Tirzepatide and exercise training in obesity

OBJECTIVES

The purpose of this study was to investigate the effects of 6 weeks of resistance training (RT) combined with aerobic training (AT) and Tirzepatide supplementation on lipid profiles, insulin resistance, anthropometric characteristics and physical fitness in prediabetic obese soldiers.

METHODS

61 obese men were randomly divided into six groups: Placebo; Tirzepatide 5 mg (T5); Tirzepatide 2.5 mg (T2.5); Hypertrophy, Strength, Power-Circuit Training+Placebo (Ex+P); Hypertrophy, Strength, Power-Circuit Training+Tirzepatide 5 mg (Ex+T5); Hypertrophy, Strength, Power-Circuit Training+Tirzepatide 2.5 mg (Ex+T2.5). All training groups performed aerobic training (AT) after resistance training. Subjects trained for six weeks, three sessions per week. Before and after the intervention period, the participants were evaluated for anthropometric measures, body composition [body weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and fat mass (FM)], cardiorespiratory fitness (VO2max), and muscle strength (chest press 1RM and leg press 1RM). Blood biochemistry evaluations included triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), insulin level and insulin resistance (HOMA-IR). To evaluate the differences between the groups, ANCOVA statistical method was used along with Bonferroni's post hoc test, and the significance level was P <  0.05.

RESULTS

Body weight, BMI, WC, FM, FBG, LDL-C, TC, TG and HOMA-IR were significantly decreased in Ex+P, Ex+T5 and Ex+T2.5 groups compared to Placebo, T5 and T2.5 groups. WHR significantly decreased in Ex+P, Ex+T5 and Ex+T2.5 groups compared to Placebo group. HDL-C, chest press and leg press significantly increased in Ex+P, Ex+T5 and Ex+T2.5 groups compared to Placebo, T5 and T2.5 groups. VO2max significantly increased and insulin significantly decreased in Ex+P group compared to Placebo, T5 and T2.5 groups. FM, FBG and TG were significantly decreased in both the T2.5 and T5 groups compared to Placebo group. HOMA-IR, LDL-C and TC significantly decreased in the T5 group compared to Placebo group. Also, leg press significantly increased in Ex+P group compared to all other groups.

CONCLUSIONS

Performing six weeks of combined resistance and aerobic training in the form of RT+AT alone is more effective than the simultaneous use of Tirzepatide on cardiorespiratory fitness, strength, and modulating insulin levels. Taking Tirzepatide in doses of 5 mg and 2.5 mg in combination with exercise training did not have a significant advantage over exercise training alone. Finally, taking Tirzepatide in doses of 5 mg or 2.5 mg in combination with exercise training is not significantly superior to each other.

Simple and Complex Wheel Running Effect on Depression, Memory, Neuroinflammation and Neurogenesis in Alzheimer's Rat Model

INTRODUCTION

The aim of this study was to investigate 12-weeks of simple and complex voluntary wheel running on Alzheimer's Disease (AD), associated biomarkers and behaviors.

METHODS

60 male Wistar rats were randomly divided into six groups: Healthy Control (Con-Sed), AD only (AD-Sed), Simple Wheel-Control (SWC), Complex Wheel-Control (CWC), Simple Wheel-AD (SWAD) and Complex Wheel-AD (CWAD). Novelty-suppressed feeding test (NSFT) and the Morris water maze (MWM) test were used to evaluate depression and memory, respectively. Ki67 was measured in the hippocampus while IL-1β and NG2 were measured in both the hippocampus and the prefrontal cortex. One-way ANOVA with Tukey's post hoc test was performed.

