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Balayan A, DeBoutray M, Molley TG, Ruoss S, Maceda M, Sevier A, Robertson CM, Ward SR, Engler AJ. Dispase/collagenase cocktail allows for coisolation of satellite cells and fibroadipogenic progenitors from human skeletal muscle. Am J Physiol Cell Physiol 2024; 326:C1193-C1202. [PMID: 38581669 DOI: 10.1152/ajpcell.00023.2024] [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: 01/16/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/08/2024]
Abstract
Satellite cells (SCs) and fibroadipogenic progenitors (FAPs) are progenitor populations found in muscle that form new myofibers postinjury. Muscle development, regeneration, and tissue-engineering experiments require robust progenitor populations, yet their isolation and expansion are difficult given their scarcity in muscle, limited muscle biopsy sizes in humans, and lack of methodological detail in the literature. Here, we investigated whether a dispase and collagenase type 1 and 2 cocktail could allow dual isolation of SCs and FAPs, enabling significantly increased yield from human skeletal muscle. Postdissociation, we found that single cells could be sorted into CD56 + CD31-CD45- (SC) and CD56-CD31-CD45- (FAP) cell populations, expanded in culture, and characterized for lineage-specific marker expression and differentiation capacity; we obtained ∼10% SCs and ∼40% FAPs, with yields twofold better than what is reported in current literature. SCs were PAX7+ and retained CD56 expression and myogenic fusion potential after multiple passages, expanding up to 1012 cells. Conversely, FAPs expressed CD140a and differentiated into either fibroblasts or adipocytes upon induction. This study demonstrates robust isolation of both SCs and FAPs from the same muscle sample with SC recovery more than two times higher than previously reported, which could enable translational studies for muscle injuries.NEW & NOTEWORTHY We demonstrated that a dispase/collagenase cocktail allows for simultaneous isolation of SCs and FAPs with 2× higher SC yield compared with other studies. We provide a thorough characterization of SC and FAP in vitro expansion that other studies have not reported. Following our dissociation, SCs and FAPs were able to expand by up to 1012 cells before reaching senescence and maintained differentiation capacity in vitro demonstrating their efficacy for clinical translation for muscle injury.
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Affiliation(s)
- Alis Balayan
- Biomedical Sciences Program, UC San Diego, La Jolla, California, United States
| | - Marie DeBoutray
- Department of ENT and Maxillofacial Surgery, Montpellier University, Montpellier, France
| | - Thomas G Molley
- Chien-Lay Department of Bioengineering, UC San Diego, La Jolla, California, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, United States
| | - Matthew Maceda
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, United States
| | - Ashley Sevier
- California State University, Bakersfield, Bakersfield, California, United States
| | - Catherine M Robertson
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, United States
| | - Samuel R Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, United States
- Department of Radiology, UC San Diego, La Jolla, California, United States
| | - Adam J Engler
- Biomedical Sciences Program, UC San Diego, La Jolla, California, United States
- Chien-Lay Department of Bioengineering, UC San Diego, La Jolla, California, United States
- Sanford Consortium for Regenerative Medicine, La Jolla, California, United States
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Shahidi B, Anderson B, Ordaz A, Berry DB, Ruoss S, Zlomislic V, Allen RT, Garfin SR, Farshad M, Schenk S, Ward SR. Paraspinal muscles in individuals undergoing surgery for lumbar spine pathology lack a myogenic response to an acute bout of resistance exercise. JOR Spine 2024; 7:e1291. [PMID: 38222805 PMCID: PMC10782077 DOI: 10.1002/jsp2.1291] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 01/16/2024] Open
Abstract
Background Lumbar spine pathology (LSP) is a common source of low back or leg pain, and paraspinal muscle in these patients demonstrates fatty and fibrotic infiltration, and cellular degeneration that do not reverse with exercise-based rehabilitation. However, it is unclear of this lack of response is due to insufficient exercise stimulus, or an inability to mount a growth response. The purpose of this study was to compare paraspinal muscle gene expression between individuals with LSP who do and do not undergo an acute bout of resistance exercise. Methods Paraspinal muscle biopsies were obtained from 64 individuals with LSP undergoing spinal surgery. Eight participants performed an acute bout of machine-based lumbar extension resistance exercise preoperatively. Gene expression for 42 genes associated with adipogenic/metabolic, atrophic, fibrogenic, inflammatory, and myogenic pathways was measured, and differential expression between exercised and non-exercised groups was evaluated for (a) the full cohort, and (b) an age, gender, acuity, and etiology matched sub-cohort. Principal components analyses were used to identify gene expression clustering across clinical phenotypes. Results The exercised cohort demonstrated upregulation of inflammatory gene IL1B, inhibition of extracellular matrix components (increased MMP3&9, decreased TIMP1&3, COL1A1) and metabolic/adipogenic genes (FABP4, PPARD, WNT10B), and downregulation of myogenic (MYOD, ANKRD2B) and atrophic (FOXO3) genes compared to the non-exercised cohort, with similar patterns in the matched sub-analysis. There were no clinical phenotypes significantly associated with gene expression profiles. Conclusion An acute bout of moderate-high intensity resistance exercise did not result in upregulation of myogenic genes in individuals with LSP. The response was characterized by mixed metabolic and fibrotic gene expression, upregulation of inflammation, and downregulation of myogenesis.
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Affiliation(s)
- Bahar Shahidi
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Bradley Anderson
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Angel Ordaz
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - David B. Berry
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
- UC San Diego Department of RadiologyLa JollaCaliforniaUSA
| | - Severin Ruoss
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Vinko Zlomislic
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - R. Todd Allen
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Steven R. Garfin
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Mazda Farshad
- Balgrist University HospitalUniversity of ZurichZürichSwitzerland
| | - Simon Schenk
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Samuel R. Ward
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
- UC San Diego Department of RadiologyLa JollaCaliforniaUSA
- UC San Diego Department of BioengineeringLa JollaCaliforniaUSA
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Vasquez-Bolanos LS, Gibbons MC, Ruoss S, Wu IT, Esparza MC, Fithian DC, Lane JG, Singh A, Nasamran CA, Fisch KM, Ward SR. Transcriptional time course after rotator cuff repair in 6 month old female rabbits. Front Physiol 2023; 14:1164055. [PMID: 37228812 PMCID: PMC10203179 DOI: 10.3389/fphys.2023.1164055] [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: 02/11/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction: Rotator cuff tears are prevalent in the population above the age of 60. The disease progression leads to muscle atrophy, fibrosis, and fatty infiltration, which is not improved upon with surgical repair, highlighting the need to better understand the underlying biology impairing more favorable outcomes. Methods: In this study, we collected supraspinatus muscle tissue from 6 month old female rabbits who had undergone unilateral tenotomy for 8 weeks at 1, 2, 4, or 8 weeks post-repair (n = 4/group). RNA sequencing and enrichment analyses were performed to identify a transcriptional timeline of rotator cuff muscle adaptations and related morphological sequelae. Results: There were differentially expressed (DE) genes at 1 (819 up/210 down), 2 (776/120), and 4 (63/27) weeks post-repair, with none at 8 week post-repair. Of the time points with DE genes, there were 1092 unique DE genes and 442 shared genes, highlighting that there are changing processes in the muscle at each time point. Broadly, 1-week post-repair differentially expressed genes were significantly enriched in pathways of metabolism and energetic activity, binding, and regulation. Many were also significantly enriched at 2 weeks, with the addition of NIF/NF-kappaB signaling, transcription in response to hypoxia, and mRNA stability alongside many additional pathways. There was also a shift in transcriptional activity at 4 weeks post-repair with significantly enriched pathways for lipids, hormones, apoptosis, and cytokine activity, despite an overall decrease in the number of differentially expressed genes. At 8 weeks post-repair there were no DE genes when compared to control. These transcriptional profiles were correlated with the histological findings of increased fat, degeneration, and fibrosis. Specifically, correlated gene sets were enriched for fatty acid metabolism, TGF-B-related, and other pathways. Discussion: This study identifies the timeline of transcriptional changes in muscle after RC repair, which by itself, does not induce a growth/regenerative response as desired. Instead, it is predominately related to metabolism/energetics changes at 1 week post-repair, unclear or asynchronous transcriptional diversity at 2 weeks post-repair, increased adipogenesis at 4 weeks post-repair, and a low transcriptional steady state or a dysregulated stress response at 8 weeks post-repair.
