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Martin CA, Tilz RRR, Anic A, Defaye P, Luik A, de Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht EM, Raybuck JD, Richards E, Cielen N, Yap SC. Acute procedural efficacy and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR ICE study. J Cardiovasc Electrophysiol 2023; 34:833-840. [PMID: 36786515 DOI: 10.1111/jce.15861] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/03/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is well established as a primary treatment for atrial fibrillation (AF). The POLAR ICE study was designed to collect prospective real world data on the safety and effectiveness of the POLARxTM cryoballoon for PVI to treat paroxysmal AF. METHODS POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 399 patients across 19 European centers. Procedural characteristics, such as time to isolation, cryoablations per pulmonary vein (PV), balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing. RESULTS Data on 372 de novo PVI procedures (n = 2190 ablations) were collected. Complete PVI was achieved in 96.8% of PVs. Procedure and fluoroscopy times were 68.2 ± 24.6 and 15.6 ± 9.6 min, respectively. Left atrial dwell time was 46.6 ± 18.3 min. Grade 3 or 4 occlusion was achieved in 98.2% of PVs reported and 71.2% of PVs isolation required only a single cryoablation. Of 2190 cryoapplications, 83% had a duration of at least 120 s; nadir temperature of these ablations averaged -56.3 ± 6.5°C. There were 6 phrenic nerve palsy events, 2 of which resolved within 3 months of the procedure. CONCLUSION This real-world usage data on a novel cryoballoon suggests this device is effective, safe, and relatively fast in centers with cryoballoon experience. These data are comparable to prior POLARx reports and in keeping with reported data on other cryoballoons. Future studies should examine the long-term outcomes and the relationship between biophysical parameters and outcomes for this novel cryoballoon.
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Affiliation(s)
- Claire A Martin
- Royal Papworth Hospital NHS Foundation Trust and Cambridge University, Cambridge, UK
| | - Roland R R Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Ante Anic
- Klinicki Bolnicki Centar Split, Split, Croatia
| | - Pascal Defaye
- University Grenoble Alpes, INSERM unité 1039 and Grenoble university Hospital, Cardiology Department, Grenoble, France
| | - Armin Luik
- Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Laure Champ-Rigot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Cardiology Department, Caen, France
| | | | - Philipp Sommer
- Clinic for Electrophysiology Herz und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | | | | | | | - Nele Cielen
- Boston Scientific, Arden Hills, Minnesota, USA
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Martin C, Tilz RR, Anic A, Defaye P, Luik A, Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht E, Raybuck JD, Wehrenberg S, Cielen N, Yap SC. Biophysical parameters and time to isolation of pulmonary veins with a novel cryoballoon: results of POLAR ICE study. Europace 2022. [DOI: 10.1093/europace/euac053.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific
Introduction
Low nadir temperatures and long thaw times with cryoballoon ablation are associated with successful pulmonary vein isolation (PVI). Recently, a system that maintains uniform pressure and size has been introduced to improve catheter stability during cryoballoon ablation. The present results examine the relationship between cryoballoon time to isolation (TTI) and other biophysical parameters; time to -40ºC (TT-40), nadir temperature, time to thaw (TT0), and first pass isolation success in patients with paroxysmal AF (PAF).
Methods
POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 400 patients across 19 centers, between Aug 2020 and May 2021. This study included any patients indicated for treatment of PAF with the POLARx cryoablation system. Cryodosing regimen was left to the operator and not specified by study protocol. Procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, nadir temperature, and occlusion grade were recorded. PVI was confirmed via entrance block. Biophysical parameters for ablations longer than 120s were evaluated.
Results
Data on 389 PVI procedures (n=2303 ablations) were collected. Of those ablations, 1914 (83%) had a duration of at least 120s and were included in this analysis. Isolation was attempted using the CB alone. TTI was reported in 1335 ablations with the majority (64%) occurring within 60s. Biophysical parameters and single shot success rates were examined based on TTI. Ablations with TTI<60s had significantly faster TT-40 (30.6±7.4s), lower nadir temperatures (-58.3±5.8ºC), longer thaw times (21.1±6.7s), and a greater proportion of grade 4 occlusions (88%) than longer TTIs or ablation with no TTI reported (Table 1). In TTIs<60s single shot success was 95%, significantly greater than TT≥60s, or No TTI. Procedure-related complications included: phrenic nerve palsy (0.5%), tamponade (0.5%), AV block (0.3%), stroke (0.3%), and transient ischemic attack (0.3%).
