Assessment of measurement properties of peak VO2 in children with pulmonary arterial hypertension

ABSTRACT: BACKGROUND: The 6-minute walk test evaluates the effect of pharmacologic intervention in adults with pulmonary arterial hypertension (PAH) but, for reasons of compliance or reliability, may not be appropriate for children at all ages. Thus, peak oxygen consumption (VO2, maximal exercise test) was used instead in a pediatric PAH trial (STARTS-1) to evaluate pharmacologic intervention with sildenafil. This was the first large placebo-controlled trial to use the peak VO2 endpoint in this population. Our working hypothesis was that, as with other populations, percentage changes in peak VO2 in pediatric patients with PAH are reliable and are associated with changes in other clinical endpoints. METHODS: Using data from the subpopulation of 106 patients who were developmentally and physically able to perform exercise testing, all of whom were World Health Organization Functional Class (WHO FC) I, II, or III, reliability was assessed using the intraclass correlation coefficient and Bland-Altman plot on screening and baseline data. Relationships between percentage change in peak VO2 from baseline to end of treatment and other endpoints were evaluated using correlation coefficients and regression analyses. RESULTS: The intraclass correlation was 0.79 between screening and baseline peak VO2, an agreement that was supported by the Bland-Altman plot. Percentage change in peak VO2 correlated well (r [greater than or equal to]0.40) and showed responsiveness to a physician global assessment of change and with change in WHO FC (for baseline classes I and III). Percentage change in peak VO2 did not correlate with change in the Family Cohesion of the Child Health Questionnaire (r = 0.04) or with a subject global assessment of change (r = 0.12). The latter may have been influenced by child and parental-proxy response and instrument administration. CONCLUSION: In pediatric PAH patients who are developmentally and physically able to perform exercise testing, peak VO2 measurements exhibited good reliability and improvements that were associated with improvements in certain other clinical endpoints, such as the WHO FC and a physician global assessment. Trial registration ClinicalTrials.gov identifier NCT00159913.     

CCAAT-enhancer-binding protein-beta expression in vivo is associated with muscle strength

Declining muscle strength is a core feature of aging. Several mechanisms have been postulated, including CCAAT/enhancer-binding protein-beta (C/EBP-β)-triggered macrophage-mediated muscle fiber regeneration after micro-injury, evidenced in a mouse model. We aimed to identify in vivo circulating leukocyte gene expression changes associated with muscle strength in the human adult population. We undertook a genome-wide expression microarray screen, using peripheral blood RNA samples from InCHIANTI study participants (aged 30 and 104). Logged expression intensities were regressed with muscle strength using models adjusted for multiple confounders. Key results were validated by real-time PCR. The Short Physical Performance Battery (SPPB) score tested walk speed, chair stand, and balance. CEBPB expression levels were associated with muscle strength (β coefficient = 0.20560, P = 1.03*10(-6), false discovery rate q = 0.014). The estimated handgrip strength in 70-year-old men in the lowest CEBPB expression tertile was 35.2 kg compared with 41.2 kg in the top tertile. CEBPB expression was also associated with hip, knee, ankle, and shoulder strength and the SPPB score (P = 0.018). Near-study-wide associations were also noted for TGF-β3 (P = 3.4*10(-5) , q = 0.12) and CEBPD expression (P = 9.7*10(-5) , q = 0.18) but not for CEBPA expression. We report here a novel finding that raised CEBPB expression in circulating leukocyte-derived RNA samples in vivo is associated with greater muscle strength and better physical performance in humans. This association may be consistent with mouse model evidence of CEBPB-triggered muscle repair: if this mechanism is confirmed, it may provide a target for intervention to protect and enhance aging muscle.     

