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Chronic oral ascorbic acid therapy worsens skeletal muscle metabolism in patients with chronic heart failure.

BACKGROUND: Chronic heart failure (CHF) is associated with abnormalities of skeletal muscle metabolism. This may be due to impaired oxygen delivery as a result of endothelial dysfunction. AIMS: We postulated that ascorbic acid would improve oxygen delivery to exercising muscle and improve skeletal muscle metabolism. METHODS: We studied skeletal muscle metabolism using (31)P magnetic resonance spectroscopy in 39 CHF patients. Endothelial function was assessed by changes in pulse wave velocity. Subjects were randomised to receive 4 g ascorbic acid daily for 4 weeks in a placebo-controlled double-blind study. RESULTS: Ascorbic acid significantly increased phosphocreatine utilization during exercise. In addition, glycolytic ATP synthesis increased in the ascorbic acid group (change in rate of ATP synthesis at 1 min -0.21+/-0.76 with placebo, 2.06+/-0.60 following ascorbic acid; p<0.05). Phosphocreatine and ADP recovery after exercise were not changed. The fall in pulse wave velocity during reactive hyperaemia was increased by ascorbic acid from -6.3+/-2.6% to -12.1+/-2.0% (p<0.05). CONCLUSIONS: These findings suggest that ascorbic acid increased both phosphocreatine utilization and glycolytic ATP synthesis during exercise in patients with CHF implying worsened skeletal muscle metabolism despite improvements in endothelial function.

Adenosine Triphosphate↗

Changes in gait associated with acute stage II posterior tibial tendon dysfunction.

The purpose of this study was to examine differences in gait mechanics between patients with acute stage II PTTD and healthy volunteers. Hindfoot and midfoot kinematics, plantar foot pressures and electromyographic (EMG) activity of the posterior tibialis, gastrocnemius, anterior tibialis and the peroneals were measured in five patients with acute stage II PTTD. Kinematics and kinetics were compared to a database of 20 healthy volunteers. EMG and plantar pressure data were obtained from five healthy volunteers. Hindfoot moments and powers were also calculated. The center of pressure excursion index (CPEI) was calculated from the plantar pressures. Significant differences were observed between the two groups, which confirmed clinical observations. Limited hindfoot eversion and increased midfoot external rotation occurred during the first and third rockers. The EMG data suggested that tendon dysfunction in the posterior tibialis is associated with compensatory activity, not only in its antagonists (the peroneals), but also in the anterior tibialis and the gastrocnemius. These data suggest that non-operative treatment of patients with PTTD should consider minimizing the activity of the posterior tibialis as well as the peroneals, the anterior tibialis and the gastrocnemius.

Adult↗

Primary structure and muscle-specific expression of the 50-kDa dystrophin-associated glycoprotein (adhalin).

The 50-kDa dystrophin-associated glycoprotein (50-DAG) is a component of the dystrophin-glycoprotein complex, which links the muscle cytoskeleton to the extracellular matrix. 50-DAG is specifically deficient in skeletal muscle of patients with severe childhood autosomal recessive muscular dystrophy and in skeletal and cardiac muscles of BIO 14.6 cardiomyopathic hamsters. The lack of 50-DAG leads to a disruption and dysfunction of the dystrophin-glycoprotein complex in these diseases. The cDNA encoding 50-DAG has now been cloned from rabbit skeletal muscle. The 50-DAG deduced amino acid sequence predicts a novel protein having 387 amino acids, a 17-amino acid signal sequence, one transmembrane domain, and two potential sites of N-linked glycosylation. Affinity-purified antibodies against rabbit 50-DAG fusion proteins or synthetic peptides specifically recognized a 50-kDa protein in skeletal muscle sarcolemma and the 50-kDa component of the dystrophin-glycoprotein complex. In contrast to dystroglycan, which is expressed in a wide variety of muscle and non-muscle tissues, 50-DAG is expressed only in skeletal and cardiac muscles and in selected smooth muscles. Finally, 50-DAG mRNA is present in mdx and Duchenne muscular dystrophy (DMD) muscle, indicating that the down-regulation of this protein in DMD and the mdx mouse is likely a post-translational event.

Amino Acid Sequence↗

Adjustable model of chronic left ventricular dysfunction.