Conclusions
These data suggest a correlation between cryoballoon biophysical parameters and single shot success. Good occlusion likely drives faster freeze and lower nadir temperatures, resulting in longer thaw times with this novel cryoballoon. Future research should examine the relationship between these parameters to drive optimization of cryoablation techniques and provide guidance toward improved workflow.
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Affiliation(s)
- C Martin
- Royal Papworth Hospital, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - RR Tilz
- University Hospital Schleswig-Holstein, Lübeck, Germany
| | - A Anic
- Klinicki Bolnicki Centar, Split, Croatia
| | - P Defaye
- Grenoble Alpes University Hospital, Grenoble, France
| | - A Luik
- Staedtisches Klinikum, Karlsruhe, Germany
| | - C Asmundis
- University Hospital (UZ) Brussels, Brussels, Belgium
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - P Sommer
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - E Albrecht
- Boston Scientific, Arden Hills, United States of America
| | - JD Raybuck
- Boston Scientific, Arden Hills, United States of America
| | - S Wehrenberg
- Boston Scientific, Arden Hills, United States of America
| | - N Cielen
- Boston Scientific, Arden Hills, United States of America
| | - SC Yap
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
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Tilz R, Martin CA, Anic A, Defaye P, Luik A, Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht E, Raybuck JD, Wehrenberg S, Cielen N, Yap SC. Acute procedural characteristics, efficacy, and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR-ICE study. Europace 2022. [DOI: 10.1093/europace/euac053.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific
Background/Introduction
Pulmonary vein isolation (PVI) using a cryoballoon is well-established for the treatment of paroxysmal atrial fibrillation (PAF). Initial experience with a novel cryoballoon (CB) with a stable low balloon pressure (POLARx, Boston Scientific) has demonstrated acute procedural safety and efficacy in de novo PVI procedures in patients with paroxysmal AF. However, to date, there is limited multicenter data on real world acute outcomes and procedural characteristics with this novel cryoballoon.
Purpose
The purpose of POLAR ICE was to provide real-world data on the acute and chronic outcomes of cryoballoon ablation with POLARx for the treatment of PAF. Here we report on the initial acute outcomes up to 3 months including procedural efficacy, safety, and biophysical parameters.
Methods
POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 400 patients across 19 centers, between Aug 2020 and May 2021. This study included any patients indicated for treatment of PAF with the POLARx cryoablation system. The study protocol did not mandate any specific cryodosing regimen, this was left to the operator. Procedural characteristics, such as time to isolation (TTI), cryoablations per pulmonary vein, balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing.
Results
Complete PVI was achieved in 96.1% of PVs (1437/1496). Procedure and fluoroscopy times were 69.0±25.2 min and 15.8±10.0 min, respectively. Left atrial dwell time was 47.3±18.8 min. The cryoablation characteristics by vein are shown in the Table 1. An average of 4.9±1.8 ablations were performed per patient (1.3±0.7 per vein). Grade 3 or 4 occlusion was achieved in 98.1% of PVs reported. Electrical isolation was achieved with an average TTI of 50±33.8s and in 81.4% of PVs isolation required only a single cryoablation. Nadir temperatures across all pulmonary veins averaged -56.3± 6.5C. Time to -40C was 32.9±11s and Time to Thaw (0C) was 19.5±6.7s across all veins. PVI was performed on atypical anatomies (12 LCPV, 7 RMPV, & 3 RCPV) in 19 pts. Serious adverse events included phrenic nerve palsy (0.5%), tamponade (0.5%), AV block (0.3%), stroke (0.3%), and transient ischemic attack (0.3%).
Conclusions
Real world usage data on the novel CB suggests that this device is safe and effective, with a PV isolation success rate of 96.2% and 81.4% of PVs isolated with a single cryoablation. These data are in keeping with reports on other cryoballon systems and have markedly shorter procedure times than have been previously reported on this cryoballon.