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Affiliation(s)
- Laura S. Vasquez-Bolanos
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Michael C. Gibbons
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Isabella T. Wu
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mary C. Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Donald C. Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - John G. Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, Kaiser Permanente, San Diego, CA, United States
| | - Chanond A. Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Kathleen M. Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
- Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Diego, San Diego, CA, United States
| | - Samuel R. Ward
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
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Ruoss S, Nasamran CA, Singh A, Lane JG, Ward SR. Are there sex-dependent transcriptional differences in human subacromial bursa from traumatic versus degenerative rotator cuff tears? J Orthop Res 2022; 40:2705-2707. [PMID: 36250743 DOI: 10.1002/jor.25450] [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] [Received: 06/22/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, USA
| | - Chanond A Nasamran
- Center for Computational Biology and Bioinformatics, UC San Diego, La Jolla, California, USA
| | - Anshuman Singh
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, USA.,Southern California Kaiser Permanente, San Diego, California, USA
| | - John G Lane
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, USA.,Department of Bioengineering, UC San Diego, La Jolla, California, USA.,Department of Radiology, UC San Diego, La Jolla, California, USA
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5
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Ruoss S, Esparza MC, Vasquez-Bolanos LS, Nasamran CA, Fisch KM, Engler AJ, Ward SR. Spatial transcriptomics tools allow for regional exploration of heterogeneous muscle pathology in the pre-clinical rabbit model of rotator cuff tear. J Orthop Surg Res 2022; 17:440. [PMID: 36195913 PMCID: PMC9531386 DOI: 10.1186/s13018-022-03326-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Conditions affecting skeletal muscle, such as chronic rotator cuff tears, low back pain, dystrophies, and many others, often share changes in muscle phenotype: intramuscular adipose and fibrotic tissue increase while contractile tissue is lost. The underlying changes in cell populations and cell ratios observed with these phenotypic changes complicate the interpretation of tissue-level transcriptional data. Novel single-cell transcriptomics has limited capacity to address this problem because muscle fibers are too long to be engulfed in single-cell droplets and single nuclei transcriptomics are complicated by muscle fibers’ multinucleation. Therefore, the goal of this project was to evaluate the potential and challenges of a spatial transcriptomics technology to add dimensionality to transcriptional data in an attempt to better understand regional cellular activity in heterogeneous skeletal muscle tissue. Methods The 3′ Visium spatial transcriptomics technology was applied to muscle tissue of a rabbit model of rotator cuff tear. Healthy control and tissue collected at 2 and 16 weeks after tenotomy was utilized and freshly snap frozen tissue was compared with tissue stored for over 6 years to evaluate whether this technology is retrospectively useful in previously acquired tissues. Transcriptional information was overlayed with standard hematoxylin and eosin (H&E) stains of the exact same histological sections. Results Sequencing saturation and number of genes detected was not affected by sample storage duration. Unbiased clustering matched the underlying tissue type-based on H&E assessment. Connective-tissue-rich areas presented with lower unique molecular identifier counts are compared with muscle fibers even though tissue permeabilization was standardized across the section. A qualitative analysis of resulting datasets revealed heterogeneous fiber degeneration–regeneration after tenotomy based on (neonatal) myosin heavy chain 8 detection and associated differentially expressed gene analysis. Conclusions This protocol can be used in skeletal muscle to explore spatial transcriptional patterns and confidently relate them to the underlying histology, even for tissues that have been stored for up to 6 years. Using this protocol, there is potential for novel transcriptional pathway discovery in longitudinal studies since the transcriptional information is unbiased by muscle composition and cell type changes.
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Affiliation(s)
- Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA
| | - Mary C Esparza
- Department of Orthopaedic Surgery, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA
| | - Laura S Vasquez-Bolanos
- Department of Orthopaedic Surgery, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA.,Department of Bioengineering, UC San Diego, La Jolla, CA, USA
| | - Chanond A Nasamran
- Center for Computational Biology and Bioinformatics, UC San Diego, La Jolla, CA, USA
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, UC San Diego, La Jolla, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, UC San Diego, La Jolla, CA, USA
| | - Adam J Engler
- Department of Bioengineering, UC San Diego, La Jolla, CA, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA. .,Department of Bioengineering, UC San Diego, La Jolla, CA, USA. .,Department of Radiology, UC San Diego, La Jolla, CA, USA.
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6
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Wu IT, Gibbons MC, Esparza MC, Vasquez-Bolanos LS, Hyman SA, Dorn SN, Singh A, Lane JG, Fithian DC, Ruoss S, Ward SR. The “Second Hit” of Repair in a Rabbit Model of Chronic Rotator Cuff Tear. Front Physiol 2022; 13:801829. [PMID: 35350696 PMCID: PMC8958027 DOI: 10.3389/fphys.2022.801829] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/28/2022] [Indexed: 01/04/2023] Open
Abstract
The rabbit supraspinatus is a useful translational model for rotator cuff (RC) repair because it recapitulates muscle atrophy and fat accumulation observed in humans after a chronic tear (the “first hit”). However, a timeline of RC tissue response after repair, especially with regard to recent evidence of muscle degeneration and lack of regeneration, is currently unavailable. Thus, the purpose of this study was to characterize the progression of muscle and fat changes over time after the repair of a chronic RC tear in the rabbit model. Two rounds of experiments were conducted in 2017–2018 and 2019–2020 with N = 18 and 16 skeletally mature New Zealand White rabbits, respectively. Animals underwent left supraspinatus tenotomy with repair 8 weeks later. The unoperated right shoulder served as control. The rabbits were sacrificed at 1-, 2-, 4-, and 8-weeks post-repair for histological and biochemical analysis. Atrophy, measured by fiber cross-sectional area and muscle mass, was greatest around 2 weeks after repair. Active muscle degeneration peaked at the same time, involving 8% of slide areas. There was no significant regeneration at any timepoint. Fat accumulation and fibrosis were significantly increased across all time points compared to contralateral. Statement of Clinical Significance: These results demonstrate model reproducibility and a “second hit” phenomenon of repair-induced muscle atrophy and degeneration which partially recovers after a short time, while increased fat and fibrosis persist.
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Affiliation(s)
- Isabella T. Wu
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Michael C. Gibbons
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Mary C. Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Laura S. Vasquez-Bolanos
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Sydnee A. Hyman
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Shanelle N. Dorn
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, Kaiser Permanente, San Diego, CA, United States
| | - John G. Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Donald C. Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- *Correspondence: Samuel R. Ward,
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Gasser B, Franchi MV, Ruoss S, Frei A, Popp WL, Niederseer D, Catuogno S, Frey WO, Flück M. Accelerated Muscle Deoxygenation in Aerobically Fit Subjects During Exhaustive Exercise Is Associated With the ACE Insertion Allele. Front Sports Act Living 2022; 4:814975. [PMID: 35295536 PMCID: PMC8918772 DOI: 10.3389/fspor.2022.814975] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/24/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction The insertion/deletion (I/D) polymorphism in the gene for the major regulator of vascular tone, angiotensin-converting enzyme-insertion/deletion (ACE-I/D) affects muscle capillarization and mitochondrial biogenesis with endurance training. We tested whether changes of leg muscle oxygen saturation (SmO2) during exhaustive exercise and recovery would depend on the aerobic fitness status and the ACE I/D polymorphism. Methods In total, 34 healthy subjects (age: 31.8 ± 10.2 years, 17 male, 17 female) performed an incremental exercise test to exhaustion. SmO2 in musculus vastus lateralis (VAS) and musculus gastrocnemius (GAS) was recorded with near-IR spectroscopy. Effects of the aerobic fitness status (based on a VO2peak cutoff value of 50 ml O2 min−1 kg−1) and the ACE-I/D genotype (detected by PCR) on kinetic parameters of muscle deoxygenation and reoxygenation were assessed with univariate ANOVA. Results Deoxygenation with exercise was comparable in VAS and GAS (p = 0.321). In both leg muscles, deoxygenation and reoxygenation were 1.5-fold higher in the fit than the unfit volunteers. Differences in muscle deoxygenation, but not VO2peak, were associated with gender-independent (p > 0.58) interaction effects between aerobic fitness × ACE-I/D genotype; being reflected in a 2-fold accelerated deoxygenation of VAS for aerobically fit than unfit ACE-II genotypes and a 2-fold higher deoxygenation of GAS for fit ACE-II genotypes than fit D-allele carriers. Discussion Aerobically fit subjects demonstrated increased rates of leg muscle deoxygenation and reoxygenation. Together with the higher muscle deoxygenation in aerobically fit ACE-II genotypes, this suggests that an ACE-I/D genotype-based personalization of training protocols might serve to best improve aerobic performance.