BACKGROUND: As an adjunct to the development of skeletal muscle-powered left ventricular assist devices, an adjustable model of chronic left ventricular failure was developed. METHODS: Implantation of a left ventricular balloon to induce heart failure was accomplished via left thoracotomy. Upon recovery, left ventricular failure was simulated by manipulation of left ventricular balloon volume to chronically raise left atrial pressure. RESULTS: Left atrial pressure increased from a baseline of 9.3 +/- 0.7 mm Hg to 18.5 +/- 1.2 mm Hg, 20.2 +/- 1.8 mm Hg, and 26.0 +/- 1.2 mm Hg by the 2nd, 6th, and 10th postoperative week, respectively. Cardiac index declined from a baseline of 4.4 +/- 0.3 L x min(-1) x m(-2), reaching stability by the 8th postoperative week at 3.0 +/- 0.4 L x min(-1) x m(-2). Stroke volume index declined from 1.12 +/- 0.1 mL x kg(-1) x beat(-1) to 0.60 +/- 0.1 mL x kg(-1) x beat(-1) by the 10th postoperative week. Mean survival was 75 +/- 7 days. Causes of death included left ventricular failure, thromboembolism, and euthanasia. CONCLUSIONS: This method of simulating chronic left ventricular dysfunction proved to be stable and adjustable and has been useful in the development of ventricular assist systems.

Animals↗

Injection of skeletal muscle-derived cells into the penis improves erectile function.

We investigated the effect of intrapenile injection of muscle-derived cells (MDC) on the erectile function in rats with bilateral cavernous nerve injury. Rat MDC were harvested and transduced with a retrovirus expressing the lacZ gene. Hanks' balanced salt solution (HBSS) (20 microl) or MDC (1 x 10(6) cells/side) were injected in each corpora cavernosa immediately before bilateral cavernous nerve transection. Intracavernous pressures (ICP) were measured 2 or 4 weeks after surgery with electrical stimulation of the pelvic nerves. Mean maximal ICP of sham group was significantly lower than that of control group both at 2 and 4 weeks after surgery. When MDC were injected into the penis, ICP improved over the sham-injected group at both 2 and 4 weeks after surgery. Percent area of PGP 9.5 staining was significantly greater in MDC-injected penis than in sham-injected at 2 and 4 weeks. Penile MDC injection can facilitate recovery of injured penile innervation and improve erectile function.

Animals↗

[Global muscle dysfunction and exacerbation of COPD: a cohort study].

BACKGROUND AND OBJECTIVE: The purpose of this study was to evaluate on a prospective fashion the effects of clinical relapses of chronic obstructive pulmonary disease (COPD) on both peripheral and respiratory skeletal muscle functions. PATIENTS AND METHOD: We included 49 patients (males, 63 [11] years) who were assigned to three cohorts: a) COPD patients who were hospitalized in a conventional ward because of a relapse of their disease; b) patients hospitalized in conventional wards because of another lung disease or a pulmonary nodule; and c) COPD patients whose disease was stabilized (outpatients). Sequential measurements were made by means of anthropometry, serum biochemistry and body bioimpedance (BIA). In COPD patients with a disease relapse, we assessed changes in the function of peripheral muscles [force (Fhand) and resistance (Tlimhand) of hands], inspiratory muscles (PImax) and respiratory muscles (PEmax). RESULTS: Patients were evaluated during a 6 [2] days period. Patients with a COPD relapse displayed a global and progressive functional muscle impairment, which was expressed as a decrease of PEmax (17 [12]%), F hand-D (6 [9]%), F hand-ND (7 [8]%), Tlim hand-D (28 [26]%) and Tlim hand-ND (23 [16]%). These changes showed a linear trend. BIA exhibited a loss of lean mass (7 [6]%, p < 0.05) which would have been unnoticeable if only the body weight was quantified. Pneumonia cases showed similar changes in BIA. On the other hand, the cohort of patients with stable COPD did not have changes in both muscle function and BIA. CONCLUSIONS: COPD exacerbation is associated with an acute and global impairment of the function of respiratory and peripheral skeletal muscles. It is possible that these changes are related to an acute loss of muscular mass (proteolysis). This muscle dysfunction is not detected if only the inspiratory muscular function is evaluated--possibly because of the coexistence of transitory mechanic factors.

Aged↗

Site-dependent pathological differences in smooth muscles and skeletal muscles of the adult mdx mouse.