RESULTS

AD-Sed group had significantly lower spacial memory (p < 0.001) compared to Con-Sed. Simple and complex wheel running attenuated these deficits in the SWAD and CWAD groups, respectively (p < 0.001). Only the CWAD group had significantly improved NSFT time compared to AD-Sed (p < 0.001), equivalent to the healthy wheel running groups. AD-Sed has significantly higher hippocampal concentrations of Ki67 (p = 0.01) compared to the Con-Sed. Both SWAD and CWAD had significantly reduced Ki67 with similar concentrations compared to the SWC and CWC groups (p > 0.05). AD-Sed animals also presented with significantly higher hippocampal and prefrontal cortex concentrations of IL-1β compared to Con-Sed (p < 0.001). SWAD and CWAD had no effect in changing these concentrations. Complex wheel running significantly increased NG2 in the healthy control and AD models while simple wheel running significantly increased NG2 in the AD model.

CONCLUSIONS

The results of our study suggest that complex wheel running might be more advantageous in promoting memory and neuroplasticity while reducing depression that is associated with AD.

Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study protocol

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, https://www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5000 richly phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.

Abstract 4230: Transcriptomic evaluation of exercise-induced suppression of prostate cancer aggressiveness

Previous studies from our laboratory have showed that aerobic exercise significantly reduced the number of aggressive poorly differentiated tumors in the transgenic adenocarcinoma of the mouse prostate (TRAMP) model. Despite these encouraging data the underlying mechanism of how exercise reduces tumor aggressiveness remains undefined. We aimed to fill this scientific gap by utilizing a transcriptomics approach to identify potential mechanisms by which aerobic exercise suppresses prostate tumor aggressiveness.

Methods: Twelve TRAMP mice, 8-10 weeks of age, were equally randomized to exercise or control group. Mice in the exercise group were singularly housed in cages with running wheels for 12 weeks. Mice in the control group maintained normal group housing and activity conditions for 12 weeks. At euthanasia, prostate tumors were excised, weighed and processed for immunohistochemistry and transcriptome analysis. Two independent pathologists, blinded to the interventions, performed histological analysis of the genitourinary mass. Outputs of sequencing data were assessed for quality and accuracy. Counts for all known mRNA, differential expression, and heatmap were prepared. Differential expression was filtered to identify genes that had a ≥2-fold change with an adjusted p&lt;0.05. Gene ontology and pathway analyses was performed to reveal selective pathways activated.

Results: No significant difference in genitourinary mass, body mass or tumor free body mass was found between groups. Pathology revealed majority of the tissue from the control group exhibited moderate to poorly differentiated tumors (3/6). On the other hand, none of the animals in the exercise intervention group showed such pathology. Four out of five showed well differentiated tumors including prostatic intraepithelial neoplasia (PIN) lesions in one animal. Transcriptomic analysis coupled with gene set enrichment identified pathways associated with triglyceride catabolic process, lipid homeostasis, lipid metabolic process, triglyceride metabolic process to be most impacted. Differentially expressed genes of interest include haptoglobin (HP) and hormone sensitive lipoprotein lipase (Lipe) were significantly lower in the exercise group.

Conclusion: Our preliminary findings provide novel evidence suggesting that exercise suppresses prostate tumor aggressiveness, in part, through transcriptomic modulation and altered cellular pathways associated with intratumoral energy metabolism. This project was supported by the National Center Institute designated Mays Cancer Center at UT Health San Antonio.

Citation Format: Darpan I. Patel, Paul Rivas, Yidong Chen, Zhao Lai, Robert L. Reddick, Yuji Ikeno, Rita Ghosh, A. Pratap Kumar. Transcriptomic evaluation of exercise-induced suppression of prostate cancer aggressiveness. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4230.

Effectiveness of exercise interventions in animal models of multiple sclerosis

Multiple sclerosis (MS) is associated with an impaired immune system that severely affects the spinal cord and brain, and which is marked by progressive inflammatory demyelination. Patients with MS may benefit from exercise training as a suggested course of treatment. The most commonly used animal models of studies on MS are experimental autoimmune/allergic encephalomyelitis (EAE) models. The present review intends to concisely discuss the interventions using EAE models to understand the effectiveness of exercise as treatment for MS patients and thereby provide clear perspective for future research and MS management. For the present literature review, relevant published articles on EAE animal models that reported the impacts of exercise on MS, were extracted from various databases. Existing literature support the concept that an exercise regimen can reduce the severity of some of the clinical manifestations of EAE, including neurological signs, motor function, pain, and cognitive deficits. Further results demonstrate the mechanisms of EAE suppression with information relating to the immune system, demyelination, regeneration, and exercise in EAE. The role for neurotrophic factors has also been investigated. Analyzing the existing reports, this literature review infers that EAE is a suitable animal model that can help researchers develop further understanding and treatments for MS. Besides, findings from previous animal studies supports the contention that exercise assists in ameliorating MS progression.

Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study Protocol

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5,000 richly-phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.

Pilot Study on the Impact of a Home-Based Exercise Program on Inflammatory Cytokines and Quality of Life in Men with Prostate Cancer Under Active Surveillance

OBJECTIVES

This study aimed to demonstrate potential translation of pre-clinical studies to a home-based exercise intervention in mediating inflammatory cytokine markers and tumor progression in men under active surveillance for prostate cancer.

METHODS

A 2-arm randomized control parallel group design was used. The exercise intervention consisted of 24 weeks of an aerobic and resistance home-based exercise program and results were compared to a waitlist control group. Data were collected at baseline and end of study for eotaxin, interferon-γ (INF-γ), interleukin-12 (IL-12), interleukin-1α (IL-1α), interleukin-5 (IL-5), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and vascular endothelial growth factor (VEGF), distanced walked during a 6-minute walk test (6MWT), body mass index, and health-related quality of life.

RESULTS

Non-significant decreases were observed in all biomarkers, especially VEGF (pre: 125.16 ± 198.66, post: 80.29 ± 124.30, P = .06) and INF-γ (pre: 152.88 ± 312.71, post: 118.93 ± 158.79, P = .08), in the intervention group; only IL- α (pre: 332.15 ± 656.77, post: 255.12 ± 502.09, P = .20) decreased in the control group while all other biomarkers increased from baseline to end of study. A non-significant increase in 6MWT distance was observed in the intervention group, while a decrease was seen in the control group. Significant decreases in physical function, emotional wellbeing, and total composite scale on the FACIT-F were observed in the intervention group, possibly due to the isolation restrictions of COVID-19. Physical function on the SF-36 significantly increased in the control group.

CONCLUSIONS

Future studies with powered samples are needed to confirm the trends observed for inflammatory biomarkers and functional fitness.

Exercise and Creatine Supplementation to Augment the Adaptation of Exercise Training Among Breast Cancer Survivors Completing Chemotherapy: Protocol for an Open-label Randomized Controlled Trial (the THRIVE Study)

BACKGROUND

In breast cancer survivors, chemotherapy-induced muscle loss has been shown to be attenuated with structured resistance exercise. Creatine supplementation can increase bioenergetics in skeletal muscle, which helps to improve overall strength and endurance and reduce muscular fatigue. Therefore, we hypothesize that adding creatinine supplementation to exercise training will accelerate improvements in strength, endurance, and bioenergetics in breast cancer survivors.

OBJECTIVE

The primary objective is to determine the effects of combining creatine supplementation with exercise on modulating strength and physical function in breast cancer survivors by comparing these effects to those of exercise alone. The secondary objectives are to determine if creatine supplementation and exercise can increase the intramuscular storage of creatine and improve body composition by comparing this intervention to exercise alone.

METHODS

We aim to test our hypothesis by conducting an open-label randomized controlled trial of 30 breast cancer survivors who have completed chemotherapy within 6 months of enrollment. Eligible participants will be equally randomized (1:1) to either a creatine and exercise group or an exercise-only group for this 12-week intervention. Individuals who are randomized to receive creatine will be initially dosed at 20 g per day for 7 days to boost the availability of creatine systemically. Thereafter, the dose will be reduced to 5 g per day for maintenance throughout the duration of the 12-week protocol. All participants will engage in 3 center-based exercise sessions, which will involve completing 3 sets of 8 to 12 repetitions on chest press, leg press, seated row, shoulder press, leg extension, and leg curl machines. The primary outcomes will include changes in strength, body composition, and physical function in breast cancer survivors. The secondary outcomes will be intramuscular concentrations of creatine and adenosine triphosphate in the vastus lateralis, midthigh cross-sectional area, and quality of life.