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Affiliation(s)
- Benedikt Gasser
- Departement für Bewegung und Sport – Universität Basel, Basel, Switzerland
- *Correspondence: Benedikt Gasser
| | - Martino V. Franchi
- Departement für Bewegung und Sport – Universität Basel, Basel, Switzerland
| | - Severin Ruoss
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Annika Frei
- Departement für Bewegung und Sport – Universität Basel, Basel, Switzerland
| | - Werner L. Popp
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio Catuogno
- Swiss Olympic Medical Center, Balgrist University Hospital, Zurich, Switzerland
| | - Walter O. Frey
- Swiss Olympic Medical Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Flück
- Laboratory for Muscle Plasticity, University of Zurich, Balgrist Campus, Zurich, Switzerland
- Martin Flück
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Vasquez-Bolanos LS, Gibbons MC, Ruoss S, Wu IT, Vargas-Vila M, Hyman SA, Esparza MC, Fithian DC, Lane JG, Singh A, Nasamran CA, Fisch KM, Ward SR. Corrigendum: Transcriptional Time Course After Rotator Cuff Tear. Front Physiol 2021; 12:775297. [PMID: 34777027 PMCID: PMC8589024 DOI: 10.3389/fphys.2021.775297] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura S Vasquez-Bolanos
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Michael C Gibbons
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Isabella T Wu
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mario Vargas-Vila
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Sydnee A Hyman
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Donald C Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - John G Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Orthopedic Surgery, Kaiser Permanente, San Diego, CA, United States
| | - Chanond A Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Samuel R Ward
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Radiology, University of California, San Diego, San Diego, CA, United States
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9
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Vasquez-Bolanos LS, Gibbons MC, Ruoss S, Wu IT, Vargas-Vila M, Hyman SA, Esparza MC, Fithian DC, Lane JG, Singh A, Nasamran CA, Fisch KM, Ward SR. Transcriptional Time Course After Rotator Cuff Tear. Front Physiol 2021; 12:707116. [PMID: 34421646 PMCID: PMC8378535 DOI: 10.3389/fphys.2021.707116] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/06/2021] [Indexed: 12/13/2022] Open
Abstract
Rotator cuff (RC) tears are prevalent in the population above the age of 60. The disease progression leads to muscle atrophy, fibrosis, and fatty infiltration in the chronic state, which is not improved with intervention or surgical repair. This highlights the need to better understand the underlying dysfunction in muscle after RC tendon tear. Contemporary studies aimed at understanding muscle pathobiology after RC tear have considered transcriptional data in mice, rats and sheep models at 2–3 time points (1 to 16 weeks post injury). However, none of these studies observed a transition or resurgence of gene expression after the initial acute time points. In this study, we collected rabbit supraspinatus muscle tissue with high temporal resolution (1, 2, 4, 8, and 16 weeks) post-tenotomy (n = 6/group), to determine if unique, time-dependent transcriptional changes occur. RNA sequencing and analyses were performed to identify a transcriptional timeline of RC muscle changes and related morphological sequelae. At 1-week post-tenotomy, the greatest number of differentially expressed genes was observed (1,069 up/873 down) which decreases through 2 (170/133), 4 (86/41), and 8 weeks (16/18), followed by a resurgence and transition of expression at 16 weeks (1,421/293), a behavior which previously has not been captured or reported. Broadly, 1-week post-tenotomy is an acute time point with expected immune system responses, catabolism, and changes in energy metabolism, which continues into 2 weeks with less intensity and greater contribution from mitochondrial effects. Expression shifts at 4 weeks post-tenotomy to fatty acid oxidation, lipolysis, and general upregulation of adipogenesis related genes. The effects of previous weeks’ transcriptional dysfunction present themselves at 8 weeks post-tenotomy with enriched DNA damage binding, aggresome activity, extracellular matrix-receptor changes, and significant expression of genes known to induce apoptosis. At 16 weeks post-tenotomy, there is a range of enriched pathways including extracellular matrix constituent binding, mitophagy, neuronal activity, immune response, and more, highlighting the chaotic nature of this time point and possibility of a chronic classification. Transcriptional activity correlated significantly with histological changes and were enriched for biologically relevant pathways such as lipid metabolism. These data provide platform for understanding the biological mechanisms of chronic muscle degeneration after RC tears.
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Affiliation(s)
- Laura S Vasquez-Bolanos
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Michael C Gibbons
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Isabella T Wu
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mario Vargas-Vila
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Sydnee A Hyman
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Donald C Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - John G Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Orthopedic Surgery, Kaiser Permanente, San Diego, CA, United States
| | - Chanond A Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Samuel R Ward
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Radiology, University of California, San Diego, San Diego, CA, United States
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10
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Ruoss S, Walker JT, Nasamran CA, Fisch KM, Paez C, Parekh JN, Ball ST, Chen JL, Ahmed SS, Ward SR. Strategies to Identify Mesenchymal Stromal Cells in Minimally Manipulated Human Bone Marrow Aspirate Concentrate Lack Consensus. Am J Sports Med 2021; 49:1313-1322. [PMID: 33646886 PMCID: PMC8409176 DOI: 10.1177/0363546521993788] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a need to identify and quantify mesenchymal stromal cells (MSCs) in human bone marrow aspirate concentrate (BMAC) source tissues, but current methods to do so were established in cultured cell populations. Given that surface marker and gene expression change in cultured cells, it is doubtful that these strategies are valid to quantify MSCs in fresh BMAC. PURPOSE To establish the presence, quantity, and heterogeneity of BMAC-derived MSCs in minimally manipulated BMAC using currently available strategies. STUDY DESIGN Descriptive laboratory study. METHODS Five published strategies to identify MSCs were compared for suitability and efficiency to quantify clinical-grade BMAC-MSCs and cultured MSCs at the single cell transcriptome level on BMAC samples being used clinically from 15 orthopaedic patients and on 1 cultured MSC sample. Strategies included (1) the guidelines by the International Society for Cellular Therapy (ISCT), (2) CD271 expression, (3) the Ghazanfari et al transcriptional profile, (4) the Jia et al transcriptional profile, and (5) the Silva et al transcriptional profile. RESULTS ISCT guidelines did not identify any MSCs in BMAC at the transcriptional level and only 1 in 9 million cells at the protein level. Of 12,850 BMAC cells, 9 expressed the CD271 gene. Only 116 of 396 Ghazanfari genes were detected in BMAC, whereas no cells expressed all of them. No cells expressed all Jia genes, but 25 cells expressed at least 13 of 22. No cells expressed all Silva genes, but 19 cells expressed at least 8 of 23. Most importantly, the liberalized strategies tended to identify different cells and most of them clustered with immune cells. CONCLUSION Currently available methods need to be liberalized to identify any MSCs in fresh human BMAC and lack consensus at the single cell transcriptome and protein expression levels. These different cells should be isolated and challenged to establish phenotypic differences. CLINICAL RELEVANCE This study demonstrated that improved strategies to quantify MSC concentrations in BMAC for clinical applications are urgently needed. Until then, injected minimally manipulated MSC doses should be reported as rough estimates or as unknown.
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Affiliation(s)
- Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - J. Todd Walker
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Chanond A. Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, UC San Diego, La Jolla CA, USA
| | - Kathleen M. Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, UC San Diego, La Jolla CA, USA
| | - Conner Paez
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Jesal N. Parekh
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Scott T. Ball
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Jeffrey L. Chen
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Sonya S. Ahmed
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
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11
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Chavez J, Shah NA, Ruoss S, Cuomo RE, Ward SR, Mackey TK. Online marketing practices of regenerative medicine clinics in US-Mexico border region: a web surveillance study. Stem Cell Res Ther 2021; 12:189. [PMID: 33736697 PMCID: PMC7977255 DOI: 10.1186/s13287-021-02254-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The potential of regenerative medicine to improve human health has led to the rapid expansion of stem cell clinics throughout the world with varying levels of regulation and oversight. This has led to a market ripe for stem cell tourism, with Tijuana, Mexico, as a major destination. In this study, we characterize the online marketing, intervention details, pricing of services, and assess potential safety risks through web surveillance of regenerative medicine clinics marketing services in Tijuana. Methods We conducted structured online search queries from March to April 2019 using 296 search terms in English and Spanish on two search engines (Google and Bing) to identify websites engaged in direct-to-consumer advertising of regenerative medicine services. We performed content analysis to characterize three categories of interest: online presence, tokens of scientific legitimacy, and intervention details. Results Our structured online searches resulted in 110 unique websites located in Tijuana corresponding to 76 confirmed locations. These clinics’ online presence consisted of direct-to-consumer advertising mainly through a dedicated website (94.5%) or Facebook page (65.5%). The vast majority of these websites (99.1%) did not mention any affiliation to an academic institutions or other overt tokens of scientific legitimacy. Most clinics claimed autologous tissue was the source of treatments (67.3%) and generally did not specify route of administration. Additionally, of the Tijuana clinics identified, 13 claimed licensing, though only 1 matched with available licensing information. Conclusions Regenerative medicine clinics in Tijuana have a significant online presence using direct-to-consumer advertising to attract stem-cell tourism clientele in a bustling border region between Mexico and the USA. This study adds to existing literature evidencing the unregulated nature of online stem cell offerings and provides further evidence of the need for regulatory harmonization, particularly to address stem cell services being offered online across borders. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02254-4.
