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Background: Critical illness myopathy (CIM) is a consequence of modern critical care resulting in general muscle wasting and paralyses of all limb and trunk muscles, resulting in prolonged weaning from the ventilator, intensive care unit (ICU) treatment and rehabilitation. CIM is associated with severe morbidity/mortality and significant negative socioeconomic consequences, which has become increasingly evident during the current COVID-19 pandemic, but underlying mechanisms remain elusive. Methods: Ten neuro-ICU patients exposed to long-term controlled mechanical ventilation were followed with repeated muscle biopsies, electrophysiology and plasma collection three times per week for up to 12 days. Single muscle fibre contractile recordings were conducted on the first and final biopsy, and a multiomics approach was taken to analyse gene and protein expression in muscle and plasma at all collection time points. Results: (i) A progressive preferential myosin loss, the hallmark of CIM, was observed in all neuro-ICU patients during the observation period (myosin:actin ratio decreased from 2.0 in the first to 0.9 in the final biopsy, P < 0.001). The myosin loss was coupled to a general transcriptional downregulation of myofibrillar proteins (P < 0.05; absolute fold change >2) and activation of protein degradation pathways (false discovery rate [FDR] <0.1), resulting in significant muscle fibre atrophy and loss in force generation capacity, which declined >65% during the 12 day observation period (muscle fibre cross-sectional area [CSA] and maximum single muscle fibre force normalized to CSA [specific force] declined 30% [P < 0.007] and 50% [P < 0.0001], respectively). (ii) Membrane excitability was not affected as indicated by the maintained compound muscle action potential amplitude upon supramaximal stimulation of upper and lower extremity motor nerves. (iii) Analyses of plasma revealed early activation of inflammatory and proinflammatory pathways (

Ventilation-induced diaphragm dysfunction (VIDD) is a marked decline in diaphragm function in response to mechanical ventilation, which has negative consequences for individual patients' quality of life and for the health care system, but specific treatment strategies are still lacking. We used an experimental intensive care unit (ICU) model, allowing time-resolved studies of diaphragm structure and function in response to long-term mechanical ventilation and the effects of a pharmacological intervention (the chaperone co-inducer BGP-15). The marked loss of diaphragm muscle fiber function in response to mechanical ventilation was caused by post-translational modifications (PTMs) of myosin. In a rat model, 10 days of BGP-15 treatment greatly improved diaphragm muscle fiber function (by about 100%), although it did not reverse diaphragm atrophy. The treatment also provided protection from myosin PTMs associated with HSP72 induction and PARP-1 inhibition, resulting in improvement of mitochondrial function and content. Thus, BGP-15 may offer an intervention strategy for reducing VIDD in mechanically ventilated ICU patients.

Controlled mechanical ventilation (CMV) plays a key role in triggering the impaired diaphragm muscle function and the concomitant delayed weaning from the respirator in critically ill intensive care unit (ICU) patients. To date, experimental and clinical studies have primarily focused on early effects on the diaphragm by CMV, or at specific time points. To improve our understanding of the mechanisms underlying the impaired diaphragm muscle function in response to mechanical ventilation, we have performed time‐resolved analyses between 6 h and 14 days using an experimental rat ICU model allowing detailed studies of the diaphragm in response to long‐term CMV. A rapid and early decline in maximum muscle fibre force and preceding muscle fibre atrophy was observed in the diaphragm in response to CMV, resulting in an 85% reduction in residual diaphragm fibre function after 9–14 days of CMV. A modest loss of contractile proteins was observed and linked to an early activation of the ubiquitin proteasome pathway, myosin:actin ratios were not affected and the transcriptional regulation of myosin isoforms did not show any dramatic changes during the observation period. Furthermore, small angle X‐ray diffraction analyses demonstrate that myosin can bind to actin in an ATP‐dependent manner even after 9–14 days of exposure to CMV. Thus, quantitative changes in muscle fibre size and contractile proteins are not the dominating factors underlying the dramatic decline in diaphragm muscle function in response to CMV, in contrast to earlier observations in limb muscles. The observed early loss of subsarcolemmal neuronal nitric oxide synthase activity, onset of oxidative stress, intracellular lipid accumulation and post‐translational protein modifications strongly argue for significant qualitative changes in contractile proteins causing the severely impaired residual function in diaphragm fibres after long‐term mechanical ventilation. For the first time, the present study demonstrates n