RESULTS

As of October 2021, a total of 9 patients have been enrolled into the study. No unexpected adverse events have been reported.

CONCLUSIONS

Creatine is being studied as a potential agent for improving strength, endurance, and bioenergetics in breast cancer survivors following chemotherapy. The findings from our trial may have future implications for supporting breast cancer survivors in reversing the muscle loss experienced during chemotherapy and improving their physical function and quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04207359; https://clinicaltrials.gov/ct2/show/NCT04207359.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/26827.

Understanding Questions and Concerns Regarding COVID-19 and the COVID-19 Vaccine Among Populations Presenting at a COVID-19 Vaccine Clinic Hub: A Qualitative Study

BACKGROUND

Skepticism among the public surrounding the COVID-19 vaccine is still prevalent despite vaccine-positive communication and many Americans having already received the vaccine. Side effects of the vaccine, as well as its expeditious research and development, are among the top concerns among those hesitant to receive the coronavirus vaccine. Moreover, there is additional concern regarding the association between comorbidities and severity of illness due to the coronavirus pandemic.

OBJECTIVE

We aimed to describe the pandemic- and vaccine-related concerns of South Texas residents who attended the UT Health San Antonio School of Nursing's vaccine clinic with the goal of better understanding vaccine-related misconceptions and hesitancy for subsequent vaccination campaigns and boosters.

METHODS

An electronic survey accessible via a QR code on printed flyers was distributed throughout the waiting areas and post-vaccine observation rooms within the COVID-19 vaccine clinic at UT Health San Antonio School of Nursing from April 5 to 16, 2021. The survey contained a primary open-ended question designed to obtain information on concerns of the clinic attendees regarding the COVID-19 pandemic and COVID-19 vaccine. A thematic analysis was performed on the qualitative data to identify major themes to better understand concerns of vaccine clinic visitors.

RESULTS

During the 11-day period, 510 attendees received vaccinations through the vaccination clinic and completed the survey. Five areas of concern were identified by the 277 attendees: immunity, future vaccinations, vaccine symptoms and safety, protocol post-vaccination, and child vaccinations. Post-hoc sentiment analysis showed that responses were generally neutral or negative.

CONCLUSION

This study provides a perspective regarding questions and concerns of South Texas residents regarding the COVID-19 pandemic, the vaccine, and their general health status within a vaccinated population. Vaccine recipients were found to still have questions even after receiving the vaccine, suggesting that eliminating uncertainty surrounding the COVID-19 vaccine is not necessary to motivate individuals to receive the vaccine. Instead, addressing concerns through public health messaging could be a useful strategy to address vaccine-related concerns and increase subsequent vaccine uptake in future vaccination campaigns and boosters.

Examining the Potential Effect of a Salt Sensitivity Biomarker in Korean American Immigrants: A Pilot Study

The genetic factors involved with salt sensitivity (SS) have been studied using a genetic approach to identify individuals at high risk for developing hypertension and could benefit from a low sodium diet intervention, but this has not been well-studied in Korean American immigrants (KAIs). The purpose of this pilot study was to investigate the influence of SS that moderates blood pressure (BP) in KAIs (n = 34). KAIs were recruited from local communities and completed a blood draw, a 8-day food log, and BP testing. The dietary sodium intake was measured using the Fitbit mobile app, and an SS biomarker was assessed using targeted genotyping. out of five GNAI2 single nucleotide polymorphisms (SNPs) tested, rs4547694 significantly moderated the relationship of dietary sodium intake on BP in KAIs. Conclusions: Further studies are warranted to test the effect of a reduced sodium diet on BP while accounting for the moderating influence of an SS genotype.