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Affiliation(s)
- Javier Chavez
- Masters Program in Clinical Research, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Neal A Shah
- Department of Healthcare Research and Policy, UC San Diego - Extension, 8950 Villa La Jolla Drive Suite A124, San Diego, CA, 92037, USA.,Global Health Policy and Data Institute, San Diego, CA, USA
| | - Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, CA, USA.,Department of Anesthesiology and Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery and Department of Radiology, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Tim K Mackey
- Department of Healthcare Research and Policy, UC San Diego - Extension, 8950 Villa La Jolla Drive Suite A124, San Diego, CA, 92037, USA. .,Global Health Policy and Data Institute, San Diego, CA, USA. .,Department of Anesthesiology and Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA. .,S-3 Research, LLC, San Diego, CA, USA.
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12
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Flück M, Fitze D, Ruoss S, Valdivieso P, von Rechenberg B, Bratus-Neuenschwander A, Opitz L, Hu J, Laczko E, Wieser K, Gerber C. Down-Regulation of Mitochondrial Metabolism after Tendon Release Primes Lipid Accumulation in Rotator Cuff Muscle. Am J Pathol 2020; 190:1513-1529. [PMID: 32305353 DOI: 10.1016/j.ajpath.2020.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/14/2020] [Accepted: 03/26/2020] [Indexed: 12/12/2022]
Abstract
Atrophy and fat accumulation are debilitating aspects of muscle diseases and are rarely prevented. Using a vertical approach combining anatomic techniques with omics methodology in a tenotomy-induced sheep model of rotator cuff disease, we tested whether mitochondrial dysfunction is implicated in muscle wasting and perturbed lipid metabolism, speculating that both can be prevented by the stimulation of β-oxidation with l-carnitine. The infraspinatus muscle lost 22% of its volume over the first 6 weeks after tenotomy before the area-percentage of lipid increased from 8% to 18% at week 16. Atrophy was associated with the down-regulation of mitochondrial transcripts and protein and a slow-to-fast shift in muscle composition. Correspondingly, amino acid levels were increased 2 weeks after tendon release, when the levels of high-energy phosphates and glycerophospholipids were lowered. l-Carnitine administration (0.9 g/kg per day) prevented atrophy over the first 2 weeks, and mitigated alterations of glutamate, glycerophospholipids, and carnitine levels in released muscle, but did not prevent the level decrease in high-energy phosphates or protein constituents of mitochondrial respiration, promoting the accumulation of longer lipids with an increasing saturation. We conclude that the early phase of infraspinatus muscle degeneration after tendon release involves the elimination of oxidative characteristics associated with an aberrant accumulation of lipid species but is largely unrelated to the prevention of atrophy with oral l-carnitine administration.
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Affiliation(s)
- Martin Flück
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Daniel Fitze
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Severin Ruoss
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Paola Valdivieso
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Vetsuisse Faculty, Musculoskeletal Research Unit, Competence Center for Applied Biotechnology, University of Zurich, Zurich, Switzerland
| | | | - Lennart Opitz
- Functional Genomics Center Zurich, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Junmin Hu
- Functional Genomics Center Zurich, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Endre Laczko
- Functional Genomics Center Zurich, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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13
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Fitze DP, Franchi M, Popp WL, Ruoss S, Catuogno S, Camenisch K, Lehmann D, Schmied CM, Niederseer D, Frey WO, Flück M. Concentric and Eccentric Pedaling-Type Interval Exercise on a Soft Robot for Stable Coronary Artery Disease Patients: Toward a Personalized Protocol. JMIR Res Protoc 2019; 8:e10970. [PMID: 30916659 PMCID: PMC6456820 DOI: 10.2196/10970] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading causes of death worldwide, and coronary artery disease (CAD) is one of the most common causes of death in Europe. Leading cardiac societies recommend exercise as an integral part of cardiovascular rehabilitation because it reduces the morbidity and mortality of patients with CAD. Continuous low-intensity exercise using shortening muscle actions (concentric, CON) is a common training modality during cardiovascular rehabilitation. However, a growing clinical interest has been recently developed in high-intensity interval training (HIIT) for stable patients with CAD. Exercise performed with lengthening muscle actions (eccentric, ECC) could be tolerated better by patients with CAD as they can be performed with higher loads and lower metabolic cost than CON exercise. OBJECTIVE We developed a clinical protocol on a soft robot to compare cardiovascular and muscle effects of repeated and work-matched CON versus ECC pedaling-type interval exercise between patients with CAD during cardiovascular rehabilitation. This study aims to ascertain whether the developed training protocols affect peak oxygen uptake (VO2peak), peak aerobic power output (Ppeak), and parameters of muscle oxygen saturation (SmO2) during exercise, and anaerobic muscle power. METHODS We will randomize 20-30 subjects to either the CON or ECC group. Both groups will perform a ramp test to exhaustion before and after the training period to measure cardiovascular parameters and SmO2. Moreover, the aerobic skeletal muscle power (Ppeak) is measured weekly during the 8-week training period using a simulated squat jump and a counter movement jump on the soft robot and used to adjust the training load. The pedaling-type interval exercise on the soft robot is performed involving either CON or ECC muscle actions. The soft robotic device being used is a closed kinetic chain, force-controlled interactive training, and testing device for the lower extremities, which consists of two independent pedals and free footplates that are operated by pneumatic artificial muscles. RESULTS The first patients with CAD, who completed the training, showed protocol-specific improvements, reflecting, in part, the lower aerobic training status of the patient completing the CON protocol. Rehabilitation under the CON protocol, more than under the ECC protocol, improved cardiovascular parameters, that is, VO2peak (+26% vs -6%), and Ppeak (+20% vs 0%), and exaggerated muscle deoxygenation during the ramp test (248% vs 49%). Conversely, markers of metabolic stress and recovery from the exhaustive ramp test improved more after the ECC than the CON protocol, that is, peak blood lactate (-9% vs +20%) and peak SmO2 (+7% vs -7%). Anaerobic muscle power only improved after the CON protocol (+18% vs -15%). CONCLUSIONS This study indicates the potential of the implemented CON and ECC protocols of pedaling-type interval exercise to improve oxygen metabolism of exercised muscle groups while maintaining or even increasing the Ppeak. The ECC training protocol seemingly provided a lower cardiovascular stimulus in patients with CAD while specifically enhancing the reoxygenation and blood lactate clearance in recruited muscle groups during recovery from exercise. TRIAL REGISTRATION ClinicalTrials.gov NCT02845063; https://clinicaltrials.gov/ct2/show/NCT02845063.
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Affiliation(s)
- Daniel P Fitze
- Laboratory for Muscle Plasticity, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martino Franchi
- Laboratory for Muscle Plasticity, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Balgrist Move>Med, Swiss Olympic Medical Center, Balgrist University Hospital, Zurich, Switzerland
| | - Werner L Popp
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.,Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Severin Ruoss
- Laboratory for Muscle Plasticity, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Silvio Catuogno
- Balgrist Move>Med, Swiss Olympic Medical Center, Balgrist University Hospital, Zurich, Switzerland
| | - Karin Camenisch
- Balgrist Move>Med, Swiss Olympic Medical Center, Balgrist University Hospital, Zurich, Switzerland
| | - Debora Lehmann
- Balgrist Move>Med, Swiss Olympic Medical Center, Balgrist University Hospital, Zurich, Switzerland
| | - Christian M Schmied
- University Heart Center Zurich, Sports Cardiology Section, Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Niederseer
- University Heart Center Zurich, Sports Cardiology Section, Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Walter O Frey
- Balgrist Move>Med, Swiss Olympic Medical Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Flück
- Laboratory for Muscle Plasticity, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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14
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Capri M, Morsiani C, Santoro A, Moriggi M, Conte M, Martucci M, Bellavista E, Fabbri C, Giampieri E, Albracht K, Flück M, Ruoss S, Brocca L, Canepari M, Longa E, Di Giulio I, Bottinelli R, Cerretelli P, Salvioli S, Gelfi C, Franceschi C, Narici M, Rittweger J. Recovery from 6-month spaceflight at the International Space Station: muscle-related stress into a proinflammatory setting. FASEB J 2019; 33:5168-5180. [PMID: 30620616 PMCID: PMC6436655 DOI: 10.1096/fj.201801625r] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Indexed: 12/13/2022]
Abstract
The Sarcolab pilot study of 2 crewmembers, investigated before and after a 6-mo International Space Station mission, has demonstrated the substantial muscle wasting and weakness, along with disruption of muscle's oxidative metabolism. The present work aimed at evaluating the pro/anti-inflammatory status in the same 2 crewmembers (A, B). Blood circulating (c-)microRNAs (miRs), c-proteasome, c-mitochondrial DNA, and cytokines were assessed by real-time quantitative PCR or ELISA tests. Time series analysis was performed ( i.e., before flight and after landing) at 1 and 15 d of recovery (R+1 and R+15, respectively). C-biomarkers were compared with an age-matched control population and with 2-dimensional proteomic analysis of the 2 crewmembers' muscle biopsies. Striking differences were observed between the 2 crewmembers at R+1, in terms of inflamma-miRs (c-miRs-21-5p, -126-3p, and -146a-5p), muscle specific (myo)-miR-206, c-proteasome, and IL-6/leptin, thus making the 2 astronauts dissimilar to each other. Final recovery levels of c-proteasome, c-inflamma-miRs, and c-myo-miR-206 were not reverted to the baseline values in crewmember A. In both crewmembers, myo-miR-206 changed significantly after recovery. Muscle biopsy of astronaut A showed an impressive 80% increase of α-1-antitrypsin, a target of miR-126-3p. These results point to a strong stress response induced by spaceflight involving muscle tissue and the proinflammatory setting, where inflamma-miRs and myo-miR-206 mediate the systemic recovery phase after landing.-Capri, M., Morsiani, C., Santoro, A., Moriggi, M., Conte, M., Martucci, M., Bellavista, E., Fabbri, C., Giampieri, E., Albracht, K., Flück, M., Ruoss, S., Brocca, L., Canepari, M., Longa, E., Di Giulio, I., Bottinelli, R., Cerretelli, P., Salvioli, S., Gelfi, C., Franceschi, C., Narici, M., Rittweger, J. Recovery from 6-month spaceflight at the International Space Station: muscle-related stress into a proinflammatory setting.