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Affiliation(s)
- R Tilz
- University Heart Center, Luebeck, Germany
| | - CA Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - A Anic
- Klinicki Bolnicki Centar, Split, Croatia
| | - P Defaye
- Grenoble Alpes University Hospital, Grenoble, France
| | - A Luik
- Staedtisches Klinikum, Karlsruhe, Germany
| | - C Asmundis
- University Hospital (UZ) Brussels, Brussels, Belgium
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - P Sommer
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - E Albrecht
- Boston Scientific, Arden Hills, United States of America
| | - JD Raybuck
- Boston Scientific, Arden Hills, United States of America
| | - S Wehrenberg
- Boston Scientific, Arden Hills, United States of America
| | - N Cielen
- Boston Scientific, Arden Hills, United States of America
| | - SC Yap
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
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Martin A, Fowler M, Breskovic T, Ouss A, Dekker L, Yap SC, Bhagwandien R, Albrecht EM, Cielen N, Richards E, Tran BC, Lever N, Anic A. Novel cryoballoon to isolate pulmonary veins in patients with paroxysmal atrial fibrillation: long-term outcomes in a multicentre clinical study. J Interv Card Electrophysiol 2022; 65:609-616. [PMID: 35412168 PMCID: PMC9726810 DOI: 10.1007/s10840-022-01200-5] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/23/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently, a novel cryoballoon ablation catheter has demonstrated acute safety and efficacy in de novo pulmonary vein isolation (PVI) procedures in patients with paroxysmal atrial fibrillation (PAF). However, there are limited studies demonstrating the long-term efficacy. The aim of this study was to evaluate the long-term safety and efficacy of this novel cryoballoon in treating PAF. METHODS This was a non-randomized, prospective, multicentre study enrolling 58 consecutive patients. Cryoablation was delivered for 180 s if time to isolation was ≤ 60 s. Otherwise a 240-s cryoablation was performed. One centre performed pre- and post-ablation high-density mapping (n = 9) to characterize lesion formation. After a 3-month blanking period, recurrence was defined as having any documented, symptomatic episode(s) of AF or atrial tachycardia. All patients were followed for 1 year. RESULTS Acute PVI was achieved in 230 of 231 pulmonary veins (99.6%) with 5.3 ± 1.6 cryoablations per patient (1.3 ± 0.7 cryoablations per vein). Forty-three (77%) patients remained arrhythmia-free at 1-year follow-up. Four patients (6.9%) experienced phrenic nerve injury (3 resolved during the index procedure; 1 resolved at 6 months). One serious adverse device event was reported: femoral arterial embolism event occurring 2 weeks post-index procedure. For patients who underwent high-density mapping, cryoablation was antral with 50% of the posterior wall ablated. CONCLUSIONS Initial multicentre clinical experience with a novel cryoballoon has demonstrated safety and efficacy of PVI in patients with PAF. Ablation with this cryoballoon provides a wide, antral lesion set with significant debulking of the posterior wall of the left atrium.