Decline of Psychological Health Following the Designation of COVID-19 as a Pandemic: Descriptive Study

BACKGROUND

COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020, and as of this writing, Texas, United States, has reported >675,000 cases with over 14,000 deaths. Many of the preventive measures implemented during the pandemic can increase sedentary lifestyles, which can lead to the development of chronic diseases, including obesity, among the general population and cause serious threats to people's physical health and overall quality of life. Individuals with pre-existing comorbidities are at an increased risk of COVID-19 and may hence have higher levels of stress.

OBJECTIVE

This study aimed to investigate the relationship between physical activity levels and mental health status on an individual level and to compare them between those with and those without comorbidities in a cohort of Texas residents, before and after COVID-19 was declared a pandemic.

METHODS

An electronic survey was disseminated throughout various regions of Texas. In total, 160 individuals were asked questions about their demographic characteristics, time spent on daily physical activities, and daily mental health status before and after COVID-19 was declared a pandemic. Frequency distributions and descriptive statistics were analyzed.

RESULTS

Overall, 94 (58%) participants reported having ≥1 medical condition, and 31 (13.1%) had >3 medical conditions. Physical activity levels among participants with ≥1 pre-existing comorbidity drastically-but not significantly-decreased, as evident from a 10% increase in sedentary lifestyles after COVID-19 was declared a pandemic. On the contrary, we observed a 9% increase in the number of individuals without a pre-existing comorbidity who reported 30-60 min of physical activity per week. There was a 2-fold increase in the number of participants reporting more frequent feelings of nervousness, too much worry, trouble relaxing, and the fear of something awful happening after the pandemic. More specifically, individuals with pre-existing medical conditions reported, on average, a 10% higher incidence of feelings of stress, anxiety, and sadness compared to their healthy counterparts after COVID-19 was declared a pandemic.

CONCLUSIONS

Stressful life conditions and chronic comorbidities are risk factors that can affect mental health and reduce the ability to perform activities of daily life. Therefore, when implementing pandemic protocols, municipalities should consider providing mental health support to their citizens to protect them from this rather inconspicuous adverse effect.

A randomized controlled trial of a home-based exercise program on prognostic biomarkers in men with prostate cancer: A study protocol

Background

Herein, we propose a novel RCT study to collect preliminary data on the impact of a 24-week home-based exercise program that can improve prognosis, physical function, and quality of life (QoL) in men with prostate cancer (PCa). This study will provide data on the feasibility of conducting a home-based exercise study and pilot data on the impact of exercise on circulating concentrations of biomarkers reported in the literature to be beneficial for the prognostication of PCa.

Methods/design

Thirty male patients, clinically-diagnosed with prostate cancer under active surveillance, will be recruited to participate in a 2-arm, 24-week home-based program. Random allocation to each arm - intervention, and control – will be performed in a 1:1 ratio. Participants assigned to the intervention group will perform 30 min of light-to-moderate intensity walking five days a week (40–60% heart rate reserve) and three sets of 15 repetitions of light callisthenic exercises (bodyweight squats, incline push-ups, and hip thrusts) 3 days a week. Participants randomized to the control group will maintain normal activity throughout the 24 weeks. Four visits occurring at baseline, 12-, 18-, and 24-weeks will be used to assess QoL, body composition, prognostic biomarker concentrations, and overall physical function. Primary endpoints include significant changes in prognostic biomarkers. Secondary endpoints include changes in quality of life, physical function and body composition.

Discussion

This study should demonstrate preliminary evidence that a home-based exercise intervention can impact biomarkers of progression while improving quality of life, physical function and body composition. Results from this study have the potential to promote health and wellness while minimizing cancer progression in men with PCa.