This study presents a survey of the morphometric characteristics, the regeneration rate, and the extent of muscle dystrophy in several smooth and skeletal muscles from adult mdx mice, an animal model of the Duchenne muscular dystrophy (DMD). Smooth muscles from adult mdx mice showed neither cell necrosis nor fibrosis. As compared to control C57 mice, the thickness of the mdx smooth muscle was normal in the vascular and urogenital layers but significantly reduced in the digestive layers, a finding relevant to clinical reports of gastrointestinal dilatation in DMD patients, and suggesting that gastrointestinal dysfunctions should be systemically searched for in DMD patients. Adult mdx skeletal muscles, however, presented different patterns of muscle suffering: either absent (esophagus); very mild (trunk and limb muscles); or severe (diaphragm). In these three conditions we studied the fiber diameters, the nuclei locations, and the regeneration rate. From this comparative study, it seems that severe dystrophy occurs in muscle tissues showing large fiber diameter and peripheral location of the nuclei. We showed that this combination occurs in the mouse diaphragm which is thus a realistic model for human DMD muscles.

Animals↗

[Two cases of polymyositis with cardiac involvement].

Cardiac involvement in polymyositis is more prevalent than previously assumed. A 59-year-old and a 58-year-old man presented with cardiac involvement preceding skeletal muscular lesions, admitted because of increased levels of muscle-derived enzymes and left ventricular dysfunction with ECG abnormalities. Coronary angiography revealed no stenotic lesions. Right ventricular endomyocardial biopsy disclosed myocarditis. Left ventriculography showed local asynergy of cardiac wall motion. After admission the weakness and atrophy of skeletal muscles progressed gradually and high levels of muscle-derived enzymes persisted. Electromyography and skeletal muscle biopsy confirmed the clinical diagnosis of polymyositis. Both patients were diagnosed as having polymyositis with cardiac involvement, and treatment with steroids was started. Symptoms improved significantly, and the CK enzyme level was reduced effectively. The condition of one patient was well controlled, but the other suffered from repeated heart failure due to severe left ventricular dysfunction. The clinical spectrum of polymyositis is wide and variable. Further studies are needed to evaluate the detection, management, and prognosis of the disease as well as the pathogenesis and to prevent progression of cardiac involvement.

Electrocardiography↗

MR morphometry of posterior tibialis muscle in adult acquired flat foot.

We conducted magnetic resonance imaging of the posterior tibial (PT) and flexor digitorum longus (FDL) muscle bellies in 12 patients undergoing surgical treatment for unilateral posterior tibial tendon (PTT) dysfunction. All patients had atrophy of the PT muscle compared to the normal leg (mean 10.7%, p = 0.008). In those patients with a complete rupture of PTT there was replacement of the PT muscle by fatty infiltration. Conversely, the FDL muscle showed a compensatory hypertrophy (mean 17.2%, p < 0.002). We support the use of FDL as an appropriate tendon for augmentation of PTT in stage II disease. This study also demonstrates that in the presence of a complete rupture, excision of the PTT is a reasonable surgical procedure and pure tenodesis will be more likely to fail because the PT muscle belly undergoes fatty infiltration. In patients with a diseased but intact PTT there was no fatty infiltration and the muscle volume was at least 83% of the normal side in all cases. We therefore suggest that in the presence of an intact PTT the PT muscle belly may provide some useful function if used to augment the FDL transfer when the diseased tendon is excised.

Adult↗

A mutation in serca underlies motility dysfunction in accordion zebrafish.

Zebrafish acquire the ability for fast swimming early in development. The motility mutant accordion (acc) undergoes exaggerated and prolonged contractions on both sides of the body, interfering with the acquisition of patterned swimming responses. Our whole cell recordings from muscle indicate that the defect is not manifested in neuromuscular transmission. However, imaging of skeletal muscle of larval acc reveals greatly prolonged calcium transients and associated contractions in response to depolarization. Positional cloning of acc identified a serca mutation as the cause of the acc phenotype. SERCA is a sarcoplasmic reticulum transmembrane protein in skeletal muscle that mediates calcium re-uptake from the myoplasm. The mutation in SERCA, a serine to phenylalanine substitution, is likely to result in compromised protein function that accounts for the observed phenotype. Indeed, direct evidence that mutant SERCA causes the motility dysfunction was provided by the finding that wild type fish injected with an antisense morpholino directed against serca, exhibited accordion-like contractions and impaired swimming. We conclude that the motility dysfunction in embryonic and larval accordion zebrafish stems directly from defective calcium transport in skeletal muscle rather than defective CNS drive.

Amino Acid Sequence↗

Gene transfer of parvalbumin improves diastolic dysfunction in senescent myocytes.

