Haemostatic and fibrinolytic factors in men with a small abdominal aortic aneurysm.

BACKGROUND: : The presence of an abdominal aortic aneurysm (AAA) independently predicts cardiovascular disease (CVD) and its complications. Levels of plasma markers of fibrin turnover are raised in men with a large AAA (at least 5.5 cm) and predict CVD risk in healthy subjects. This study examined fibrin turnover in men with a small AAA. METHODS: : Seventy-five men with a small AAA (30-55 mm) were compared with 90 controls matched for age, sex and race. Haemostatic and fibrinolytic parameters were assessed. RESULTS: : Men with a small AAA had higher mean levels of fibrinogen (2.92 versus 2.59 g/l; P = 0.019), thrombin-antithrombin (TAT) complex (4.57 versus 1.89 ng/ml; P < 0.001), prothrombin F1 + 2 (1.13 versus 0.82 ng/ml; P = 0.004) and D-dimer (346.7 versus 120.2 ng/ml; P < 0.001). All markers correlated with maximum aortic diameter determined by ultrasonography. On multivariable regression the association between presence of an AAA and fibrinogen, TAT complex, prothrombin F1 + 2 and D-dimer levels remained significant after adjustment for confounding influences. CONCLUSION: : Fibrin turnover was increased in these men with a small AAA, independently of concomitant CVD, conventional risk factors and inflammatory markers. Enhanced fibrin turnover may contribute to the risk of cardiac complications in this group.

Histochemical changes in fast and slow muscles of nutritionally dystrophic rabbits.

Rabbits were rendered dystrophic by feeding them a diet deficient in vitamin E and their fast-twitch EDL and slow-twitch SOL muscles were examined histochemically. The soleus muscle of control rabbits consisted largely of type I fibres with occasional areas of scattered type II fibres. In the nutritionally dystrophic rabbits type II fibres were consistently found homogeneously distributed throughout the entire muscle and in increased proportion. A very similar pattern was observed in the solei of rabbits following sciatic nerve section. The normal EDL contained three fibre types (I, IIoxidative and IIglycolytic). Vitamin E deficiency appeared to be associated with a shift towards an increase in the proportion of IIglycolytic fibres at the expense of IIoxidative. In denervation as well as vitamin E deficiency the type I fibres of the EDL appeared to be spared. A small number of the E-deficient rabbits exhibited degenerative changes in their sciatic and sural nerves. When animals were both denervated and E-deprived the resulting muscle changes were very much more severe than in the case of either challenge in isolation. We suggest that although some of the signs of vitamin E deficiency resemble those of a neural defect there is, in addition, a direct myopathic effect.

Regulation of myosin heavy chain expression in adult rat hindlimb muscles during short-term paralysis: comparison of denervation and tetrodotoxin-induced neural inactivation.

The extent to which myosin profiles within adult fast and slow muscles are altered by short-term paralysis remains equivocal. We used an array of specific antibodies to identify adult and developmental MHC isoforms within EDL and soleus muscle fibers, and show a marked multiple expression of MHCs with a general shift towards slower and more energy efficient MHC profiles after 2 weeks of denervation or TTX nerve conduction block. Paralysis also induced marked expression of an embryonic MHC within most EDL cell types, and a subtle, paralysis-sensitive, expression of alpha-cardiac MHC within specific EDL and soleus extrafusal fibers. Comparison of treatment groups also permitted assessment of the relative influence of neural activity versus trophic factors on these isoforms, and confirmed activity as a major, but not sole, regulator of MHC expression.

Expression of utrophin and its mRNA in denervated mdx mouse muscle.

Utrophin is a large cytoskeletal protein which shows high homology to dystrophin. In contrast to the sarcolemmal distribution of dystrophin, utrophin accumulates at the postsynaptic membrane of the neuromuscular junction. Because of its localization within this compartment of muscle fibers, expression of utrophin may be significantly influenced by the presence of the motor nerve. We tested this hypothesis by denervating muscles of mdx mouse and monitoring levels of utrophin and its mRNA by immunofluorescence, immunoblotting and RT-PCR. A significant increase in the number of utrophin positive fibers was observed by immunofluorescence 3 to 21 days after sectioning of the sciatic nerve. Quantitative analyses of utrophin and its transcripts in hindlimb muscles denervated for two weeks showed only a moderate increase in the levels of both utrophin (approximately 2-fold) and its transcript (approximately 60 to 90%). The present data suggest that although utrophin is a component of the postsynaptic membrane, its neural regulation is distinct from that of the acetylcholine receptor.

Ciliary neurotrophic factor: regulation of acetylcholinesterase in skeletal muscle and distribution of messenger RNA encoding its receptor in synaptic versus extrasynaptic compartments.