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Affiliation(s)
- Andrew Martin
- grid.414055.10000 0000 9027 2851Green Lane Cardiovascular Services, Auckland Mail Centre, Auckland City Hospital, Private Bag 92 189, Auckland, 1142 New Zealand
| | - Marina Fowler
- grid.414055.10000 0000 9027 2851Green Lane Cardiovascular Services, Auckland Mail Centre, Auckland City Hospital, Private Bag 92 189, Auckland, 1142 New Zealand
| | - Toni Breskovic
- grid.412721.30000 0004 0366 9017University Hospital Center Split, Split, Croatia
| | - Alexandre Ouss
- grid.413532.20000 0004 0398 8384Catharina Hospital, Eindhoven, Netherlands
| | - Lukas Dekker
- grid.413532.20000 0004 0398 8384Catharina Hospital, Eindhoven, Netherlands
| | - Sing-Chien Yap
- grid.5645.2000000040459992XErasmus MC, Rotterdam, Netherlands
| | | | - Elizabeth M. Albrecht
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Nele Cielen
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Elizabeth Richards
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Binh C. Tran
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Nigel Lever
- grid.414055.10000 0000 9027 2851Green Lane Cardiovascular Services, Auckland Mail Centre, Auckland City Hospital, Private Bag 92 189, Auckland, 1142 New Zealand
| | - Ante Anic
- grid.412721.30000 0004 0366 9017University Hospital Center Split, Split, Croatia
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Martin A, Breskovic T, Ouss A, Dekker L, Yap SC, Bhagwandien R, Cielen N, Albrecht EM, Richards E, Tran B, Lever N, Anic A. Novel cryoballoon to isolate pulmonary veins in patients with paroxysmal atrial fibrillation: one-year outcomes in a multicenter study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recently, a novel cryoballoon (CB; POLARx) has been developed with increased steerability which maintains size and pressure throughout the ablation. Initial clinical data has demonstrated acute procedural safety and efficacy in de novo pulmonary vein isolation (PVI) procedures in patients with paroxysmal atrial fibrillation (AF). However, there are limited studies demonstrating the long-term efficacy of the CB.
Purpose
To evaluate the long-term safety and efficacy of the novel CB in treating paroxysmal AF.
Methods
This was a non-randomized, prospective, multi-center study. Fifty-eight consecutive patients with paroxysmal AF were enrolled at 4 centers for de novo PVI procedures. Cryoablation was delivered for 180s if time to isolation was ≤60s. Otherwise a 240s cryoablation was performed. PVI was confirmed with entrance and exit block testing. Patients were followed for 1 year with 24-hour Holter monitoring at 3, 6, and 12 months. After a 3-month blanking period, recurrence was defined as having any documented, symptomatic episode(s) of AF or atrial tachycardia.
Results
Acute isolation with the CB was achieved in 230 of 231 pulmonary veins (99.6%) with 5.2±1.5 cryoapplications per patient (1.3±0.6 cryoapplications per vein). There were 4 patients (6.9%) with phrenic nerve injury (3 resolved during the index procedure; 1 resolved at 6 months follow-up). One serious adverse device event was reported: femoral arterial embolism event occurring 2 weeks post index procedure (1.7%). Of the 56 patients that had complete 12-month follow-up, 43 (76.8%) were free from recurrent atrial arrhythmias.
Conclusion
Initial multicenter clinical experience with the novel CB has demonstrated long-term safety and efficacy of PVI in patients with paroxysmal AF. Further studies are underway to confirm these findings.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Boston Scientific
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Affiliation(s)
- A Martin
- Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - T Breskovic
- University Hospital Center Split, Split, Croatia
| | - A Ouss
- Catharina Hospital, Eindhoven, Netherlands (The)
| | - L Dekker
- Catharina Hospital, Eindhoven, Netherlands (The)
| | - S C Yap
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - R Bhagwandien
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - N Cielen
- Boston Scientific, Brussels, Belgium
| | - E M Albrecht
- Boston Scientific, St. Paul, United States of America
| | - E Richards
- Boston Scientific, St. Paul, United States of America
| | - B Tran
- Boston Scientific, St. Paul, United States of America
| | - N Lever
- Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - A Anic
- University Hospital Center Split, Split, Croatia
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Cielen N, Maes K, Heulens N, Troosters T, Carmeliet G, Janssens W, Gayan-Ramirez GN. Interaction between Physical Activity and Smoking on Lung, Muscle, and Bone in Mice. Am J Respir Cell Mol Biol 2017; 54:674-82. [PMID: 26448063 DOI: 10.1165/rcmb.2015-0181oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Physical inactivity is an important contributor to skeletal muscle weakness, osteoporosis, and weight loss in chronic obstructive pulmonary disease. However, the effects of physical inactivity, in interaction with smoking, on lung, muscle, and bone are poorly understood. To address this issue, male mice were randomly assigned to an active (daily running), moderately inactive (space restriction), or extremely inactive group (space restriction followed by hindlimb suspension to mimic bed rest) during 24 weeks and simultaneously exposed to either cigarette smoke or room air. The effects of different physical activity levels and smoking status and their respective interaction were examined on lung function, body composition, in vitro limb muscle function, and bone parameters. Smoking caused emphysema, reduced food intake with subsequent loss of body weight, and fat, lean, and muscle mass, but increased trabecular bone volume. Smoking induced muscle fiber atrophy, which did not result in force impairment. Moderate inactivity only affected lung volumes and compliance, whereas extreme inactivity increased lung inflammation, lowered body and fat mass, induced fiber atrophy with soleus muscle dysfunction, and reduced exercise capacity and all bone parameters. When combined with smoking, extreme inactivity also aggravated lung inflammation and emphysema, and accelerated body and muscle weight loss. This study shows that extreme inactivity, especially when imposed by absolute rest, accelerates lung damage and inflammation. When combined with smoking, extreme inactivity is deleterious for muscle bulk, bone, and lungs. These data highlight that the consequences of physical inactivity during the course of chronic obstructive pulmonary disease should not be neglected.