BACKGROUND: Impaired relaxation is a cardinal feature of senescent myocardial dysfunction. Recently, adenoviral gene transfer of parvalbumin, a small calcium-buffering protein found exclusively in skeletal muscle and neurons, has been shown to improve cardiomyocyte relaxation in disease models of diastolic dysfunction. The goal of this study was to investigate whether parvalbumin gene transfer could reverse diastolic dysfunction in senescent cardiomyocytes. METHODS AND RESULTS: Myocytes were isolated from senescent (26 months) and adult (6 months) F344/BN hybrid rats and were infected with Ad.Parv.GFP (where GFP is green fluorescent protein) or Ad.betagal.GFP at a multiplicity of infection of 250 for 48 hours. Uninfected senescent and adult myocytes served as controls. After stimulation at a frequency of 0.5 Hz, intracellular calcium transients and myocyte contractility were measured using dual excitation spectrofluorometry and video-edge detection system (Ionoptix). Parvalbumin significantly improved relaxation parameters in senescent myocytes: Both the rate of calcium transient decay and the rate of myocyte relengthening were dramatically increased in senescent cardiac myocytes transduced with parvalbumin compared with nontransduced and GFP-expressing controls, with no effect on myocyte shortening. CONCLUSIONS: Parvalbumin expression corrects impaired relaxation in aging myocytes. Given that abnormalities of myocyte relaxation underlie diastolic dysfunction in a large proportion of elderly patients with heart failure, gene transfer of parvalbumin may thus be a novel approach to target diastolic dysfunction in senescent myocardium.

Adenoviridae↗

Effect of carnitine feeding on the levels of heart and skeletal muscle carnitine of elderly mice.

Aging has been associated with an increase in muscle dysfunction and weakness. We found a decrease in muscle carnitine with age [Biochem. Biophys. Res. Commun., 161 (1989) 1135-1143]. Prolonged oral administration to both young (2-month-old) and adult (7-month-old) mice with L-carnitine increased its content in blood by 50%. The levels of carnitine in skeletal and heart muscle of old treated animals became higher than in untreated mice of the same age. However, this extensive restoration did not reach the maximum values present in skeletal muscle of young mice. Our findings indicate that an alteration of the carnitine carrier in the sarcolemma could be responsible for the decrease with age of carnitine in skeletal but not in heart muscle.

Administration, Oral↗

Hypothesis of human penile anatomy, erection hemodynamics and their clinical applications.

AIM: To summarize recent advances in human penile anatomy, hemodynamics and their clinical applications. METHODS: Using dissecting, light, scanning and transmission electron microscopy the fibroskeleton structure, penile venous vasculature, the relationship of the architecture between the skeletal and smooth muscles, and erection hemodynamics were studied on human cadaveric penises and clinical patients over a period of 10 years. RESULTS: The tunica albuginea of the corpora cavernosa is a bi-layered structure with inner circular and outer longitudinal collagen bundles. Although there is no bone in the human glans, a strong equivalent distal ligament acts as a trunk of the glans penis. A guaranteed method of local anesthesia for penile surgeries and a tunical surgery was developed accordingly. On the venous vasculature it is elucidated that a deep dorsal vein, a couple of cavernosal veins and two pairs of para-arterial veins are located between the Buck's fascia and the tunica albuginea. Furthermore, a hemodynamic study suggests that a fully rigid erection may depend upon the drainage veins as well, rather than just the intracavernosal smooth muscle. It is believed that penile venous surgery deserves another look, and that it may be meaningful if thoroughly and carefully performed. Accordingly, a penile venous surgery was developed. CONCLUSION: Using this new insight into penile anatomy and physiology, exact penile curvature correction, refined penile implants and promising penile venous surgery, as well as a venous patch, for treating Peyronie's deformity might be performed under pure local anesthesia on an outpatient basis.

Erectile Dysfunction↗

Y chromosome detection of three-dimensional tissue-engineered skeletal muscle constructs in a syngeneic rat animal model.