Several recent studies have shown that the ciliary neurotrophic factor exerts myotrophic effects in addition to its well-characterized neurotrophic actions on various neuronal populations. Since expression of acetylcholinesterase in skeletal muscle has been shown to be regulated by putative yet unknown nerve-derived trophic factors, we tested the hypothesis that the ciliary neurotrophic factor is a neurotrophic agent capable of influencing expression of acetylcholinesterase in adult rat skeletal muscle in vivo. To this end, we first determined the impact of daily ciliary neurotrophic factor administration on expression of acetylcholinesterase in both intact and denervated rat soleus muscles. The results of our experiments indicate that although chronic administration of ciliary neurotrophic factor partially counteracted the atrophic response of soleus muscles to surgical denervation, thus confirming its myotrophic effects, it failed to either increase acetylcholinesterase expression in intact muscles or prevent the decrease normally occurring in seven-day denervated muscles. In fact, acetylcholinesterase messenger RNA and enzyme levels were further reduced by ciliary neurotrophic factor treatment in denervated muscles without significant modifications in the pattern of acetylcholinesterase molecular forms. Conversely, transcript levels of the epsilon subunit of the acetylcholine receptor in intact and denervated soleus muscles treated with the ciliary neurotrophic factor were similar to those observed in their respective counterparts from vehicle-treated animals. In addition, we also determined whether transcripts encoding the receptor for the ciliary neurotrophic factor selectively accumulate in junctional domains of rat skeletal muscle fibres. In contrast to the preferential localization of transcripts encoding acetylcholinesterase and the epsilon subunit of the acetylcholine receptor within the postsynaptic sarcoplasm, messenger RNAs for the ciliary neurotrophic factor receptor appeared homogeneously distributed between junctional and extra-junctional compartments of both diaphragm and extensor digitorum longus muscle fibres, with no compelling evidence for a selective accumulation within the postsynaptic sarcoplasm. These data show that the ciliary neurotrophic factor exerts an inhibitory influence on expression of acetylcholinesterase in muscle fibres. Furthermore, the lack of an effect on expression of the epsilon acetylcholine receptor transcripts indicates that treatment with ciliary neurotrophic factor does not lead to general adaptations in the expression of all synaptic proteins. Given the distribution of transcripts encoding the ciliary neurotrophic factor receptor along multinucleated muscle fibres, we propose a model whereby the ciliary neurotrophic factor, or a related unknown molecule that also utilizes the receptor for the ciliary neurotrophic factor, contributes to the maintenance of low levels of enzyme activity in extrajunctional regions of muscle fibres by acting as a repressor of acetylcholinesterase expression that functions directly or indirectly via a pretranslational regulatory mechanism. Accordingly, these results further highlight the complexity of the regulatory mechanisms presiding over acetylcholinesterase expression in vivo.

Gamma irradiation prevents compensatory hypertrophy of overloaded mouse extensor digitorum longus muscle.

Mouse extensor digitorum longus (EDL) muscle was subjected to a dose of gamma irradiation that causes reproductive death of satellite cells and/or to chronic compensatory overload, achieved by removal of the distal portion of the tibialis anterior muscle. Four weeks later the mass, fiber type percentage, and fiber size of the EDL muscle were measured. Both the irradiated + overloaded and the irradiated only EDL muscles were significantly lighter and contained significantly smaller fibers than untreated muscle or muscle subjected to chronic overload only. Overload muscle, whether irradiated or not, had a larger percentage of type IIx fibers and a smaller percentage of type IIb fibers than muscle that had not been overloaded. The results confirm that satellite cell proliferation is a prerequisite for muscle hypertrophy induced by synergist incapacitation, but it appears not to be required for the maintenance of, or change in, normal muscle fiber myosin heavy chain phenotype expression.

The relationship between surface potentials and the number of active motor units.

One of the assumptions inherent in a technique recently devised for enumerating motor units in human muscles is that the surface potentials from active motor units summate in a linear fashion. We present an electrical model of a muscle which predicts that a linear relationship between the number of active units and the electrical response recorded at the surface overlying the muscle would not be expected. The extent of the non-linearity, and hence the error in the calculation of the number of motor units in a given muscle, depends upon the ratio between the mean conductance of the motor units themselves and that of the external conduction pathway through which the electrical signal is fed (Gu/Ge). The extent of non-linearity is assessed experimentally in human hypothenar muscles using a "collision" technique. The average underestimate introduced into the calculation of the number of motor units in this particular case was concluded to be 26%. The value of Gu/Ge derived from these experiments, in 2 subjects, was checked by simulating an intramuscular action potential and determining the attenuation at the surface. The 2 independently obtained values were sufficiently close to suggest that the model may be a valid one. We conclude that caution should be employed in the interpretation of experiments which purport to determine the number of motor units in a muscle by means of surface recordings.