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Affiliation(s)
- Miriam Capri
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy.,Galvani Interdepartmental Center, University of Bologna, Bologna, Italy
| | - Cristina Morsiani
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy.,Galvani Interdepartmental Center, University of Bologna, Bologna, Italy
| | - Aurelia Santoro
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy.,Galvani Interdepartmental Center, University of Bologna, Bologna, Italy
| | - Manuela Moriggi
- National Research Council-Institute of Molecular Bioimaging and Physiology (CNR-IBFM), Segrate, Milan, Italy.,Italian National Olympic Committee (CONI), Rome, Italy
| | - Maria Conte
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy.,Galvani Interdepartmental Center, University of Bologna, Bologna, Italy
| | - Morena Martucci
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy.,Galvani Interdepartmental Center, University of Bologna, Bologna, Italy
| | - Elena Bellavista
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Cristina Fabbri
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy.,Galvani Interdepartmental Center, University of Bologna, Bologna, Italy
| | - Enrico Giampieri
- Galvani Interdepartmental Center, University of Bologna, Bologna, Italy.,Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Kirsten Albracht
- Faculty of Medical Engineering and Technomathematics, FH Aachen University of Applied Sciences, Aachen, Germany.,Institute of Biomechanics and Orthopaedics, German Sport University, Cologne, Germany
| | - Martin Flück
- Department of Orthopaedics, University of Zürich, Zürich, Switzerland
| | - Severin Ruoss
- Department of Orthopaedics, University of Zürich, Zürich, Switzerland
| | - Lorenza Brocca
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Monica Canepari
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Emanuela Longa
- Sport Medicine Center, University of Pavia, Pavia, Italy
| | - Irene Di Giulio
- Centre of Human and Applied Physiological Sciences, King's College London, London, United Kingdom
| | - Roberto Bottinelli
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Fondazione Salvatore Maugeri, Institute of Hospitalization and Scientific Care (IRCCS), Scientific Institute of Pavia, Pavia, Italy
| | - Paolo Cerretelli
- National Research Council-Institute of Molecular Bioimaging and Physiology (CNR-IBFM), Segrate, Milan, Italy.,Italian National Olympic Committee (CONI), Rome, Italy
| | - Stefano Salvioli
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy.,Galvani Interdepartmental Center, University of Bologna, Bologna, Italy
| | - Cecilia Gelfi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,IRCCS, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Claudio Franceschi
- Department of Applied Mathematics, Institute of Information Technology, Mathematics, and Mechanics (ITMM), Lobachevsky State University of Nizhny Novgorod-National Research University (UNN), Nizhny Novogoro, Russia
| | - Marco Narici
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; and.,Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
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15
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Ruoss S, Kindt P, Oberholzer L, Rohner M, Jungck L, Abdel‐Aziz S, Fitze D, Rosskopf AB, Klein K, von Rechenberg B, Gerber C, Wieser K, Flück M. Inhibition of calpain delays early muscle atrophy after rotator cuff tendon release in sheep. Physiol Rep 2018; 6:e13833. [PMID: 30393967 PMCID: PMC6215759 DOI: 10.14814/phy2.13833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 05/15/2018] [Revised: 07/25/2018] [Accepted: 07/29/2018] [Indexed: 01/05/2023] Open
Abstract
Chronic rotator cuff (RC) tears are characterized by retraction, fat accumulation, and atrophy of the affected muscle. These features pose an intractable problem for surgical repair and subsequent recovery, and their prevention may be easier than reversal. Using an established ovine model, we tested the hypothesis that inhibition of the protease calpain mitigates m. infraspinatus atrophy by preservation of the myofibers' structural anchors in the sarcolemma (the costameres). Already 2 weeks of distal tendon release led to a reduction in muscle volume (-11.6 ± 9.1 cm3 , P = 0.038) and a 8.3% slow-to-fast shift of the fiber area (P = 0.046), which were both entirely abolished by chronic local administration of the calpain inhibitor calpeptin alone, and in combination with sildenafil. Calpain inhibition blunted the retraction of the muscle-tendon unit by 0.8-1.0 cm (P = 0.020) compared with the control group, and prevented cleavage of the costameric protein talin. Calpain 1 and 2 protein levels increased in the medicated groups after 4 weeks, counteracting the efficacy of calpeptin. Hence atrophic changes emerged after 4 weeks despite ongoing treatment. These findings suggest that the early muscular adaptations in the specific case of RC tear in the ovine model are indistinguishable from the atrophy and slow-to-fast fiber transformation observed with conventional unloading and can be prevented for 2 weeks. Concluding, calpain is a potential target to extend the temporal window for reconstruction of the ruptured RC tendon before recovery turns impossible.
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Affiliation(s)
- Severin Ruoss
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
| | - Philipp Kindt
- Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Linus Oberholzer
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
| | - Marco Rohner
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
| | - Ladina Jungck
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
| | - Sara Abdel‐Aziz
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
| | - Daniel Fitze
- Laboratory for Muscle PlasticityUniversity of ZurichZurichSwitzerland
| | - Andrea B. Rosskopf
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
- Radiology DepartmentBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Karina Klein
- Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Brigitte von Rechenberg
- Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM)University of ZurichZurichSwitzerland
| | - Christian Gerber
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM)University of ZurichZurichSwitzerland
- Department of OrthopaedicsBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Karl Wieser
- Department of OrthopaedicsBalgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Martin Flück
- Faculty of MedicineUniversity of ZurichZurichSwitzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM)University of ZurichZurichSwitzerland
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16
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Flück M, Viecelli C, Bapst AM, Kasper S, Valdivieso P, Franchi MV, Ruoss S, Lüthi JM, Bühler M, Claassen H, Hoppeler H, Gerber C. Knee Extensors Muscle Plasticity Over a 5-Years Rehabilitation Process After Open Knee Surgery. Front Physiol 2018; 9:1343. [PMID: 30337877 PMCID: PMC6178139 DOI: 10.3389/fphys.2018.01343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 05/21/2018] [Accepted: 09/06/2018] [Indexed: 01/26/2023] Open
Abstract
We investigated molecular and cellular parameters which set metabolic and mechanical functioning of knee extensor muscles in the operated and contralateral control leg of 9 patients with a chronically insufficient anterior cruciate ligament (ACL; 26.6 ± 8.3 years, 8 males, 1 female) after open reconstructive surgery (week 0), after ambulant physiotherapy under cast immobilization (week 9), succeeding rehabilitation training (up to week 26), and subsequent voluntary physical activity (week 260). Clinical indices of knee function in the operated leg were improved at 52 weeks and remained at a comparable level at week 260. CSA of the quadriceps (-18%), MCSA of muscle fibers (-24%), and capillary-to-fiber ratio (-24%) in m. vastus lateralis from the ACL insufficient leg were lower at week 0 than reference values in the contralateral leg at week 260. Slow type fiber percentage (-35%) and mitochondrial volume density (-39%) were reduced in m. vastus lateralis from the operated leg at weeks 9 and 26. Composition alterations in the operated leg exceeded those in the contralateral leg and, with the exception of the volume density of subsarcolemmal mitochondria, returned to the reference levels at week 260. Leg-specific deterioration of metabolic characteristics in the vasti from the operated leg was reflected by the down-regulation of mitochondrial respiration complex I-III markers (-41-57%) at week 9. After rehabilitation training at week 26, the specific Y397 phosphorylation of focal adhesion kinase (FAK), which is a proxy for mechano-regulation, was elevated by 71% in the operated leg but not in the contralateral leg, which had performed strengthening type exercise during ambulant physiotherapy. Total FAK protein and Y397 phosphorylation levels were lowered in both legs at week 26 resulting in positive correlations with mitochondrial volume densities and mitochondrial protein levels. The findings emphasize that a loss of mechanical and metabolic characteristics in knee extensor muscle remains detectable years after untreated ACL rupture, which may be aggravated in the post-operative phase by the deterioration of slow-oxidative characteristics after reconstruction due to insufficient load-bearing muscle activity. The reestablishment of muscle composition subsequent to years of voluntary physical activity reinforces that slow-to-fast fiber transformation is reversible in humans.
