted: 09/04/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the effects of gastric bypass on myocardial lipid deposition and function and the plasma lipidome in women with obesity and heart failure with preserved ejection fraction (HFpEF). METHODS A primary cohort (N = 12) with HFpEF and obesity underwent echocardiography and magnetic resonance spectroscopy both before and 3 months and 6 months after bariatric surgery. Plasma lipidomic analysis was performed before surgery and 3 months after surgery in the primary cohort and were confirmed in a validation cohort (N = 22). RESULTS After surgery-induced weight loss, Minnesota Living with Heart Failure questionnaire scores, cardiac mass, and liver fat decreased (P < 0.02, P < 0.001, and P = 0.007, respectively); echo-derived e' increased (P = 0.03), but cardiac fat was unchanged. Although weight loss was associated with decreases in many plasma ceramide and sphingolipid species, plasma lipid and cardiac function changes did not correlate. CONCLUSIONS Surgery-induced weight loss in women with HFpEF and obesity was associated with improved symptoms, reverse cardiac remodeling, and improved relaxation. Although weight loss was associated with plasma sphingolipidome changes, cardiac function improvement was not associated with lipidomic or myocardial triglyceride changes. The results of this study suggest that gastric bypass ameliorates obesity-related HFpEF and that cardiac fat deposition and lipidomic changes may not be critical to its pathogenesis.
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Affiliation(s)
- Deana Mikhalkova
- Cardiovascular Division, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Sujata R Holman
- Cardiovascular Division, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Hui Jiang
- Diabetic Cardiovascular Disease Center, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Mohammed Saghir
- Cardiovascular Division, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Eric Novak
- Cardiovascular Division, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Andrew R Coggan
- Mallinckrodt Institute of Radiology, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Robert O'Connor
- Mallinckrodt Institute of Radiology, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Adil Bashir
- Mallinckrodt Institute of Radiology, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Ali Jamal
- Mallinckrodt Institute of Radiology, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Daniel S Ory
- Diabetic Cardiovascular Disease Center, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Jean E Schaffer
- Diabetic Cardiovascular Disease Center, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
| | - J Christopher Eagon
- Department of Surgery, School of Medicine, Washington University, St Louis, Missouri, USA
| | - Linda R Peterson
- Cardiovascular Division, Department of Medicine, School of Medicine, Washington University, St Louis, Missouri, USA
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Coggan AR, Broadstreet SR, Mahmood K, Mikhalkova D, Madigan M, Bole I, Park S, Leibowitz JL, Kadkhodayan A, Thomas DP, Thies D, Peterson LR. Dietary Nitrate Increases VO 2peak and Performance but Does Not Alter Ventilation or Efficiency in Patients With Heart Failure With Reduced Ejection Fraction. J Card Fail 2017; 24:65-73. [PMID: 28916479 DOI: 10.1016/j.cardfail.2017.09.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with heart failure with reduced ejection fraction (HFrEF) exhibit lower efficiency, dyspnea, and diminished peak oxygen uptake (VO2peak) during exercise. Dietary nitrate (NO3-), a source of nitric oxide (NO), has improved these measures in some studies of other populations. We determined the effects of acute NO3- ingestion on exercise responses in 8 patients with HFrEF using a randomized, double-blind, placebo-controlled, crossover design. METHODS AND RESULTS Plasma NO3-, nitrite (NO2-), and breath NO were measured at multiple time points and respiratory gas exchange was determined during exercise after ingestion of beetroot juice containing or devoid of 11.2 mmol of NO3-. NO3- intake increased (P < .05-0.001) plasma NO3- and NO2- and breath NO by 1469 ± 245%, 105 ± 34%, and 60 ± 18%, respectively. Efficiency and ventilation during exercise were unchanged. However, NO3- ingestion increased (P < .05) VO2peak by 8 ± 2% (ie, from 21.4 ± 2.1 to 23.0 ± 2.3 mL.min-1.kg-1). Time to fatigue improved (P < .05) by 7 ± 3 % (ie, from 582 ± 84 to 612 ± 81 seconds). CONCLUSIONS Acute dietary NO3- intake increases VO2peak and performance in patients with HFrEF. These data, in conjunction with our recent data demonstrating that dietary NO3- also improves muscle contractile function, suggest that dietary NO3- supplementation may be a valuable means of enhancing exercise capacity in this population.