Culturing satellite cells from living single muscle fiber explants.

Conventional methods for isolating myogenic (satellite) cells are inadequate when only small quantities of muscle, the tissue in which satellite cells reside, are available. We have developed a tissue culture system that reliably permits isolation of intact, living, single muscle fibers with associated satellite cells from predominantly fast and slow muscles of rat and mouse; maintenance of the isolated fibers in vitro; dissociation, proliferation, and differentiation of satellite cells from each fiber; and removal of the fiber from culture for analysis.

Simplifying the internal iliac artery aneurysm.

Isolated aneurysms of the internal iliac (hypogastric) artery are a rare variant of aorto-iliac aneurysm disease, with an incidence at around 0.04% of all aorto-iliac aneurysms. Because of their location deep within the pelvis, they may present late and are often large. The incidence of rupture is high and may be up to 38% at initial presentation; furthermore, this has been reported to carry a 58% mortality rate. As such the early and aggressive management of isolated internal iliac artery aneurysms (IIAAs) is mandatory to avoid the high morbidity and mortality associated with rupture. This article includes a literature review regarding IIAAs and outlines the current surgical and endovascular management options for this most rare and technically challenging of aneurysms.

Cyclooxygenase-2 expression and its association with increased angiogenesis in human abdominal aortic aneurysms.

Although the mechanism whereby non-steroidal anti-inflammatory drugs may reduce abdominal aortic aneurysm (AAA) development is unknown, one potential route is via inhibition of the cyclooxygenase (COX) enzyme. Despite the fact that evidence from animal models suggests a role for the COX-2 isoform in promotion of AAA development, only very limited data exist on COX-2 expression in human AAAs. Semiquantitative immunohistochemistry for COX-2 was performed on a series of formalin-fixed, paraffin-embedded human AAAs (n = 49). Associated clinicopathological data, including the degree of inflammatory cell infiltration and neorevascularization, were obtained. COX-2 protein was detected in 46 of 49 (94%) human AAAs. Expression of COX-2 protein varied widely between AAAs. COX-2 protein localized to cells in the inflammatory infiltrate with a morphology characteristic of macrophages. COX-2 expression increased with the extent of inflammatory cell infiltration (P < 0.001) and with the degree of AAA neorevascularization (P < 0.001). Logistic regression analysis identified neorevascularization (P < 0.001) as the only significant independent predictor of COX-2 positivity in human AAAs. COX-2 protein is present at increased levels in the majority of human AAAs and is expressed by mononuclear cells in the inflammatory cell infiltrate. Promotion of angiogenesis by COX-2 may play a role in AAA development.

Fibrinolytic risk factor clustering and insulin resistance in healthy male relatives of men with intermittent claudication.

BACKGROUND: Raised fibrinolytic factors predict cardiovascular risk in healthy subjects. The aim of this study was to measure fibrinolytic factors and insulin resistance in healthy male first-degree relatives of men with intermittent claudication younger than 65 years. METHODS: The study compared 165 healthy first-degree relatives with 165 age-, sex- and race-matched control subjects free from a personal or family history of premature cardiovascular disease. Primary outcome measures were plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (tPA) and D-dimer levels. Insulin resistance was estimated by Homeostasis Model Assessment. Clinical and biochemical risk factors were measured and subjects genotyped for the PAI-1 4G/5G polymorphism. RESULTS: First-degree relatives had significantly higher mean PAI-1 (10.23 versus 7.85 ng/ml; P = 0.024), tPA (9.98 versus 8.29 ng/ml; P < 0.001) and D-dimer levels (56.6 versus 46.1 ng/ml; P = 0.004). They also had significantly higher insulin resistance (1.85 versus 1.53; P < 0.001) and clustered multiple atherogenic risk factors. On multivariate analysis the association between both tPA and D-dimer levels and relative status was independent of other variables. CONCLUSION: Raised levels of PAI-1, tPA, D-dimer and estimated insulin resistance were present in the healthy male first-degree relatives of men with intermittent claudication. These data support the hypothesis of fibrinolytic risk factor clustering in this high-risk population.

Myosin heavy chain expression and plasticity: role of myoblast diversity.

Muscle fibers exhibit a limited capacity to alter their myosin heavy chain expression in response to various stimuli. Recent results pertinent to this observation are discussed, and a hypothetical scheme is presented whereby the contribution of myonuclei from distinct populations of myogenic precursors may account for this limited adaptive range.