Ageing is associated with a decline in muscle mass and strength leading to increased physical dependency in old age. Postmenopausal women experience a greater decline than men of similar age in parallel with the decrease in female sex steroid hormone production. We recruited six monozygous female twin pairs (5559 years old) where only one twin pair was on hormone replacement therapy (HRT use = 7.8 +/- 4.3 years) to investigate the association of HRT with the cytoplasmic volume supported by individual myonuclei (myonuclear domain (MND) size,) together with specific force at the single fibre level. HRT use was associated with a significantly smaller (approximate to 27%; P < 0.05) mean MND size in muscle fibres expressing the type I but not the IIa myosin heavy chain (MyHC) isoform. In comparison to non-users, higher specific force was recorded in HRT users both in muscle fibres expressing type I (approximate to 27%; P < 0.05) and type IIa (approximate to 23%; P < 0.05) MyHC isoforms. These differences were fibre-type dependent, i.e. the higher specific force in fast-twitch muscle fibres was primarily caused by higher force per cross-bridge while slow-twitch fibres relied on both a higher number and force per cross-bridge. HRT use had no effect on fibre cross-sectional area (CSA), velocity of unloaded shortening (V0) and relative proportion of MyHC isoforms. In conclusion, HRT appears to have significant positive effects on both regulation of muscle contraction and myonuclei organization in postmenopausal women.

OBJECTIVE: Muscle weakness contributes to prolonged rehabilitation and adverse outcome of critically ill patients. Distinction between a neurogenic and/or myogenic underlying problem is difficult using routine diagnostic tools. Preferential loss of myosin has been suggested to point to a myogenic component. We evaluated markers of muscle atrophy and denervation, and the myosin/actin ratio in limb and abdominal wall skeletal muscle, of prolonged critically ill patients and matched controls in relation to insulin therapy and known risk factors for intensive care unit-acquired weakness. DESIGN: Secondary analysis of two large, prospective, single-center randomized clinical studies. SETTING: University hospital surgical and medical intensive care unit. PATIENTS: Critically ill patients and matched controls. INTERVENTIONS: Intensive care unit patients had been randomized to blood glucose control to 80-110 mg/dL with insulin infusion or conventional glucose management, where insulin was only administered when glucose levels rose above 215 mg/dL. MEASUREMENTS AND MAIN RESULTS: As compared with controls, rectus abdominis and vastus lateralis muscle of critically ill patients showed smaller myofiber size, decreased mRNA levels for myofibrillar proteins, increased proteolytic enzyme activities, and a lower myosin/actin ratio, virtually irrespective of insulin therapy. Increased forkhead box protein O1 action may have played a role. Most alterations were more severe in patients treated with corticosteroids. Duration of corticosteroid treatment, independent of duration of intensive care unit stay or other risk factors, was a dominant risk factor for a low myosin/actin ratio. The immature acetylcholine receptor subunit γ mRNA expression was elevated in vastus lateralis, independent of the myosin/actin ratio. CONCLUSIONS: Both limb and abdominal wall skeletal muscles of prolonged critically ill patients showed downregulation of protein synthesis at the gene expression level as we

The muscle wasting and impaired muscle function in critically ill intensive care unit (ICU) patients delay recovery from the primary disease, and have debilitating consequences that can persist for years after hospital discharge. It is likely that, in addition to pernicious effects of the primary disease, the basic life support procedures of long-term ICU treatment contribute directly to the progressive impairment of muscle function. This study aims at improving our understanding of the mechanisms underlying muscle wasting in ICU patients by using a unique experimental rat ICU model where animals are mechanically ventilated, sedated and pharmacologically paralysed for duration varying between 6 h and 14 days. Results show that the ICU intervention induces a phenotype resembling the severe muscle wasting and paralysis associated with the acute quadriplegic myopathy (AQM) observed in ICU patients, i.e. a preferential loss of myosin, transcriptional down-regulation of myosin synthesis, muscle atrophy and a dramatic decrease in muscle fibre force generation capacity. Detailed analyses of protein degradation pathways show that the ubiquitin proteasome pathway is highly involved in this process. A sequential change in localisation of muscle-specific RING finger proteins 1/2 (MuRF1/2) observed during the experimental period is suggested to play an instrumental role in both transcriptional regulation and protein degradation. We propose that, for those critically ill patients who develop AQM, complete mechanical silencing, due to pharmacological paralysis or sedation, is a critical factor underlying the preferential loss of the molecular motor protein myosin that leads to impaired muscle function or persisting paralysis.