Surgical reconstruction of muscle tissue lost by trauma or tumor ablation is limited by the lack of availability of functional native tissue substitution. Moreover, so far most inherited or acquired muscle diseases are lacking sufficient treatment, because only few alternatives exist to provide functional restoration of lost muscle tissues. Engineering those tissues and transplantation into sites of dysfunction may be an alternative approach and may allow replacement of such damaged or failing skeletal muscle tissues. Techniques attempting reconstruction of some human tissues and organs (tissue engineering) have been introduced into clinical practice recently. One major problem that previous transplantation studies were facing is the ability of detection of transplanted cells after integration. Using the Y chromosome in situ hybridization technique in a syngeneic rat model allows transplantation of cell constructs orthotopically, without manipulation of the cells, with no rejection or immunosuppression being implied, but providing a nondilutable genetic marker to identify transplanted cells. The purpose of our study was to create functional skeletal muscle tissue in vivo using the transplantation of primary myoblasts precultivated within a three-dimensional (3D) fibrin matrix and to determine the fate of the transplanted cells using the Y chromosome detection technique. 3D myoblast cultures were established derived from male donor rats and after 7 days of cultivation we performed an orthotopic transplantation of 3D cell constructs into a created muscle defect within the gracilis muscle of syngeneic female rats. Anti-desmin immunostaining and Y chromosome in situ hybridization indicated the survival and integration of transplanted male myoblasts into the female recipient animal, thus demonstrating the feasibility of this approach in tissue engineering and the research of cell transplantation in general.

Animals↗

Pharmacotherapy of respiratory muscles.

This article assesses the role of pharmacotherapy in the management of respiratory muscle dysfunction. It focuses on two classes of drugs, the methylxanthines and the sympathomimetic agents. A prospective section focuses also on the particularities of the diaphragm among the skeletal striated muscles. In addition, a new approach to respiratory pharmacotherapy, which may be beneficial in patients with respiratory muscle dysfunction, is suggested.

Animals↗

Ryanodine receptor channelopathies.

Ryanodine receptors (RyR) are the Ca2+ release channels of sarcoplasmic reticulum that provide the majority of the [Ca2+] necessary to induce contraction of cardiac and skeletal muscle cells. In their cellular environment, RyRs are exquisitely regulated by a variety of cytosolic factors and accessory proteins so that their output signal (Ca2+) induces cell contraction without igniting signaling pathways that eventually lead to contractile dysfunction or pathological cellular remodeling. Here we review how dysfunction of RyRs, most commonly expressed as enhanced Ca2+ release at rest (skeletal muscle) or during diastole (cardiac muscle), appears to be the fundamental mechanism underlying several genetic or acquired syndromes. In skeletal muscle, malignant hyperthermia and central core disease result from point mutations in RYR1, the skeletal isoform of RyRs. In cardiac muscle, RYR2 mutations lead to catecholaminergic polymorphic ventricular tachycardia and other cardiac arrhythmias. Lastly, an altered phosphorylation of the RyR2 protein may be involved in some forms of congestive heart failure.

Calcium↗

Heat stroke. Report of three fatal cases with emphasis on findings in skeletal muscle.

Three fatal cases of heat stroke were encountered in the central New York area over a two-month period. Although in each instance one or more predisposing factors were identified, exertion clearly played a role in its development in only one case. In addition to laboratory and postmortem findings indicative of dysfunction of many organ systems, there was morphological evidence of widespread damage to skeletal muscle.

Adult↗

Comparison of the effects of endotoxin on limb, respiratory, and cardiac muscles.

Recent work has shown that endotoxin administration produces reductions in respiratory muscle contractility and an increase in indexes of free radical-mediated lipid peroxidation within these muscles. It is not known, however, whether endotoxin-induced lipid peroxidation occurs only in the respiratory muscles or is a widespread phenomenon affecting all striated muscles. We therefore examined the effects of administration of a range of doses of endotoxin on the isometric force-generating ability and lipid peroxidation of three muscles: the diaphragm (Dia), a leg muscle [i.e., the flexor halluces longus (FHL)], and papillary cardiac muscle (Card). Studies were performed on hamsters divided into groups injected over 2 days with either saline or low, medium, or high doses of endotoxin. The animals were killed on the third study day, force generation by the three muscles was examined in vitro, and the muscles were assayed for 8-isoprostane, an index of lipid peroxidation. We found that endotoxin produced significant reductions in both FHL and Dia force generation, but Card force generation was unaffected. Changes in 8-isoprostane largely paralleled alterations in force, with endotoxin eliciting marked increases in Dia and FHL 8-isoprostane levels but no change in Card 8-isoprostane. These findings suggest that 1) lipid peroxidation and muscle dysfunction in response to endotoxin administration are not limited to the respiratory muscles but also occur in limb skeletal muscle and 2) cardiac muscle appear to be resistant to this particular mechanism of endotoxin-induced dysfunction.

Animals↗