Secreted VAPB/ALS8 major sperm protein domains modulate mitochondrial localization and morphology via growth cone guidance receptors

The VAPB/ALS8 major sperm protein domain (vMSP) is implicated in amyotrophic lateral sclerosis and spinal muscular atrophy, yet its function in the nervous system is not well understood. In Caenorhabditis elegans and Drosophila, the vMSP is cleaved from its transmembrane anchor and secreted in a cell type-specific fashion. We show that vMSPs secreted by neurons act on Lar-like protein-tyrosine phosphatase and Roundabout growth cone guidance receptors expressed in striated muscle. This signaling pathway promotes Arp2/3-dependent actin remodeling and mitochondrial localization to actin-rich muscle I-bands. C. elegans VAPB mutants have mitochondrial localization, morphology, mobility, and fission/fusion defects that are suppressed by Lar-like receptor or Arp2/3 inactivation. Hence, growth cone guidance receptor pathways that remodel the actin cytoskeleton have unanticipated effects on mitochondrial dynamics. We propose that neurons secrete vMSPs to promote striated muscle energy production and metabolism, in part through the regulation of mitochondrial localization and function. VIDEO ABSTRACT:     

Inhibition of post-synaptic Kv7/KCNQ/M channels facilitates long-term potentiation in the hippocampus

Activation of muscarinic acetylcholine receptors (mAChR) facilitates the induction of synaptic plasticity and enhances cognitive function. In the hippocampus, M(1) mAChR on CA1 pyramidal cells inhibit both small conductance Ca(2+)-activated KCa2 potassium channels and voltage-activated Kv7 potassium channels. Inhibition of KCa2 channels facilitates long-term potentiation (LTP) by enhancing Ca(2+)calcium influx through postsynaptic NMDA receptors (NMDAR). Inhibition of Kv7 channels is also reported to facilitate LTP but the mechanism of action is unclear. Here, we show that inhibition of Kv7 channels with XE-991 facilitated LTP induced by theta burst pairing at Schaffer collateral commissural synapses in rat hippocampal slices. Similarly, negating Kv7 channel conductance using dynamic clamp methodologies also facilitated LTP. Negation of Kv7 channels by XE-991 or dynamic clamp did not enhance synaptic NMDAR activation in response to theta burst synaptic stimulation. Instead, Kv7 channel inhibition increased the amplitude and duration of the after-depolarisation following a burst of action potentials. Furthermore, the effects of XE-991 were reversed by re-introducing a Kv7-like conductance with dynamic clamp. These data reveal that Kv7 channel inhibition promotes NMDAR opening during LTP induction by enhancing depolarisation during and after bursts of postsynaptic action potentials. Thus, during the induction of LTP M(1) mAChRs enhance NMDAR opening by two distinct mechanisms namely inhibition of KCa2 and Kv7 channels.     

Neural interfaces for upper-limb prosthesis control: opportunities to improve long-term reliability

Building on a long history of innovation in neural-recording interfaces, the Defense Advanced Research Projects Agency (DARPA) has launched a program to address the key challenges related to transitioning advanced neuroprosthesis technology to clinical use for amputated service members. The goal of the Reliable Neural Technology (RE-NET) Program is to develop new technology to extract information from the nervous system at a scale and rate needed to reliably control modern robotic prostheses over the lifetime of the amputee. The RE-NET program currently encompasses three separate efforts: histology for interface stability over time (HIST), reliable peripheral interfaces (RPIs), and reliable central nervous system (CNS) interfaces (RCIs).     

Can Carbon and Phosphorous Amendments Increase Native Forbs in a Restoration Process? A Case Study in the Northern Tall‐grass Prairie (U.S.A.)