Exercise preserves muscle mass and force in a prostate cancer mouse model

The purpose of this study was to examine the effects of exercise in modulating biomarkers of sarcopenia in a treatment naïve transgenic adenocardinoma of the mouse prostate (TRAMP) model. Thirty TRAMP mice were randomized to either exercise (voluntary wheel running) or no-treatment control group for a period of 20 weeks. During necropsy, gastrocnemius muscles and prostate tumors were harvested and weighed. Gastrocnemius concentrations of myostatin, insulin-like growth factor (IGF)-1 and tumor necrosis factor (TNF)-α were quantified. Exercise mice had greater muscle mass than controls (p=0.04). Myostatin was significantly lower in the exercise group compared to controls (p=0.01). Exercise mice maintained forelimb grip force while control mice had a significaint decrease (p=0.01). No significant difference was observed in pre-post all limb grip strength. Further, forelimb and all limb grip strength was negatively associated with tumor mass (p<0.01).

Nexrutine® preserves muscle mass similar to exercise in prostate cancer mouse model

Muscle loss is a debilitating side effect to prostate cancer (PCa) experienced by nearly 60% of men. The purpose of this study was to test the hypothesis that Nexrutine® , a bark extract from the Phellodendrum amurense, can protect against prostate cancer induced muscle loss in a similar manner as exercise, using the transgenic adenocarcinoma of mouse prostate (TRAMP) model. Forty-five, 8- to 10-week old TRAMP mice were randomized to either control, Nexrutine® (600 mg/kg pelleted in chow) or exercise (voluntary wheel running). Mice were serially sacrificed at weeks 4, 8, 12, and 20, at which time either the left or right gastrocnemius muscle was harvested, weighted, and frozen. Proteolysis inducing factor (PIF), ubiquitin, and NF-κB concentrations were quantified using ELISA kits. Nexrutine® and exercise were equally able to protect TRAMP mice against PCa-induced muscle loss (P = 0.04). Both interventions decreased intramuscular PIF concentrations at 20 weeks compared to control (P < 0.05). A treatment effect was also observed when all time points were combined with exercise significantly lowering PIF concentrations (P < 0.01). Exercise significantly lowered intramuscular ubiquitin concentrations in weeks 4, 8, and 20 compared to control mice (P < 0.001). A treatment effect was also observed with exercise significantly lowering ubiquitin compared to control mice (P < 0.001). No significant changes were observed for NF-κB. The results of this investigation demonstrate that PCa-induced muscle loss can be attenuated with the herbal supplement Nexrutine® . This investigation provides preliminary evidence to support continued research into Nexrutine® as a potential exercise analog in protecting against muscle loss.

Nursing Research, CER, PICO and PCORI

Community and public health nurse researchers encompass a unique cohort of nurse researchers that have the skills and capacity to lead projects and programs of science centered on improvement of patient outcomes through methods of comparative effectiveness research (CER). CER, as a general method, has been taught to all nurses in the form of the PICO question to improve evidence-based practices. As the climate for funding becomes more and more competitive, nurse researchers are primed to lead the change in improving patient outcomes through patient centered outcomes research (PCOR). However, the number of projects funded by agencies like the Patient Centered Outcomes Research Institute, fall well below the capabilities of the field. The purpose of this commentary is to promote the field of PCOR and encourage novice and experienced nurse researchers to apply for funding from the PCORI by introducing different methods for building capacity and promoting engagement in the national conversations of PCOR and CER.

Advancing Care for Family Caregivers of persons with dementia through caregiver and community partnerships

BACKGROUND

There are currently 15 million Americans who provide over 80% of the care required by their family members with Alzheimer's disease and other dementias. Yet care for caregivers continues to be fragmented and few evidence-based interventions have been translated into routine clinical care and therefore remain inaccessible to most family caregivers. To address this gap, the Caring for the Caregiver program is being developed at UT Health San Antonio, School of Nursing to improve support services and health outcomes for family caregivers. Our purpose is to describe the engagement process undertaken to assess caregiver and community needs and how findings are informing program development.

METHODS

We are using a model of public engagement that consists of communication of information, collection of information from stakeholders, and collaboration where stakeholders are partners in an exchange of information to guide program activities. An assessment of the community was undertaken to identify resources/services for family caregivers. Subsequently, stakeholders were invited to a community-academic forum to discuss strategies to build on existing strengths for family caregiving and to identify gaps in care. Detailed notes were taken and all discussions were recorded and transcribed for analysis. Data were analyzed using thematic content analysis.