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Affiliation(s)
- Martin Flück
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudio Viecelli
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas M Bapst
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephanie Kasper
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Paola Valdivieso
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martino V Franchi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Severin Ruoss
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jean-Marc Lüthi
- Department of Orthopedic Surgery, Inselspital Bern, Bern, Switzerland
| | - Martin Bühler
- Department of Orthopedic Surgery, Inselspital Bern, Bern, Switzerland
| | | | - Hans Hoppeler
- Department of Anatomy, University of Bern, Bern, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Department of Orthopedic Surgery, Inselspital Bern, Bern, Switzerland
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17
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Rittweger J, Albracht K, Flück M, Ruoss S, Brocca L, Longa E, Moriggi M, Seynnes O, Di Giulio I, Tenori L, Vignoli A, Capri M, Gelfi C, Luchinat C, Francheschi C, Bottinelli R, Cerretelli P, Narici M. Sarcolab pilot study into skeletal muscle's adaptation to long-term spaceflight. NPJ Microgravity 2018; 4:18. [PMID: 30246141 PMCID: PMC6141586 DOI: 10.1038/s41526-018-0052-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 12/31/2022] Open
Abstract
Spaceflight causes muscle wasting. The Sarcolab pilot study investigated two astronauts with regards to plantar flexor muscle size, architecture, and function, and to the underlying molecular adaptations in order to further the understanding of muscular responses to spaceflight and exercise countermeasures. Two crew members (A and B) spent 6 months in space. Crew member A trained less vigorously than B. Postflight, A showed substantial decrements in plantar flexor volume, muscle architecture, in strength and in fiber contractility, which was strongly mitigated in B. The difference between these crew members closely reflected FAK-Y397 abundance, a molecular marker of muscle's loading history. Moreover, crew member A showed downregulation of contractile proteins and enzymes of anaerobic metabolism, as well as of systemic markers of energy and protein metabolism. However, both crew members exhibited decrements in muscular aerobic metabolism and phosphate high energy transfer. We conclude that countermeasures can be effective, particularly when resistive forces are of sufficient magnitude. However, to fully prevent space-related muscular deterioration, intersubject variability must be understood, and intensive exercise countermeasures programs seem mandatory. Finally, proteomic and metabolomic analyses suggest that exercise benefits in space may go beyond mere maintenance of muscle mass, but rather extend to the level of organismic metabolism.
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Affiliation(s)
- Jörn Rittweger
- 1Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.,2Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Kirsten Albracht
- 3Faculty of Medical Engineering and Technomathematics, FH Aachen University of Applied Science Aachen, Aachen, Germany.,4Institute of Biomechanics and Orthopaedics, German Sport University, Cologne, Germany
| | - Martin Flück
- 5Department of Orthopaedics, University of Zürich, Zürich, Switzerland
| | - Severin Ruoss
- 5Department of Orthopaedics, University of Zürich, Zürich, Switzerland
| | - Lorenza Brocca
- 6Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Emanuela Longa
- 6Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Olivier Seynnes
- 8Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Irene Di Giulio
- 9Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Leonardo Tenori
- 10Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessia Vignoli
- CERM Centro di Ricerca di Risonanze Magnetiche, Florence, Italy
| | - Miriam Capri
- 12Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Cecilia Gelfi
- 13Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
| | | | - Claudio Francheschi
- 12Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Roberto Bottinelli
- 6Department of Molecular Medicine, University of Pavia, Pavia, Italy.,14Fondazione Salvatore Maugeri (IRCSS), Scientific Institute of Pavia, Pavia, Italy
| | | | - Marco Narici
- 15Department of Biomedical Sciences, University of Padova, Padova, Italy
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18
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Flück M, Valdivieso P, Ruoss S, von Rechenberg B, Benn MC, Meyer DC, Wieser K, Gerber C. Neurectomy preserves fast fibers when combined with tenotomy of infraspinatus muscle via upregulation of myogenesis. Muscle Nerve 2018; 59:100-107. [PMID: 30073680 DOI: 10.1002/mus.26316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2018] [Indexed: 11/10/2022]
Abstract
INTRODUCTION We evaluated the contribution of denervation-related molecular processes to rotator cuff muscle degeneration after tendon release. METHODS We assessed the levels of myogenic (myogenin and myogenic differentiation factor [myoD]) and proadipogenic (peroxisome proliferator-activated receptor γ) transcription factors; the denervation-associated proteins tenascin-C, laminin-2, and calcium/calmodulin-dependent kinase II (CaMKII); and cellular alterations in sheep after infraspinatus tenotomy (TEN), suprascapular neurectomy (NEU), or both (TEN-NEU). RESULTS Extracellular ground substance increased at the expense of contractile tissue 16 weeks after surgery, correlating with CaMKII isoform levels. Sheep undergoing NEU and TEN-NEU had exaggerated infraspinatus atrophy and increased fast fibers compared with TEN sheep. The βMCaMKII isoform levels increased with TEN, and myoD levels tripled after denervation and were associated with slow fibers. DISCUSSION In sheep, denervation did not affect muscle-to-fat conversion after TEN of the infraspinatus. Furthermore, concurrent NEU mitigated the loss of fast fibers after TEN by inducing a fast-contractile phenotype. Muscle Nerve 59:100-107, 2019.
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Affiliation(s)
- Martin Flück
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Lengghalde 5, Balgrist Campus, 8008, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Paola Valdivieso
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Lengghalde 5, Balgrist Campus, 8008, Zurich, Switzerland
| | - Severin Ruoss
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Lengghalde 5, Balgrist Campus, 8008, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, Department of Molecular Mechanisms, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Mario C Benn
- Musculoskeletal Research Unit, Department of Molecular Mechanisms, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Dominik C Meyer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
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19
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Franchi MV, Ruoss S, Valdivieso P, Mitchell KW, Smith K, Atherton PJ, Narici MV, Flück M. Regional regulation of focal adhesion kinase after concentric and eccentric loading is related to remodelling of human skeletal muscle. Acta Physiol (Oxf) 2018; 223:e13056. [PMID: 29438584 DOI: 10.1111/apha.13056] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 08/29/2017] [Revised: 01/31/2018] [Accepted: 02/07/2018] [Indexed: 12/31/2022]
Abstract
AIMS We assessed focal adhesion kinase (FAK) response to concentric (CON) vs eccentric (ECC) resistance training (RT) at two vastus lateralis (VL) sites, and the relationships between FAK, muscle protein synthesis (MPS) and morphological remodelling. METHODS Six young males trained both legs unilaterally 3 times/week for 8 weeks; one leg performed CON RT, the contralateral performed ECC RT. Muscle biopsies were collected after training from VL mid-belly (MID) and distal (distal) sites at 0, 4, 8 weeks. Focal adhesion kinase content and activation were evaluated by immunoblotting. MPS was assessed by deuterium oxide tracer; morphological adaptations were evaluated by ultrasound and DXA. RESULTS pY397-FAK 8 weeks levels were ~4-fold greater after ECC at the distal site compared to CON (P < .05); pY397FAK to total FAK ratio was greater in ECC vs CON at 4 (~2.2-fold, P < .05) and 8 weeks (~9-fold, P < .001) at the distal site. Meta-vinculin was found transiently increased at 4 weeks at the distal site only after ECC RT. ECC presented greater fascicle length (Lf) increases (10.5% vs 4%), whereas CON showed greater in pennation angle (PA) changes (12.3% vs 2.1%). MPS did not differ between exercise types or muscle sites at all time points. distal pY397-FAK and pY397-FAK/FAK values correlated to changes in Lf at 8 weeks (r = .76, P < .01 and r = .66, P < .05 respectively). CONCLUSION Focal adhesion kinase phosphorylation was greater at 8 weeks after ECC RT and was muscle region-specific. FAK activity correlated to contraction-dependent architectural remodelling, suggesting a potential role of FAK in orienting muscle structural changes in response to distinct mechanical stimuli.