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Affiliation(s)
- Andrew R Coggan
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana; Department of Cellular and Integrative Physiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana; Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| | - Seth R Broadstreet
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, Indiana
| | - Kiran Mahmood
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Deana Mikhalkova
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Madigan
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Indra Bole
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Soo Park
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua L Leibowitz
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ana Kadkhodayan
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Deepak P Thomas
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Dakkota Thies
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Linda R Peterson
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Kadkhodayan A, Lin CH, Coggan AR, Kisrieva-Ware Z, Schechtman KB, Novak E, Joseph SM, Dávila-Román VG, Gropler RJ, Dence C, Peterson LR. Sex affects myocardial blood flow and fatty acid substrate metabolism in humans with nonischemic heart failure. J Nucl Cardiol 2017; 24:1226-1235. [PMID: 27048307 PMCID: PMC5517366 DOI: 10.1007/s12350-016-0467-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/25/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND In animal models of heart failure (HF), myocardial metabolism shifts from high-energy fatty acid (FA) metabolism toward glucose. However, FA (vs glucose) metabolism generates more ATP/mole; thus, FA metabolism may be especially advantageous in HF. Sex modulates myocardial blood flow (MBF) and substrate metabolism in normal humans. Whether sex affects MBF and metabolism in patients with HF is unknown. METHODS AND RESULTS We studied 19 well-matched men and women with nonischemic HF (EF ≤ 35%). MBF and myocardial substrate metabolism were quantified using positron emission tomography. Women had higher MBF (mL/g/minute), FA uptake (mL/g/minute), and FA utilization (nmol/g/minute) (P < 0.005, P < 0.005, P < 0.05, respectively) and trended toward having higher FA oxidation than men (P = 0.09). These findings were independent of age, obesity, and insulin resistance. There were no sex-related differences in fasting myocardial glucose uptake or metabolism. Higher MBF was related to improved event-free survival (HR 0.31, P = 0.02). CONCLUSIONS In nonischemic HF, women have higher MBF and FA uptake and metabolism than men, irrespective of age, obesity, or insulin resistance. Moreover, higher MBF portends a better prognosis. These sex-related differences should be taken into account in the development and targeting of novel agents aimed at modulating MBF and metabolism in HF.
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Affiliation(s)
- Ana Kadkhodayan
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Cardiovascular Division, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - C Huie Lin
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Campus Box 8086, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
- Debakey Cardiovascular Associates, Houston Methodist Hospital, Houston, USA
| | - Andrew R Coggan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Zulfia Kisrieva-Ware
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Novak
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Campus Box 8086, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Susan M Joseph
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Campus Box 8086, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Víctor G Dávila-Román
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Campus Box 8086, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Robert J Gropler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carmen Dence
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Linda R Peterson
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Campus Box 8086, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
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Abstract
Heart failure (HF) patients suffer from exercise intolerance that diminishes their ability to perform normal activities of daily living and hence compromises their quality of life. This is due largely to detrimental changes in skeletal muscle mass, structure, metabolism, and function. This includes an impairment of muscle contractile performance, i.e., a decline in the maximal force, speed, and power of muscle shortening. Although numerous mechanisms underlie this reduction in contractility, one contributing factor may be a decrease in nitric oxide (NO) bioavailability. Consistent with this, recent data demonstrate that acute ingestion of NO3 (-)-rich beetroot juice, a source of NO via the NO synthase-independent enterosalivary pathway, markedly increases maximal muscle speed and power in HF patients. This review discusses the role of muscle contractile dysfunction in the exercise intolerance characteristic of HF, and the evidence that dietary NO3 (-) supplementation may represent a novel and simple therapy for this currently underappreciated problem.