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Affiliation(s)
- Nele Cielen
- 1 Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, Catholic University (KU) of Leuven, Leuven, Belgium
| | - Karen Maes
- 1 Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, Catholic University (KU) of Leuven, Leuven, Belgium
| | - Nele Heulens
- 1 Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, Catholic University (KU) of Leuven, Leuven, Belgium
| | - Thierry Troosters
- 1 Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, Catholic University (KU) of Leuven, Leuven, Belgium.,2 Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; and
| | - Geert Carmeliet
- 3 Department of Clinical and Experimental Medicine, Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- 1 Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, Catholic University (KU) of Leuven, Leuven, Belgium
| | - Ghislaine N Gayan-Ramirez
- 1 Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, Catholic University (KU) of Leuven, Leuven, Belgium
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Grant RA, Cielen N, Maes K, Heulens N, Galli GL, Janssens W, Gayan-Ramirez G, Degens H. The effects of smoking on whisker movements: A quantitative measure of exploratory behaviour in rodents. Behav Processes 2016; 128:17-23. [DOI: 10.1016/j.beproc.2016.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 01/15/2023]
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Cielen N, Heulens N, Maes K, Carmeliet G, Mathieu C, Janssens W, Gayan-Ramirez G. Vitamin D deficiency impairs skeletal muscle function in a smoking mouse model. J Endocrinol 2016; 229:97-108. [PMID: 26906744 PMCID: PMC5064769 DOI: 10.1530/joe-15-0491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/23/2016] [Indexed: 12/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with skeletal muscle dysfunction. Vitamin D plays an important role in muscle strength and performance in healthy individuals. Vitamin D deficiency is highly prevalent in COPD, but its role in skeletal muscle dysfunction remains unclear. We examined the time-course effect of vitamin D deficiency on limb muscle function in mice with normal or deficient vitamin D serum levels exposed to air or cigarette smoke for 6, 12 or 18 weeks. The synergy of smoking and vitamin D deficiency increased lung inflammation and lung compliance from 6 weeks on with highest emphysema scores observed at 18 weeks. Smoking reduced body and muscle mass of the soleus and extensor digitorum longus (EDL), but did not affect contractility, despite type II atrophy. Vitamin D deficiency did not alter muscle mass but reduced muscle force over time, downregulated vitamin D receptor expression, and increased muscle lipid peroxidation but did not alter actin and myosin expression, fiber dimensions or twitch relaxation time. The combined effect of smoking and vitamin D deficiency did not further deteriorate muscle function but worsened soleus mass loss and EDL fiber atrophy at 18 weeks. We conclude that the synergy of smoking and vitamin D deficiency in contrast to its effect on lung disease, had different, independent but important noxious effects on skeletal muscles in a mouse model of mild COPD.