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Affiliation(s)
- M V Franchi
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- MRC-ARUK Centre for Musculoskeletal Ageing, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - S Ruoss
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - P Valdivieso
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - K W Mitchell
- MRC-ARUK Centre for Musculoskeletal Ageing, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - K Smith
- MRC-ARUK Centre for Musculoskeletal Ageing, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - P J Atherton
- MRC-ARUK Centre for Musculoskeletal Ageing, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - M V Narici
- MRC-ARUK Centre for Musculoskeletal Ageing, Royal Derby Hospital, University of Nottingham, Derby, UK
- Department of Biomedical Sciences, Institute of Physiology, University of Padua, Padua, Italy
| | - M Flück
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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20
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Ruoss S, Möhl CB, Benn MC, von Rechenberg B, Wieser K, Meyer DC, Gerber C, Flück M. Costamere protein expression and tissue composition of rotator cuff muscle after tendon release in sheep. J Orthop Res 2018; 36:272-281. [PMID: 28574610 PMCID: PMC5873452 DOI: 10.1002/jor.23624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 05/24/2017] [Indexed: 02/04/2023]
Abstract
Previous studies suggested that degradation of contractile tissue requires cleavage of the costamere, a structural protein complex that holds sarcomeres in place. This study examined if costamere turnover is affected by a rotator cuff tear in a previously established ovine model. We found the activity of focal adhesion kinase (FAK), a main regulator of costamere turnover, was unchanged at 2 weeks but decreased by 27% 16 weeks after surgical release of the infraspinatus tendon. This was accompanied by cleavage of the costamere protein talin into a 190 kDa fragment while full length talin remained unchanged. At 2 weeks after tendon release, muscle volume decreased by 17 cm3 from an initial 185 cm3 , the fatty tissue volume was halved, and the contractile tissue volume remained unchanged. After 16 weeks, the muscle volume decreased by 36 cm3 , contractile tissue was quantitatively lost, and the fat content increased by 184%. Nandrolone administration mitigated the loss of contractile tissue by 26% and prevented fat accumulation, alterations in FAK activity, and talin cleavage. Taken together, these findings imply that muscle remodeling after tendon release occurs in two stages. The early decrease of muscle volume is associated with reduction of fat; while, the second stage is characterized by substantial loss of contractile tissue accompanied by massive fat accumulation. Regulation of costamere turnover is associated with the loss of contractile tissue and seems to be impacted by nandrolone treatment. Clinically, the costamere may represent a potential intervention target to mitigate muscle loss after a rotator cuff tear. © 2017 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:272-281, 2018.
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Affiliation(s)
- Severin Ruoss
- Laboratory for Muscle Plasticity, Balgrist CampusUniversity of ZurichZurichSwitzerland
| | - Christoph B. Möhl
- Laboratory for Muscle Plasticity, Balgrist CampusUniversity of ZurichZurichSwitzerland
| | - Mario C. Benn
- Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | | | - Karl Wieser
- Department of Orthopaedics, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Dominik C. Meyer
- Department of Orthopaedics, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
| | - Martin Flück
- Laboratory for Muscle Plasticity, Balgrist CampusUniversity of ZurichZurichSwitzerland
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21
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Shahidi B, Hubbard JC, Gibbons MC, Ruoss S, Zlomislic V, Allen RT, Garfin SR, Ward SR. Lumbar multifidus muscle degenerates in individuals with chronic degenerative lumbar spine pathology. J Orthop Res 2017; 35:2700-2706. [PMID: 28480978 PMCID: PMC5677570 DOI: 10.1002/jor.23597] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [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: 01/13/2017] [Accepted: 05/03/2017] [Indexed: 02/04/2023]
Abstract
Histological and cell-level changes in the lumbar musculature in individuals with chronic lumbar spine degenerative conditions are not well characterized. Although prior literature supports evidence of changes in fiber type and size, little information exists describing the tissue quality and biology of pathological features of muscle in this population. The purpose of this study was to quantify multifidus tissue composition and structure, inflammation, vascularity, and degeneration in individuals with chronic degenerative lumbar spine pathology. Human multifidus biopsies were acquired from 22 consecutive patients undergoing surgery for chronic degenerative lumbar spine pathology. Relative fractions of muscle, adipose, and extracellular matrix were quantified along with muscle fiber type and cross-sectional area (CSA) and markers of inflammation, vascularity, satellite cell density, and muscle degeneration. On average, multifidus biopsies contained 48.5% muscle, 11.7% adipose tissue, and 26.1% collagen tissue. Elevated inflammatory cell counts (48.5 ± 30.0 macrophages/mm2 ) and decreased vascularity (275.6 ± 69.4 vessels/mm2 ) were also observed compared to normative values. Satellite cell densities were on average 13 ± 9 cells per every 100 muscle fibers. Large fiber CSA (3,996.0 ± 1,909.2 µm2 ) and a predominance of type I fibers (61.8 ± 18.0%) were observed in addition to evidence of pathological degeneration-regeneration cycling (18.8 ± 9.4% centrally nucleated fibers, and 55.2 ± 24.2% of muscle regions containing degeneration). High levels of muscle degeneration, inflammation, and decreased vascularity were commonly seen in human multifidus biopsies of individuals with lumbar spine pathology in comparison to normative data. Evidence of active muscle degeneration suggests that changes in muscle tissue are more complex than simple atrophy. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2700-2706, 2017.
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Affiliation(s)
- Bahar Shahidi
- University of California San Diego Department of Radiology, San Diego USA,University of California San Diego Department of Orthopaedic Surgery, San Diego, USA
| | - James C Hubbard
- University of California San Diego Department of Orthopaedic Surgery, San Diego, USA
| | - Michael C Gibbons
- University of California San Diego Department of Bioengineering, San Diego USA
| | - Severin Ruoss
- University of Zurich Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Vinko Zlomislic
- University of California San Diego Department of Orthopaedic Surgery, San Diego, USA
| | - R. Todd Allen
- University of California San Diego Department of Orthopaedic Surgery, San Diego, USA
| | - Steven R Garfin
- University of California San Diego Department of Orthopaedic Surgery, San Diego, USA
| | - Samuel R Ward
- University of California San Diego Department of Radiology, San Diego USA,University of California San Diego Department of Orthopaedic Surgery, San Diego, USA,University of California San Diego Department of Bioengineering, San Diego USA
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22
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Flück M, Ruoss S, Möhl CB, Valdivieso P, Benn MC, von Rechenberg B, Laczko E, Hu J, Wieser K, Meyer DC, Gerber C. Genomic and lipidomic actions of nandrolone on detached rotator cuff muscle in sheep. J Steroid Biochem Mol Biol 2017; 165:382-395. [PMID: 27523963 DOI: 10.1016/j.jsbmb.2016.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 01/06/2023]
Abstract
Reversal of fatty infiltration of pennate rotator cuff muscle after tendon release is hitherto impossible. The administration of nandrolone starting at the time of tendon release prevents the increase in fat content, but does not revert established fatty infiltration. We hypothesised that tendon release and myotendinous retraction cause alterations in lipid related gene expression leading to fatty muscle infiltration, which can be suppressed by nandrolone through its genomic actions if applied immediately after tendon release. The effects of infraspinatus tendon release and subsequent tendon repair at 16 weeks were studied in six Swiss Alpine sheep. In the interventional groups, 150mg nandrolone was administered weekly after tendon release until sacrifice (N22W, n=6) or starting at the time of repair (N6W, n=6). Infraspinatus volume, composition, expressed transcripts, lipids, and selected proteins were analyzed at baseline, 16 and 22 weeks. Tendon release reduced infraspinatus volume by 22% and increased fat content from 11% to 38%. These changes were not affected by repair. Fatty infiltration was associated with up-regulation of 227 lipid species, and increased levels of the adipocyte differentiation marker PPARG2 (peroxisome proliferator-activated receptor gamma 2). Nandrolone abrogated lipid accumulation, halved the loss in fiber area percentage, and up-regulated androgen receptor levels and transcript expression in the N22W but not the N6W group. The results document that nandrolone mitigates muscle-to-fat transformation after tendon release via a general down-regulation of lipid accumulation concomitantly with up-regulated expression of its nuclear receptor and downstream transcripts in skeletal muscle. Reduced responsiveness of retracted muscle to nandrolone as observed in the N6W group is reflected by a down-regulated transcript response.
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Affiliation(s)
- Martin Flück
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Balgrist Campus, Zurich, Switzerland.