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Affiliation(s)
- Andrew R Coggan
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd. - Campus Box 8225, St. Louis, MO, 63110, USA.
| | - Linda R Peterson
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd. - Campus Box 8225, St. Louis, MO, 63110, USA
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave. - Campus Box 8086, St. Louis, MO, 63110, USA
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Coggan AR, Mahmood K, Mikhalkova D, Dole I, Park S, Leibowitz J, Kadkhodayan A, Thomas D, Thies D, Peterson LR. Dietary Nitrate Reduces Ventilatory Demands and Increases VO2peak in Patients With Systolic Heart Failure. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000485774.28625.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cedars AM, Saef J, Peterson LR, Coggan AR, Novak EL, Kemp D, Ludbrook PA. Effect of Ambrisentan on Exercise Capacity in Adult Patients After the Fontan Procedure. Am J Cardiol 2016; 117:1524-32. [PMID: 27063478 DOI: 10.1016/j.amjcard.2016.02.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 11/19/2022]
Abstract
The Fontan operation is a common end point for children born with a single functional ventricle. Fontan patients typically experience physiological deterioration leading to transplant or death in their third or fourth decades of life. This deterioration is partially attributable to progressive increases in pulmonary vascular resistance (PVR) and as such endothelin receptor antagonists, which are known to decrease pulmonary vascular resistance, have been proposed as potentially beneficial in this population. We conducted a single-center, randomized, double-blind, placebo-controlled, crossover study of 12 weeks of ambrisentan therapy (10 mg per day) versus placebo to test the hypothesis that endothelin receptor antagonism will improve cardiopulmonary exercise test parameters and 36-item short form (SF-36) assessed quality of life in adult Fontan patients. Twenty-eight patients entered the trial, 19 patients completed the protocol. Ambrisentan therapy improved peak oxygen consumption by 1.7 ml/kg/min in patients who achieved a respiratory exchange ratio of >0.95 (p = 0.05) and decreased the slope of the ventilatory equivalent ratio for oxygen (-2.8, p = 0.019) in all completers. It did not change SF-36 physical function score compared with placebo (p = 0.28). Ambrisentan therapy resulted in a decrease in (-1.4 g/dl, p <0.001) with no change in liver or renal function. Therapy was generally well tolerated, with no greater rate of side effects than placebo. In conclusion, ambrisentan is well tolerated and improves exercise capacity in adult Fontan patients.
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Affiliation(s)
- Ari M Cedars
- Department of Cardiology, Baylor University Hospital, Dallas, Texas.
| | - Joshua Saef
- Department of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Linda R Peterson
- Department of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew R Coggan
- Department of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric L Novak
- Department of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Debra Kemp
- Department of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Philip A Ludbrook
- Department of Cardiology, Washington University School of Medicine, St. Louis, Missouri
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Zheng J, Muccigrosso D, Zhang X, An H, Coggan AR, Adil B, Hildebolt CF, Vemuri C, Geraghty P, Hastings MK, Mueller MJ. Oximetric angiosome imaging in diabetic feet. J Magn Reson Imaging 2016; 44:940-6. [PMID: 26970103 DOI: 10.1002/jmri.25220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/19/2016] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To develop a noncontrast oximetric angiosome imaging approach to assess skeletal muscle oxygenation in diabetic feet. MATERIALS AND METHODS In four healthy and five subjects with diabetes, the feasibility of foot oximetry was examined using a 3T clinical magnetic resonance imaging (MRI) scanner. The subjects' feet were scanned at rest and during a toe-flexion isometric exercise. The oxygen extraction fraction of skeletal muscle was measured using a susceptibility-based MRI method. Our newly developed MR foot oximetric angiosome model was compared with the traditional angiosome model in the assessment of the distribution of oxygen extraction fraction. RESULTS Using the traditional angiosome during the toe-flexion exercise, the oxygen extraction fraction in the medial foot of healthy subjects increased (4.9 ± 3%) and decreased (-2.7 ± 4.4%) in subjects with diabetes (difference = 7.6%; 95% confidence interval = -13.7 ± 1.4; P = 0.02). Using the oximetric angiosome, the percent difference in the areas of oxygen extraction fraction within the 0.7-1.0 range (expected oxygen extraction fraction during exercise) between rest and exercise was higher in healthy subjects (8 ± 4%) than in subjects with diabetes (4 ± 4%; P = 0.02). CONCLUSION This study demonstrates the feasibility of measuring skeletal muscle oxygen extraction fraction in the foot muscle during a toe-flexion isometric exercise. Instead of assessing oxygen extraction fraction in a foot muscle region linked to a supplying artery (traditional angiosome), the foot oximetric angiosome model assesses oxygen extraction fraction by its different levels in all foot muscle regions and thus may be more appropriate for assessing local ischemia in ulcerated diabetic feet. J. Magn. Reson. Imaging 2016. J. MAGN. RESON. IMAGING 2016;44:940-946.