RESULTS

We conducted site visits with 15 community agencies, interviewed 13 family caregivers, and attended community events including support groups and health and senior fairs. Fifty-three diverse stakeholders attended the community-academic forum. Participants identified existing assets within our community to support family caregivers. Consistent among groups was the need to increase awareness in our community about family caregivers. Themes identified from the discussion were: making the invisible visible, you don't know what you don't know, learning too late, and anticipating and preparing for the future.

CONCLUSIONS

Incorporating caregiver and community stakeholders was critical to ensure that the priorities of our community are addressed in a culturally responsive accessible program for family caregivers. The forum served as important mechanism to partner with the community and will be an annual event where we can continue to work with our stakeholders around needs for practice, education, and research.

The citizen scientist: Community-academic partnerships through Translational Advisory Boards

OBJECTIVE

To describe the effectiveness of engaging patient partners as "citizen scientists" in the research process to boost patient centered outcomes research in underrepresented populations.

METHODS

Translational Advisory Boards in South Texas have effectively collaborated with University researchers to develop community-based patient centered research. Here we describe innovative approaches in research to engage patients and offer practical methods to enhance partnerships between patients and researchers to facilitate patient engagement.

RESULTS

Three health issues identified by the TABs were diabetes, obesity and teen pregnancy Examples of other community inspired research topics include air and water quality, methicillin-resistant staphylococcus aureus, intimate partner violence, chronic pain, and human papilloma virus and hepatitis C vaccinations.

CONCLUSION

Patient engagement of underrepresented populations is inverse to the vast disparities they experience. In order to adequately address our nation's deficits in providing equitable healthcare, we must fully integrate disparate partners into the research process. By engaging community champions, academic health centers can fully integrate meaningful interventions on topics of interest to the catchment area in which they serve.

PRACTICE IMPLICATIONS

These lessons can be used in developing local and regional collaborations across the country to boost active participation of patient stakeholder in PCOR to reduce healthcare disparities and improve our healthcare systems.

Forced exercise increases muscle mass in EAE despite early onset of disability

We aimed to determine whether 10 days of treadmill exercise can increase skeletal muscle mass and intramuscular concentrations of brain derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in experimental autoimmune encephalomyelitis (EAE). Forty female Lewis rats were randomly assigned to either EAE sedentary (EAE-Sed), EAE exercise (EAE-Ex), Control sedentary (Con-Sed) and Control exercise (Con-Ex). Exercising animals completed a 10 day forced exercising training program. Hind limb skeletal muscles were excised and weighed with soleus muscle used for BDNF and NGF quantification. Statistical analysis was done using a one-way analysis of variance. Disability was more pronounced in the EAE-Ex group than in the EAE-Sed group. Exercising animals (EAE-Ex and Con-Ex) had significantly greater bilateral EDL, plantaris and gastrocnemius muscle mass compared to their sedentary animals (p=0.01). The EAE-Ex group had significantly higher NGF concentrations (1.98+/-0.3 pg/mg) compared to Con-Ex (0.96+/-0.07 pg/mg, p=0.003) and Con-Sed (1.2+/-0.2 pg/mg, p=0.04) groups. The main effect of exercise represented a significantly lower BDNF concentrations in the soleus of exercising animals compared to sedentary animals (p=0.03). Our study provides preliminary evidence that exercise increases skeletal muscle mass despite the early onset of disability in EAE animals.