In the northern Great Plains (United States), sites with less than 20% of native species are difficult to restore. We have experimented with a restoration method that shows some promise. It consists of systematically installing simulated small‐scale patches (8.0 m² in size) over 25% of an old field and then seeding these patches with native species. The working hypothesis is that these patches will generate a constant source of propagules which in time will lead to increases in native species diversity within the surrounding grass matrix. The objective of this paper was to determine whether soil amendments should be used to facilitate the establishment and persistence of native species (primarily forbs) within these patches. We seeded the patches with a mixture of native grass and forb species and applied four soil treatments: P fertilization, C additions, C + P, and a control (no amendments). Results for the first 5 years were as follows: (1) seeded forb richness was mostly unaffected by soil amendments; (2) seeded and nonseeded forb biomass and density were substantially reduced by C additions, whereas they were unaffected or increased under P additions; (3) both seeded and non‐native grass biomass substantially increased with C additions; and (4) there was an inverse relationship between native seeded forbs and non‐native grass biomass. Our conclusions are that: (1) P amendments are a potential tool for enhancing native seeded forb biomass in simulated small‐scale disturbance patches; and (2) C additions, although enhancing seeded grass biomass do not reduce the biomass of non‐native grasses.     

Using the Functional Movement Screen™ to evaluate the effectiveness of training

The Functional Movement Screen? (FMS) has demonstrated some efficacy in the prediction of injuries and is thus used by many practitioners to make recommendations for exercise. However, questions remain regarding its utility as a means to evaluate the effectiveness of training. Sixty firefighters volunteered to participate, and their FMS scores were examined before and after 12 weeks of training. Individuals were graded on how they chose to perform rather than how they could perform. The participants were assigned to 1 of 3 groups: intervention 1, intervention 2, or control. The 2 intervention groups received three 1.5-hour training sessions each week and differed in the emphasis that was placed on movement quality. Sagittal and frontal plane videos were used to grade the FMS with 3 methods: the standard 0-3 scale, a 100-point scale that weighted specific compensations (research standard), and a modified 100-point scale whereby grades were assigned based on the total number of compensations present. There were no significant differences in the total FMS scores for any group posttraining. However, the scores of 85% of the firefighters who did not receive training did change. The 100-point scale methods resulted in more FMS score changes posttraining, but the between-group interactions were identical to those found with the standard scoring method. The control group's scores were not consistent pretraining and posttraining; thus, the influence of each intervention could not be evaluated. Currently, the FMS might provide a momentary impression of general movement quality, although further efforts would likely assist in the development of better ways to implement the test, interpret the results, and generate reliable scores.     

Hepcidin-25 in chronic hemodialysis patients is related to residual kidney function and not to treatment with erythropoiesis stimulating agents

Hepcidin-25, the bioactive form of hepcidin, is a key regulator of iron homeostasis as it induces internalization and degradation of ferroportin, a cellular iron exporter on enterocytes, macrophages and hepatocytes. Hepcidin levels are increased in chronic hemodialysis (HD) patients, but as of yet, limited information on factors associated with hepcidin-25 in these patients is available. In the current cross-sectional study, potential patient-, laboratory- and treatment-related determinants of serum hepcidin-20 and -25, were assessed in a large cohort of stable, prevalent HD patients. Baseline data from 405 patients (62% male; age 63.7 ± 13.9 [mean SD]) enrolled in the CONvective TRAnsport STudy (CONTRAST; NCT00205556) were studied. Predialysis hepcidin concentrations were measured centrally with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Patient-, laboratory- and treatment related characteristics were entered in a backward multivariable linear regression model. Hepcidin-25 levels were independently and positively associated with ferritin (p<0.001), hsCRP (p<0.001) and the presence of diabetes (p = 0.02) and inversely with the estimated glomerular filtration rate (p = 0.01), absolute reticulocyte count (p = 0.02) and soluble transferrin receptor (p<0.001). Men had lower hepcidin-25 levels as compared to women (p = 0.03). Hepcidin-25 was not associated with the maintenance dose of erythropoiesis stimulating agents (ESA) or iron therapy. In conclusion, in the currently studied cohort of chronic HD patients, hepcidin-25 was a marker for iron stores and erythropoiesis and was associated with inflammation. Furthermore, hepcidin-25 levels were influenced by residual kidney function. Hepcidin-25 did not reflect ESA or iron dose in chronic stable HD patients on maintenance therapy. These results suggest that hepcidin is involved in the pathophysiological pathway of renal anemia and iron availability in these patients, but challenges its function as a clinical parameter for ESA resistance.