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Affiliation(s)
- Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - David Muccigrosso
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrew R Coggan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bashir Adil
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charles F Hildebolt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chandu Vemuri
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrick Geraghty
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mary K Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael J Mueller
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
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Airhart S, Cade WT, Jiang H, Coggan AR, Racette SB, Korenblat K, Spearie CA, Waller S, O'Connor R, Bashir A, Ory DS, Schaffer JE, Novak E, Farmer M, Waggoner AD, Dávila-Román VG, Javidan-Nejad C, Peterson LR. A Diet Rich in Medium-Chain Fatty Acids Improves Systolic Function and Alters the Lipidomic Profile in Patients With Type 2 Diabetes: A Pilot Study. J Clin Endocrinol Metab 2016; 101:504-12. [PMID: 26652763 PMCID: PMC4880128 DOI: 10.1210/jc.2015-3292] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Excessive cardiac long-chain fatty acid (LCFA) metabolism/storage causes cardiomyopathy in animal models of type 2 diabetes. Medium-chain fatty acids (MCFAs) are absorbed and oxidized efficiently. Data in animal models of diabetes suggest MCFAs may benefit the heart. OBJECTIVE Our objective was to test the effects of an MCFA-rich diet vs an LCFA-rich diet on plasma lipids, cardiac steatosis, and function in patients with type 2 diabetes. DESIGN This was a double-blind, randomized, 2-week matched-feeding study. SETTING The study included ambulatory patients in the general community. PATIENTS Sixteen patients, ages 37-65 years, with type 2 diabetes, an ejection fraction greater than 45%, and no other systemic disease were included. INTERVENTION Fourteen days of a diet rich in MCFAs or LCFAs, containing 38% as fat in total, was undertaken. MAIN OUTCOME MEASURES Cardiac steatosis and function were the main outcome measures, with lipidomic changes considered a secondary outcome. RESULTS The relatively load-independent measure of cardiac contractility, S', improved in the MCFA group (P < .05). Weight-adjusted stroke volume and cardiac output decreased in the LCFA group (both P < .05). The MCFA, but not the LCFA, diet decreased several plasma sphingolipids, ceramide, and acylcarnitines implicated in diabetic cardiomyopathy, and changes in several sphingolipids correlated with improved fasting insulins. CONCLUSIONS Although a diet high in MCFAs does not change cardiac steatosis, our findings suggest that the MCFA-rich diet alters the plasma lipidome and may benefit or at least not harm cardiac function and fasting insulin levels in humans with type 2 diabetes. Larger, long-term studies are needed to further evaluate these effects in less-controlled settings.