Effect of 10-day forced treadmill training on neurotrophic factors in experimental autoimmune encephalomyelitis

The impact of exercise on disease progression in multiple sclerosis (MS) is unclear. In the present study, we evaluated the clinical effects of forced wheel running on rats induced with experimental autoimmune encephalomyelitis (EAE), a model of MS. Female Lewis rats (n = 40) were randomly assigned to 1 of 4 groups prior to inoculation: EAE exercise (EAE-Ex), EAE sedentary (EAE-Sed), control exercise (Con-Ex), or control sedentary (Con-Sed). Exercise training was composed of forced treadmill running at increasing intensity across 10 consecutive days. No significant differences in clinical disability were observed in the EAE groups at the conclusion of this study. Furthermore, no significant differences in brain mass were observed across groups. Analysis of brain tissue proteins revealed that tumour necrosis factor-α (TNF-α) concentrations were higher in both EAE groups compared with the control groups (p < 0.05); however, no significant differences were seen between the EAE-Ex and EAE-Sed groups. The Con-Ex group had lower whole-brain TNF-α compared with the Con-Sed group (p < 0.05). Nerve growth factor concentrations were greater in the EAE-Ex animals compared with both control groups (p < 0.05 for both). No differences were seen in brain-derived neurotrophic factor. Our results indicate that aerobic exercise can modulate the proteins associated with disability in EAE; however, further research is required to understand the total impact of exercise on EAE disability and disease progression.

Cytokine responses to acute and chronic exercise in multiple sclerosis

Regular exercise reduces functional loss associated with multiple sclerosis (MS). However, the impact of exercise on inflammatory mediators associated with disease activity remains relatively unexplored. The purpose of this study was to determine whether ambulatory MS subjects would respond similarly to aerobic cycle training compared with matched controls on circulating immune variables, interleukin (IL)-6, tumor necrosis factor (TNF)-α and interferon (IFN)-γ. Eleven MS and 11 non-MS control subjects (8 women and 3 men in both groups) matched in age, height, body mass, body fat, and peak O2 uptake completed the study. Subjects completed 30 min of cycle ergometry at 60% of peak O2 uptake, 3 day/wk for 8 wk. Plasma cytokine concentrations were determined before and after exercise at weeks 0, 4, and 8. MS and control subjects showed a similar cytokine responses to exercise. IL-6 at rest tended to decrease ( P = 0.08) with training in both groups. Resting plasma TNF-α tended to be higher in MS compared with controls throughout the study ( P = 0.08). MS subjects showed elevated resting TNF-α in MS at the end of the 8-wk program ( P = 0.04), whereas resting TNF-α remained unchanged in controls ( P > 0.05). Resting plasma IFN-γ at rest was elevated in MS subjects ( P = 0.008) and unchanged in controls at the end of the intervention ( P > 0.05). The response of plasma IL-6, TNF-α, and IFN-γ after a single bout of exercise was similar between MS and control subjects ( P > 0.05). Additional research to understand the impact of exercise on immune variables in MS is warranted.

A randomized, prospective, double-masked clinical trial of Optisol vs DexSol corneal storage media

We compared Optisol and DexSol, two chondroitin-sulfate-based media for corneal storage at 4 degrees C, by transplanting 31 donor cornea pairs (one cornea stored in Optisol and its mate in DexSol for 20 to 134 hours) into 31 pairs of recipients (62 patients). All grafts were clear 1 year after transplantation except for one primary donor failure (Optisol group). Optisol-stored corneas were significantly thinner than DexSol-stored corneas after cardinal suture placement (0.64 mm vs 0.76 mm) and at the end of surgery (0.69 mm vs 0.78 mm); at all points afterward through 1 year the two groups did not differ. The activity of two lysosomal enzymes released into the media during storage, alpha-mannosidase and alpha-glucosidase, was lower in the Optisol group. Epithelial status and all endothelial morphometric parameters, except the figure coefficient at 1 year, did not differ between the two groups before surgery and 3, 6, and 12 months after surgery. Mean endothelial cell loss at 1 year was 15% for the Optisol group and 21% for the DexSol group (P = .22). Thus, Optisol-stored corneas were thinner during surgery than DexSol-stored corneas and there was less lysosomal enzyme activity in the Optisol medium after tissue storage. There were no significant differences in postoperative clinical or endothelial morphometric parameters, however.