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Affiliation(s)
- Nele Cielen
- Laboratory of Respiratory DiseasesDepartment of Clinical and Experimental Medicine, KULeuven, Leuven, Belgium
| | - Nele Heulens
- Laboratory of Respiratory DiseasesDepartment of Clinical and Experimental Medicine, KULeuven, Leuven, Belgium
| | - Karen Maes
- Laboratory of Respiratory DiseasesDepartment of Clinical and Experimental Medicine, KULeuven, Leuven, Belgium
| | - Geert Carmeliet
- Laboratory of Clinical and Experimental EndocrinologyDepartment of Clinical and Experimental Medicine, KULeuven, Leuven, Belgium
| | - Chantal Mathieu
- Laboratory of Clinical and Experimental EndocrinologyDepartment of Clinical and Experimental Medicine, KULeuven, Leuven, Belgium
| | - Wim Janssens
- Laboratory of Respiratory DiseasesDepartment of Clinical and Experimental Medicine, KULeuven, Leuven, Belgium
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory DiseasesDepartment of Clinical and Experimental Medicine, KULeuven, Leuven, Belgium
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Heulens N, Korf H, Cielen N, De Smidt E, Maes K, Gysemans C, Verbeken E, Gayan-Ramirez G, Mathieu C, Janssens W. Vitamin D deficiency exacerbates COPD-like characteristics in the lungs of cigarette smoke-exposed mice. Respir Res 2015; 16:110. [PMID: 26376849 PMCID: PMC4574263 DOI: 10.1186/s12931-015-0271-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 05/19/2015] [Accepted: 08/30/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterized by excessive inflammation and disturbed bacterial clearance in the airways. Although cigarette smoke (CS) exposure poses a major risk, vitamin D deficiency could potentially contribute to COPD progression. Many in vitro studies demonstrate important anti-inflammatory and antibacterial effects of vitamin D, but a direct contribution of vitamin D deficiency to COPD onset and disease progression has not been explored. METHODS In the current study, we used a murine experimental model to investigate the combined effect of vitamin D deficiency and CS exposure on the development of COPD-like characteristics. Therefore, vitamin D deficient or control mice were exposed to CS or ambient air for a period of 6 (subacute) or 12 weeks (chronic). Besides lung function and structure measurements, we performed an in depth analysis of the size and composition of the cellular infiltrate in the airways and lung parenchyma and tested the ex vivo phagocytic and oxidative burst capacity of alveolar macrophages. RESULTS Vitamin D deficient mice exhibited an accelerated lung function decline following CS exposure compared to control mice. Furthermore, early signs of emphysema were only observed in CS-exposed vitamin D deficient mice, which was accompanied by elevated levels of MMP-12 in the lung. Vitamin D deficient mice showed exacerbated infiltration of inflammatory cells in the airways and lung parenchyma after both subacute and chronic CS exposure compared to control mice. Furthermore, elevated levels of typical proinflammatory cytokines and chemokines could be detected in the bronchoalveolar lavage fluid (KC and TNF-α) and lung tissue (IP-10, MCP-1, IL-12) of CS-exposed vitamin D deficient mice compared to control mice. Finally, although CS greatly impaired the ex vivo phagocytic and oxidative burst function of alveolar macrophages, vitamin D deficient mice did not feature an additional defect. CONCLUSIONS Our data demonstrate that vitamin D deficiency both accelerates and aggravates the development of characteristic disease features of COPD. As vitamin D deficiency is highly prevalent, large randomized trials exploring effects of vitamin D supplementation on lung function decline and COPD onset are needed.
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Affiliation(s)
- Nele Heulens
- Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Hannelie Korf
- Laboratory of Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Nele Cielen
- Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Elien De Smidt
- Laboratory of Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Karen Maes
- Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Conny Gysemans
- Laboratory of Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Erik Verbeken
- Translational Cell and Tissue Research, Department of Imaging and Pathology, Katholieke Universiteit Leuven, Minderbroederstraat 12, 3000, Leuven, Belgium.
| | - Ghislaine Gayan-Ramirez
- Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Chantal Mathieu
- Laboratory of Clinical and Experimental Endocrinology, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Wim Janssens
- Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium.