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Affiliation(s)
- Sophia Airhart
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - W Todd Cade
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Hui Jiang
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew R Coggan
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Susan B Racette
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kevin Korenblat
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Catherine Anderson Spearie
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Suzanne Waller
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Robert O'Connor
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Adil Bashir
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel S Ory
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jean E Schaffer
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Eric Novak
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Marsha Farmer
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Alan D Waggoner
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Víctor G Dávila-Román
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Cylen Javidan-Nejad
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Linda R Peterson
- Department of Medicine (S.A.), Program in Physical Therapy (W.T.C., S.B.R.), Diabetic Cardiovascular Disease Center (H.J., D.S.O., J.E.S., M.F.), Mallinckrodt Institute of Radiology (A.R.C., R.O'C., A.B., C.J.-N.), Gastroenterology Division (K.K., C.A.S., S.W.), Lifestyle Intervention Research Core, Cardiology Division (A.D.W., V.G.D.-R., L.R.P.), Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Coggan AR, Leibowitz JL, Spearie CA, Kadkhodayan A, Thomas DP, Ramamurthy S, Mahmood K, Park S, Waller S, Farmer M, Peterson LR. Acute Dietary Nitrate Intake Improves Muscle Contractile Function in Patients With Heart Failure: A Double-Blind, Placebo-Controlled, Randomized Trial. Circ Heart Fail 2015; 8:914-20. [PMID: 26179185 DOI: 10.1161/circheartfailure.115.002141] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Skeletal muscle strength, velocity, and power are markedly reduced in patients with heart failure, which contributes to their impaired exercise capacity and lower quality of life. This muscle dysfunction may be partially because of decreased nitric oxide (NO) bioavailability. We therefore sought to determine whether ingestion of inorganic nitrate (NO3 (-)) would increase NO production and improve muscle function in patients with heart failure because of systolic dysfunction. METHODS AND RESULTS Using a double-blind, placebo-controlled, randomized crossover design, we determined the effects of dietary NO3 (-) in 9 patients with heart failure. After fasting overnight, subjects drank beetroot juice containing or devoid of 11.2 mmol of NO3 (-). Two hours later, muscle function was assessed using isokinetic dynamometry. Dietary NO3 (-) increased (P<0.05-0.001) breath NO by 35% to 50%. This was accompanied by 9% (P=0.07) and 11% (P<0.05) increases in peak knee extensor power at the 2 highest movement velocities tested (ie, 4.71 and 6.28 rad/s). Maximal power (calculated by fitting peak power data with a parabola) was therefore greater (ie, 4.74±0.41 versus 4.20±0.33 W/kg; P<0.05) after dietary NO3 (-) intake. Calculated maximal velocity of knee extension was also higher after NO3 (-) ingestion (ie, 12.48±0.95 versus 11.11±0.53 rad/s; P<0.05). Blood pressure was unchanged, and no adverse clinical events occurred. CONCLUSIONS In this pilot study, acute dietary NO3 (-) intake was well tolerated and enhanced NO bioavailability and muscle power in patients with systolic heart failure. Larger-scale studies should be conducted to determine whether the latter translates into an improved quality of life in this population. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01682356.
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Affiliation(s)
- Andrew R Coggan
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO.
| | - Joshua L Leibowitz
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO
| | - Catherine Anderson Spearie
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO
| | - Ana Kadkhodayan
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO
| | - Deepak P Thomas
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO
| | - Sujata Ramamurthy
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO
| | - Kiran Mahmood
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO
| | - Soo Park
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO
| | - Suzanne Waller
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO
| | - Marsha Farmer
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO
| | - Linda R Peterson
- From the Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology (A.R.C., J.L.L., L.R.P.), Cardiovascular Division, Department of Medicine (J.L.L., A.K., D.P.T., S.R., K.M., S.P., M.F., L.R.P.), and Center for Applied Research Sciences (C.A.S.), Washington University School of Medicine, St. Louis, MO