| | - Severin Ruoss
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Balgrist Campus, Zurich, Switzerland
| | - Christoph B Möhl
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Balgrist Campus, Zurich, Switzerland
| | - Paola Valdivieso
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Balgrist Campus, Zurich, Switzerland
| | - Mario C Benn
- Musculoskeletal Research Unit, Center for Applied Biotechnology and Molecular Medicine, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, Center for Applied Biotechnology and Molecular Medicine, Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Endre Laczko
- Functional Genomics Center Zurich (FGCZ), ETH and University of Zurich, Switzerland
| | - Junmin Hu
- Functional Genomics Center Zurich (FGCZ), ETH and University of Zurich, Switzerland
| | - Karl Wieser
- Balgrist University Hospital, Department of Orthopedics, Zurich, Switzerland
| | - Dominik C Meyer
- Balgrist University Hospital, Department of Orthopedics, Zurich, Switzerland
| | - Christian Gerber
- Balgrist University Hospital, Department of Orthopedics, Zurich, Switzerland
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23
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van Ginkel S, Ruoss S, Valdivieso P, Degens H, Waldron S, de Haan A, Flück M. ACE inhibition modifies exercise-induced pro-angiogenic and mitochondrial gene transcript expression. Scand J Med Sci Sports 2015; 26:1180-7. [PMID: 26407530 DOI: 10.1111/sms.12572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 01/02/2023]
Abstract
Skeletal muscle responds to endurance exercise with an improvement of biochemical pathways that support substrate supply and oxygen-dependent metabolism. This is reflected by enhanced expression of associated factors after exercise and is specifically modulated by tissue perfusion and oxygenation. We hypothesized that transcript expression of pro-angiogenic factors (VEGF, tenascin-C, Angpt1, Angpt1R) and oxygen metabolism (COX4I1, COX4I2, HIF-1α) in human muscle after an endurance stimulus depends on vasoconstriction, and would be modulated through angiotensin-converting enzyme inhibition by intake of lisinopril. Fourteen non-specifically trained, male Caucasians subjects, carried out a single bout of standardized one-legged bicycle exercise. Seven of the participants consumed lisinopril in the 3 days before exercise. Biopsies were collected pre- and 3 h post-exercise from the m. vastus lateralis. COX4I1 (P = 0.03), COX4I2 (P = 0.04) mRNA and HIF-1α (P = 0.05) mRNA and protein levels (P = 0.01) showed an exercise-induced increase in the group not consuming the ACE inhibitor. Conversely, there was a specific exercise-induced increase in VEGF transcript (P = 0.04) and protein levels (P = 0.03) and a trend for increased tenascin-c transcript levels (P = 0.09) for subjects consuming lisinopril. The observations indicate that exercise-induced expression of transcripts involved in angiogenesis and mitochondrial energy metabolism are to some extent regulated via a hypoxia-related ACE-dependent mechanism.
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Affiliation(s)
- S van Ginkel
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK.,MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - S Ruoss
- University Hospital Balgrist, Laboratory for Muscle Plasticity, University of Zurich, Zurich, Switzerland
| | - P Valdivieso
- University Hospital Balgrist, Laboratory for Muscle Plasticity, University of Zurich, Zurich, Switzerland
| | - H Degens
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - S Waldron
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - A de Haan
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK.,MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - M Flück
- University Hospital Balgrist, Laboratory for Muscle Plasticity, University of Zurich, Zurich, Switzerland.
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Olivier K, Eagle G, McGinnis J, Micioni L, Daley C, Winthrop K, Ruoss S, Addrizzo-Harris D, Flume P, Dorgan D, Salathe M, Brown-Elliott B, Wallace R, Griffith D. WS02.3 Randomized, double-blind (DB), placebo-controlled study and open-label (OL) extension of liposomal amikacin for inhalation (LAI) in patients with refractory nontuberculous mycobacterial (NTM) lung disease (LD). J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30009-6] [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: 10/23/2022]
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Klossner S, Li R, Ruoss S, Durieux AC, Flück M. Quantitative changes in focal adhesion kinase and its inhibitor, FRNK, drive load-dependent expression of costamere components. Am J Physiol Regul Integr Comp Physiol 2013; 305:R647-57. [PMID: 23904105 DOI: 10.1152/ajpregu.00007.2013] [Citation(s) in RCA: 22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Costameres are mechanosensory sites of focal adhesion in the sarcolemma that reinforce the muscle-fiber composite and provide an anchor for myofibrillogenesis. We hypothesized that elevated content of the integrin-associated regulator of costamere turnover in culture, focal adhesion kinase (FAK), drives changes in costamere component content in antigravity muscle in a load-dependent way in correspondence with altered muscle weight. The content of FAK in soleus muscle being phosphorylated at autoregulatory tyrosine 397 (FAK-pY397) was increased after 20 s of stretch. FAK-pY397 content remained elevated after 24 h of stretch-overload due to upregulated FAK content. Overexpression of FAK in soleus muscle fibers by means of gene electrotransfer increased the β1-integrin (+56%) and meta-vinculin (+88%) content. α7-Integrin (P = 0.46) and γ-vinculin (P = 0.18) content was not altered after FAK overexpression. Co-overexpression of the FAK inhibitor FAK-related nonkinase (FRNK) reduced FAK-pY397 content by 33% and increased the percentage of fast-type fibers that arose in connection with hybrid fibers with gene transfer. Transplantation experiments confirmed the association of FRNK expression with slow-to-fast fiber transformation. Seven days of unloading blunted the elevation of FAK-pY397, β1-integrin, and meta-vinculin content with FAK overexpression, and this was reversed by 1 day of reloading. The results highlight that the expression of components for costameric attachment sites of myofibrils is under load- and fiber type-related control via FAK and its inhibitor FRNK.
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Abstract
STUDY OBJECTIVES To investigate the hypothesis that an increase in circulating vascular endothelial growth factor (VEGF) occurs in mountaineers at high altitude, particularly in association with acute mountain sickness (AMS) and/or low hemoglobin oxygen saturation. DESIGN : Collection of medical histories, AMS scores, plasma samples, and arterial oxygen saturation (SaO(2)) measurements from mountaineers at 1,500 feet (sea level) and at 14,200 feet. SETTING Mount McKinley ("Denali"), AK. PARTICIPANTS Sixty-six mountaineers. INTERVENTIONS None. MEASUREMENTS AND RESULTS Plasma VEGF at 14,200 feet was not increased in any group. In fact, plasma VEGF was significantly lower in subjects who did not develop AMS (53 +/- 7.9 pg/mL; mean +/- SEM; n = 47) compared to control subjects at sea level (98.4 +/- 14.3 pg/mL; n = 7; p = 0.005). Plasma VEGF at 14, 200 feet for subjects with AMS (62 +/- 12 pg/mL; n = 15) did not differ significantly from subjects at 14,200 feet without AMS, or from control subjects at sea level. Of a small number of subjects with paired specimens at sea level and at base camp (n = 5), subjects who exhibited a decrease in plasma VEGF at 14,200 feet were those who did not develop AMS. Neither SaO(2), prior AMS, AMS symptom scores, or acetazolamide use were correlated with plasma VEGF. CONCLUSIONS Subjects at high altitude who do not develop AMS have lower plasma VEGF levels compared to control subjects at sea level. Plasma VEGF at high altitude is not elevated in association with AMS or hypoxia. Sustained plasma VEGF at altitude may reflect a phenotype more susceptible to AMS.
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Affiliation(s)
- J Maloney
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Abstract
Anthrax, a disease of great historical interest, is once again making headlines as an agent of biological warfare. Bacillus anthracis, a rod-shaped, spore-forming bacterium, primarily infects herbivores. Humans can acquire anthrax by agricultural or industrial exposure to infected animals or animal products. More recently, the potential for intentional release of anthrax spores in the environment has caused much concern. The common clinical manifestations of anthrax are cutaneous disease, pulmonary disease from inhalation of anthrax spores, and GI disease. The course of inhalational anthrax is dramatic, from the insidious onset of nonspecific influenza-like symptoms to severe dyspnea, hypotension, and hemorrhage within days of exposure. A rapid decline, culminating in septic shock, respiratory distress, and death within 24 h is not uncommon. The high mortality seen in inhalational anthrax is in part due to delays in diagnosis. Classic findings on the chest radiograph include widening of the mediastinum as well as pleural effusions. Pneumonia is less common; key pathologic manifestations include severe hemorrhagic mediastinitis, diffuse hemorrhagic lymphadenitis, and edema. Diagnosis requires a high index of suspicion. Treatment involves supportive care in an intensive care facility and high doses of penicillin. Resistance to third-generation cephalosporins has been noted. Vaccines are currently available and have been shown to be effective against aerosolized exposure in animal studies.
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Affiliation(s)
- S Shafazand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University Medical Center, Stanford, CA 94305-5236, USA
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Leonard C, Mohindra V, Ruoss S, Doyle RL, Raffin TA. European life-support questionnaire. Crit Care Med 1999; 27:1686-7. [PMID: 10470800 DOI: 10.1097/00003246-199908000-00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Lyme disease is a tick-borne spirochaete infection which, in a proportion of patients, can lead to neuropathy. This article describes a case of diaphragmatic paralysis due to Lyme disease. A 39-yr-old male presented to the hospital because of an acute left facial palsy. Six weeks prior to admission he had developed a circular rash on his left flank during a camping holiday. He also complained of shortness of breath and arthralgia for 1 week. His chest radiograph demonstrated a raised right hemi-diaphragm. Diaphragmatic paralysis was confirmed by fluoroscopy (a positive sniff test). Serology revealed evidence of recent infection by Borrelia burgdorferi. On the basis of the patient's clinical presentation, a recent history of erythema migrans, and positive Lyme serology, a diagnosis of neuroborreliosis was made. He received oral doxycycline therapy (200 mg x day(-1)) for three weeks. Facial and diaphragmatic palsies resolved within eight weeks. On the basis of this case, a diagnosis of Lyme disease should be considered in patients from endemic regions with otherwise unexplained phrenic nerve palsy.
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Affiliation(s)
- J L Faul
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, CA 94305, USA
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Affiliation(s)
- K G Kalassian
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, California 94305-5236, USA
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