The dramatic muscle wasting, preferential loss of myosin and impaired muscle function in intensive care unit (ICU) patients with acute quadriplegic myopathy (AQM) have traditionally been suggested to be the result of proteolysis via specific proteolytic pathways. In this study we aim to investigate the mechanisms underlying the preferential loss of thick vs. thin filament proteins and the reassembly of the sarcomere during the recovery process in muscle samples from ICU patients with AQM. Quantitative and qualitative analyses of myofibrillar protein and mRNA expression were analyzed using SDS-PAGE, confocal microscopy, histochemistry and real-time PCR. The present results demonstrate that the transcriptional regulation of myofibrillar protein synthesis plays an important role in the loss of contractile proteins, as well as the recovery of protein levels during clinical improvement, myosin in particular, presumably in concert with proteolytic pathways, but the mechanisms are specific to the different thick and thin filament proteins studied.

Background: Cerebral palsy (CP) is an upper motor neuron disease that results in a progressive movement disorder. Secondary to the neurological insult, muscles from CP patients often become spastic. Spastic muscle is characterized by an increased resistance to stretch, but often develops the further complication of contracture which represents a prominent disability in children with CP. This study's purpose is to characterize alterations of spastic muscle on the transcriptional level. Increased knowledge of spastic muscle may lead to novel therapies to improve the quality of life for children with CP. Method: The transcriptional profile of spastic muscles were defined in children with cerebral palsy and compared to control patients using Affymetrix U133A chips. Expression data were verified using quantitative-PCR (QPCR) and validated with SDS-PAGE for select genes. Significant genes were determined using a 2 x 2 ANOVA and results required congruence between 3 preprocessing algorithms. Results: CP patients clustered independently and 205 genes were significantly altered, covering a range of cellular processes. Placing gene expression in the context of physiological pathways, the results demonstrated that spastic muscle in CP adapts transcriptionally by altering extracellular matrix, fiber type, and myogenic potential. Extracellular matrix adaptations occur primarily in the basal lamina although there is increase in fibrillar collagen components. Fiber type is predominately fast compared to normal muscle as evidenced by contractile gene isoforms and decrease in oxidative metabolic gene transcription, despite a paradoxical increased transcription of slow fiber pathway genes. We also found competing pathways of fiber hypertrophy with an increase in the anabolic IGF1 gene in parallel with a paradoxical increase in myostatin, a gene responsible for stopping muscle growth. We found evidence that excitation-contraction coupling genes are altered in muscles from patients wit

Ageing is associated with a decline in muscle mass and strength leading to increased physical dependency in old age. Post-menopausal women experience a greater decline than men of similar age due to a dramatic decrease in sex hormones production. We recruited six monozygous female twin pairs (55 – 59 years old) discordant for postmenopausal hormone replacement therapy (HRT use = 7.8 ± 4.3 years) to investigate the association of HRT with the cytoplasmic domain supported by individual myonuclei (myonuclear domain size, MND) together with specific force at the single fiber level. MyHC isoform content of the fibers was determined using silver-stained SDS-PAGE. HRT use was associated with a significantly smaller (~27%; p < 0.05) mean MND size in muscle fibers expressing the type I but not the IIa MyHC isoform. An increase in specific force was recorded in the HRT user group both in muscle fibers expressing type I (~27%; p < 0.05) and type IIa (~23%; p < 0.05) MyHC isoforms. These positive effects on specific force were fiber-type dependent, i.e., in fast-twitch muscle fibers the increased specific force was primarily caused by an increased force per cross-bridge while slow-twitch fibers relied on both an increase in both number and force per cross-bridge. HRT use had no effect on fiber cross-sectional area (CSA), velocity of unloaded shortening (V0) and relative proportion of MyHC isoforms. In conclusion, HRT has significant positive effects on both regulation of muscle contraction and myonuclei organization in menopausal women, but the response is fiber-type specific.

Ageing is associated with a decline in muscle mass and strength leading to increased physical dependency in old age. Post-menopausal women experience a greater decline than men of similar age due to a dramatic decrease in sex hormones production. We recruited six monozygous female twin pairs (55 – 59 years old) discordant for postmenopausal hormone replacement therapy (HRT use = 7.8 ± 4.3 years) to investigate the association of HRT with the cytoplasmic domain supported by individual myonuclei (myonuclear domain size, MND) together with specific force at the single fiber level. MyHC isoform content of the fibers was determined using silver-stained SDS-PAGE. HRT use was associated with a significantly smaller (~27%; p < 0.05) mean MND size in muscle fibers expressing the type I but not the IIa MyHC isoform. An increase in specific force was recorded in the HRT user group both in muscle fibers expressing type I (~27%; p < 0.05) and type IIa (~23%; p < 0.05) MyHC isoforms. These positive effects on specific force were fiber-type dependent, i.e., in fast-twitch muscle fibers the increased specific force was primarily caused by an increased force per cross-bridge while slow-twitch fibers relied on both an increase in both number and force per cross-bridge. HRT use had no effect on fiber cross-sectional area (CSA), velocity of unloaded shortening (V0) and relative proportion of MyHC isoforms. In conclusion, HRT has significant positive effects on both regulation of muscle contraction and myonuclei organization in menopausal women, but the response is fiber-type specific.