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Rimer EG, Peterson LR, Coggan AR, Martin JC. The Effect of Dietary Nitrate Supplementation on Maximal Cycling Power. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000476933.19719.0e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Peterson LR, Herrero P, Coggan AR, Kisrieva-Ware Z, Saeed I, Dence C, Koudelis D, McGill JB, Lyons MR, Novak E, Dávila-Román VG, Waggoner AD, Gropler RJ. Type 2 diabetes, obesity, and sex difference affect the fate of glucose in the human heart. Am J Physiol Heart Circ Physiol 2015; 308:H1510-6. [PMID: 25888511 DOI: 10.1152/ajpheart.00722.2014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/30/2015] [Indexed: 11/22/2022]
Abstract
Type 2 diabetes, obesity, and sex difference affect myocardial glucose uptake and utilization. However, their effect on the intramyocellular fate of glucose in humans has been unknown. How the heart uses glucose is important, because it affects energy production and oxygen efficiency, which in turn affect heart function and adaptability. We hypothesized that type 2 diabetes, sex difference, and obesity affect myocardial glucose oxidation, glycolysis, and glycogen production. In a first-in-human study, we measured intramyocardiocellular glucose metabolism from time-activity curves generated from previously obtained positron emission tomography scans of 110 subjects in 3 groups: nonobese, obese, and diabetes. Group and sex difference interacted in the prediction of all glucose uptake, utilization, and metabolism rates. Group independently predicted fractional glucose uptake and its components: glycolysis, glycogen deposition, and glucose oxidation rates. Sex difference predicted glycolysis rates. However, there were fewer differences in glucose metabolism between diabetic patients and others when plasma glucose levels were included in the modeling. The potentially detrimental effects of obesity and diabetes on myocardial glucose metabolism are more pronounced in men than women. This sex difference dimorphism needs to be taken into account in the design, trials, and application of metabolic modulator therapy. Slightly higher plasma glucose levels improve depressed glucose oxidation and glycogen deposition rates in diabetic patients.
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Affiliation(s)
- Linda R Peterson
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Pilar Herrero
- Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and
| | - Andrew R Coggan
- Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and
| | - Zulia Kisrieva-Ware
- Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and
| | - Ibrahim Saeed
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Carmen Dence
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Deborah Koudelis
- Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and
| | - Janet B McGill
- Endocrinology Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew R Lyons
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Eric Novak
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Víctor G Dávila-Román
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Alan D Waggoner
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Robert J Gropler
- Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and
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Abstract
The effects of type II diabetes on cardiac creatine kinase (CK) enzyme activity and/or flux are unknown. We therefore measured steady‐state phosphocreatine (PCr) and adenosine triphosphate (ATP) content and forward CK reaction kinetic parameters in Zucker Diabetic Fatty (ZDF) rat hearts, a type II diabetes research model. At baseline the PCr to ATP ratio (PCr/ATP) was significantly lower in diabetic heart when compared with matched controls (1.71 ± 0.21 vs. 2.26 ± 0.24, P < 0.01). Furthermore, the forward CK reaction rate constant (kf) was higher in diabetic animals (0.52 ± 0.09 s−1 vs. 0.35 ± 0.06 s−1, P < 0.01) and CK flux calculated as a product of PCr concentration ([PCr]) and kf was similar between two groups (4.32 ± 1.05 μmol/g/s vs. 4.94 ± 1.23 μmol/g/s, P = 0.20). Dobutamine administration resulted in similar increases in heart rate (~38%) and kf (~0.12 s−1) in both groups. No significant change in PCr and ATP content was observed with dobutamine. In summary, our data showed reduced PCr/ATP in diabetic myocardium as an indicator of cardiac energy deficit. The forward CK reaction rate constant is elevated at baseline which might reflect a compensatory mechanics to support energy flux through the CK shuttle and maintain constant ATP supply. When hearts were stimulated similar increase in kf was observed in both groups thus it seems that CK shuttle does not limit ATP supply for the range of workload studied. Noninvasive 31P MRS was used to measure PCr concentration ([PCr]) and creatine kinase (CK) reaction flux in type II diabetic rat hearts. [PCr] was reduced in diabetic myocardium as compared to controls, indicative of impairment in mitochondrial ATP production. The forward CK reaction rate constant was elevated, possibly reflecting a compensatory mechanism to support increased flux through the CK shuttle required to support cardiac work. CK reaction velocity increased in both diabetic and control hearts to maintain constant ATP content at higher work.