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10
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Dubois V, Laurent MR, Sinnesael M, Cielen N, Helsen C, Clinckemalie L, Spans L, Gayan-Ramirez G, Deldicque L, Hespel P, Carmeliet G, Vanderschueren D, Claessens F. A satellite cell-specific knockout of the androgen receptor reveals myostatin as a direct androgen target in skeletal muscle. FASEB J 2014; 28:2979-94. [PMID: 24671706 DOI: 10.1096/fj.14-249748] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Androgens have well-established anabolic actions on skeletal muscle, although the direct effects of the androgen receptor (AR) in muscle remain unclear. We generated satellite cell-specific AR-knockout (satARKO) mice in which the AR is selectively ablated in satellite cells, the muscle precursor cells. Total-limb maximal grip strength is decreased by 7% in satARKO mice, with soleus muscles containing ∼10% more type I fibers and 10% less type IIa fibers than the corresponding control littermates. The weight of the perineal levator ani muscle is markedly reduced (-52%). Thus, muscle AR is involved in fiber-type distribution and force production of the limb muscles, while it is a major determinant of the perineal muscle mass. Surprisingly, myostatin (Mstn), a strong inhibitor of skeletal muscle growth, is one of the most androgen-responsive genes (6-fold reduction in satARKO) through direct transcription activation by the AR. Consequently, muscle hypertrophy in response to androgens is augmented in Mstn-knockout mice. Our finding that androgens induce Mstn signaling to restrain their own anabolic actions has implications for the treatment of muscle wasting disorders.-Dubois, V., Laurent, M. R., Sinnesael, M., Cielen, N., Helsen, C., Clinckemalie, L., Spans, L., Gayan-Ramirez, G., Deldicque, L., Hespel, P., Carmeliet, G., Vanderschueren, D., and Claessens, F. A satellite cell-specific knockout of the androgen receptor reveals myostatin as a direct androgen target in skeletal muscle.
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Affiliation(s)
| | - Michaël R Laurent
- Molecular Endocrinology Laboratory, Division of Gerontology and Geriatrics
| | | | | | | | | | | | | | - Louise Deldicque
- Exercise Physiology Research Group, KU Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Peter Hespel
- Exercise Physiology Research Group, KU Leuven, Campus Gasthuisberg, Leuven, Belgium
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11
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Bruells CS, Maes K, Rossaint R, Thomas D, Cielen N, Bleilevens C, Bergs I, Loetscher U, Dreier A, Gayan-Ramirez G, Behnke BJ, Weis J. Prolonged mechanical ventilation alters the expression pattern of angio-neogenetic factors in a pre-clinical rat model. PLoS One 2013; 8:e70524. [PMID: 23950950 PMCID: PMC3738548 DOI: 10.1371/journal.pone.0070524] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 06/19/2013] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Mechanical ventilation (MV) is a life saving intervention for patients with respiratory failure. Even after 6 hours of MV, diaphragm atrophy and dysfunction (collectively referred to as ventilator-induced diaphragmatic dysfunction, VIDD) occurs in concert with a blunted blood flow and oxygen delivery. The regulation of hypoxia sensitive factors (i.e. hypoxia inducible factor 1α, 2α (HIF-1α,-2α), vascular endothelial growth factor (VEGF)) and angio-neogenetic factors (angiopoietin 1-3, Ang) might contribute to reactive and compensatory alterations in diaphragm muscle. METHODS Male Wistar rats (n = 8) were ventilated for 24 hours or directly sacrificed (n = 8), diaphragm and mixed gastrocnemius muscle tissue was removed. Quantitative real time PCR and western blot analyses were performed to detect changes in angio-neogenetic factors and inflammatory markers. Tissues were stained using Isolectin (IB 4) to determine capillarity and calculate the capillary/fiber ratio. RESULTS MV resulted in up-regulation of Ang 2 and HIF-1α mRNA in both diaphragm and gastrocnemius, while VEGF mRNA was down-regulated in both tissues. HIF-2α mRNA was reduced in both tissues, while GLUT 4 mRNA was increased in gastrocnemius and reduced in diaphragm samples. Protein levels of VEGF, HIF-1α, -2α and 4 did not change significantly. Additionally, inflammatory cytokine mRNA (Interleukin (IL)-6, IL-1β and TNF α) were elevated in diaphragm tissue. CONCLUSION The results demonstrate that 24 hrs of MV and the associated limb disuse induce an up-regulation of angio-neogenetic factors that are connected to HIF-1α. Changes in HIF-1α expression may be due to several interactions occurring during MV.
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Affiliation(s)
- Christian S Bruells
- Department of Anesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany.
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