Ageing is associated with a decline in muscle mass and strength leading to increased physical dependency in old age. Post-menopausal women experience a greater decline than men of similar age due to a dramatic decrease in sex hormones production. We recruited six monozygous female twin pairs (55 – 59 years old) discordant for postmenopausal hormone replacement therapy (HRT use = 7.8 ± 4.3 years) to investigate the association of HRT with the cytoplasmic domain supported by individual myonuclei (myonuclear domain size, MND) together with specific force at the single fiber level. MyHC isoform content of the fibers was determined using silver-stained SDS-PAGE. HRT use was associated with a significantly smaller (~27%; p < 0.05) mean MND size in muscle fibers expressing the type I but not the IIa MyHC isoform. An increase in specific force was recorded in the HRT user group both in muscle fibers expressing type I (~27%; p < 0.05) and type IIa (~23%; p < 0.05) MyHC isoforms. These positive effects on specific force were fiber-type dependent, i.e., in fast-twitch muscle fibers the increased specific force was primarily caused by an increased force per cross-bridge while slow-twitch fibers relied on both an increase in both number and force per cross-bridge. HRT use had no effect on fiber cross-sectional area (CSA), velocity of unloaded shortening (V0) and relative proportion of MyHC isoforms. In conclusion, HRT has significant positive effects on both regulation of muscle contraction and myonuclei organization in menopausal women, but the response is fiber-type specific.

Ageing is associated with a decline in muscle mass and strength leading to increased physical dependency in old age. Post-menopausal women experience a greater decline than men of similar age due to a dramatic decrease in sex hormones production. We recruited six monozygous female twin pairs (55 – 59 years old) discordant for postmenopausal hormone replacement therapy (HRT use = 7.8 ± 4.3 years) to investigate the association of HRT with the cytoplasmic domain supported by individual myonuclei (myonuclear domain size, MND) together with specific force at the single fiber level. MyHC isoform content of the fibers was determined using silver-stained SDS-PAGE. HRT use was associated with a significantly smaller (~27%; p < 0.05) mean MND size in muscle fibers expressing the type I but not the IIa MyHC isoform. An increase in specific force was recorded in the HRT user group both in muscle fibers expressing type I (~27%; p < 0.05) and type IIa (~23%; p < 0.05) MyHC isoforms. These positive effects on specific force were fiber-type dependent, i.e., in fast-twitch muscle fibers the increased specific force was primarily caused by an increased force per cross-bridge while slow-twitch fibers relied on both an increase in both number and force per cross-bridge. HRT use had no effect on fiber cross-sectional area (CSA), velocity of unloaded shortening (V0) and relative proportion of MyHC isoforms. In conclusion, HRT has significant positive effects on both regulation of muscle contraction and myonuclei organization in menopausal women, but the response is fiber-type specific.

Ageing is associated with a decline in muscle mass and strength leading to increased physical dependency in old age. Post-menopausal women experience a greater decline than men of similar age due to a dramatic decrease in sex hormones production. We recruited six monozygous female twin pairs (55 – 59 years old) discordant for postmenopausal hormone replacement therapy (HRT use = 7.8 ± 4.3 years) to investigate the association of HRT with the cytoplasmic domain supported by individual myonuclei (myonuclear domain size, MND) together with specific force at the single fiber level. MyHC isoform content of the fibers was determined using silver-stained SDS-PAGE. HRT use was associated with a significantly smaller (~27%; p < 0.05) mean MND size in muscle fibers expressing the type I but not the IIa MyHC isoform. An increase in specific force was recorded in the HRT user group both in muscle fibers expressing type I (~27%; p < 0.05) and type IIa (~23%; p < 0.05) MyHC isoforms. These positive effects on specific force were fiber-type dependent, i.e., in fast-twitch muscle fibers the increased specific force was primarily caused by an increased force per cross-bridge while slow-twitch fibers relied on both an increase in both number and force per cross-bridge. HRT use had no effect on fiber cross-sectional area (CSA), velocity of unloaded shortening (V0) and relative proportion of MyHC isoforms. In conclusion, HRT has significant positive effects on both regulation of muscle contraction and myonuclei organization in menopausal women, but the response is fiber-type specific.