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Affiliation(s)
- Adil Bashir
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew R Coggan
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert J Gropler
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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49
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Coggan AR, Leibowitz JL, Kadkhodayan A, Thomas DP, Ramamurthy S, Spearie CA, Waller S, Farmer M, Peterson LR. Effect of acute dietary nitrate intake on maximal knee extensor speed and power in healthy men and women. Nitric Oxide 2014; 48:16-21. [PMID: 25199856 DOI: 10.1016/j.niox.2014.08.014] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/29/2014] [Accepted: 08/31/2014] [Indexed: 01/08/2023]
Abstract
Nitric oxide (NO) has been demonstrated to enhance the maximal shortening velocity and maximal power of rodent muscle. Dietary nitrate (NO3(-)) intake has been demonstrated to increase NO bioavailability in humans. We therefore hypothesized that acute dietary NO3(-) intake (in the form of a concentrated beetroot juice (BRJ) supplement) would improve muscle speed and power in humans. To test this hypothesis, healthy men and women (n = 12; age = 22-50 y) were studied using a randomized, double-blind, placebo-controlled crossover design. After an overnight fast, subjects ingested 140 mL of BRJ either containing or devoid of 11.2 mmol of NO3(-). After 2 h, knee extensor contractile function was assessed using a Biodex 4 isokinetic dynamometer. Breath NO levels were also measured periodically using a Niox Mino analyzer as a biomarker of whole-body NO production. No significant changes in breath NO were observed in the placebo trial, whereas breath NO rose by 61% (P < 0.001; effect size = 1.19) after dietary NO3(-) intake. This was accompanied by a 4% (P < 0.01; effect size = 0.74) increase in peak knee extensor power at the highest angular velocity tested (i.e., 6.28 rad/s). Calculated maximal knee extensor power was therefore greater (i.e., 7.90 ± 0.59 vs. 7.44 ± 0.53 W/kg; P < 0.05; effect size = 0.63) after dietary NO3(-) intake, as was the calculated maximal velocity (i.e., 14.5 ± 0.9 vs. 13.1 ± 0.8 rad/s; P < 0.05; effect size = 0.67). No differences in muscle function were observed during 50 consecutive knee extensions performed at 3.14 rad/s. We conclude that acute dietary NO3(-) intake increases whole-body NO production and muscle speed and power in healthy men and women.
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Affiliation(s)
- Andrew R Coggan
- Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Joshua L Leibowitz
- Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ana Kadkhodayan
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Deepak P Thomas
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sujata Ramamurthy
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Catherine Anderson Spearie
- Center for Applied Research Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Suzanne Waller
- Center for Applied Research Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Marsha Farmer
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Linda R Peterson
- Cardiovascular Imaging Laboratory, Division of Radiological Sciences, Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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50
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Abstract
Myocardial substrate metabolism provides the energy needed for cardiac contraction and relaxation. The normal adult heart uses predominantly fatty acids (FAs) as its primary fuel source. However, the heart can switch and use glucose (and to a lesser extent, ketones, lactate, as well as endogenous triglycerides and glycogen), depending on the metabolic milieu and superimposed conditions. FAs are not a wholly better fuel than glucose, but they do provide more energy per mole than glucose. Conversely, glucose is the more oxygen-efficient fuel. Studies in animal models of heart failure (HF) fairly consistently demonstrate a shift away from myocardial fatty acid metabolism and toward glucose metabolism. Studies in humans are less consistent. Some show the same metabolic switch away from FA metabolism but not all. This may be due to differences in the etiology of HF, sex-related differences, or other mitigating factors. For example, obesity, insulin resistance, and diabetes are all related to an increased risk of HF and may complicate or contribute to its development. However, these conditions are associated with increased FA metabolism. This review will discuss aspects of human heart metabolism in systolic dysfunction as measured by the noninvasive, quantitative method-positron emission tomography. Continued research in this area is vital if we are to ameliorate HF by manipulating heart metabolism with the aim of increasing energy production and/or efficiency.
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Affiliation(s)
- Ana Kadkhodayan
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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