The effect of partial denervation of tibialis anterior (TA) muscle on the number and sizes of motorneurons in TA motornucleus of normal and dystrophic (C57BL dy2j/dy2j) mice.

The tibialis anterior (TA) muscle in one leg of normal (C57BL) and dystrophic (dy2j) mice was partially denervated by resection of a part of the lateral popliteal nerve. Two months later the muscle was injected with horseradish peroxidase to permit visualization of the motorneurons that survived. Partial denervation in both C57 and dy2j mice resulted in reduction of the number of motorneurons that supplied the muscle to approximately one-half the normal complement. The surviving motorneurons were found to be significantly larger (about 25%) than their contralateral counterparts. This condition persisted up to 18 months and is not considered to be a transient response to the trauma associated with the partial denervation. When the size of the target tissue was also reduced by extirpation of one-half of TA together with partial denervation, motorneuron size was not found to increase. It is suggested that the increase in size is a response to the metabolic demands placed upon the motorneuron by an increase in the size of the motor unit.

Adaptation of rat extensor digitorum longus muscle to gamma irradiation and overload.

The right extensor digitorum longus (EDL) muscle of growing male rats was overloaded by ablation of its synergist tibialis anterior (TA) muscle. Four weeks later, the overloaded muscle was heavier and contained larger type IIA, IIX and IIB fibres than either untreated contralateral muscle or control muscle from an untreated animal. The myonuclear-to-myoplasmic volume ratio was maintained in the overloaded muscle. Overloaded EDL muscle, previously subjected to a dose of irradiation sufficient to sterilise satellite cells, and EDL muscle which had been only irradiated, were significantly lighter and contained significantly smaller fibres than controls, though a significant amount of normal EDL muscle growth did occur following either treatment. The myonuclear-to-myoplasmic volume ratio of the irradiated muscles was smaller than in controls. Overloaded muscle, with or without prior irradiation, possessed a smaller proportion of fibres containing IIB myosin heavy chain (MHC) and a larger proportion of fibres containing IIA and IIX MHC; a significant percentage of these fibres coexpressed either type IIA and IIX MHC or type IIX and IIB MHC. Thus in the absence of satellite cell mitosis, muscles of young rats possess a limited capacity for normal growth but not for compensatory hypertrophy. Adaptations in MHC gene expression to chronic overload are completely independent of satellite cell activity.

Slowing of twitch of dystrophic mouse muscle in partially due to altered activity pattern.

Fast-twitch muscles of the hindlimb of dystrophic (dy2J) mice show a prolongation of both the contraction and relaxation phases of the isometric twitch. Comparable muscles of the forelimb of these mice exhibit relatively little increase in time to peak tension but time to half-relaxation is as severely affected as in the hindlimb. When examined with an immunohistochemical technique to demonstrate the presence of "slow" myosin it was apparent that there were no fibers containing the "slow" isoenzyme in either hindlimb or forelimb muscles of 6-month control mice. In dy2J mice hindlimb muscles contained many fibers with "slow" myosin whereas forelimb muscles did not. It is suggested that the spontaneous twitching activity produced in the hindlimbs, as a result of amyelination of the spinal roots, induces synthesis of "slow" myosin, which in turn leads to prolongation of time to peak twitch tension.

Motor units in a fast-twitch muscle of normal and dystrophic mice.

Isometric contractions of motor units, isolated functionally by ventral root splitting were recorded from extensor digitorum longus muscles of normal and dystrophic mice of the strain C57BL/6J dy2J/dy2J. Motor unit tetanic tension was significantly lower and both time to peak tension and to half-relaxation of the twitch were significantly prolonged in dystrophic mice relative to age-matched controls. In control mice, motor unit tetanic tension averaged 4.98% of whole muscle tension, corresponding to twenty motor units. Two out of fifteen dystrophic mice exhibited an apparent decrease in the number of motor units, but the data from the remaining thirteen mice indicated no change in relative motor unit size, and hence in the number of motor units. The two mice in which changes were seen were the most severely affected and it is suggested that the apparent reduction in the number of units might be due to some units becoming so small as to be unmeasurable. No evidence was obtained for a population of units with normal characteristics within the dystrophic muscles. There was no clear relationship between tetanic tension and the time to peak tension or to half-relaxation in units from control mice. In dystrophic mice, however, a significant correlation was seen. This possibly reflects two simultaneous effects of the dystrophic process, a loss of tension accompanied by slowing of the twitch.

Identification, distribution, and myosin subunit composition of type IIX fibers in mouse muscles.

The purpose of the present investigation was to study the distribution and subunit composition of type IIX fibers in mouse muscles. The existence of a population of type IIX fibers in fast-twitch muscles of the mouse was shown by mean of immunohistochemistry and gel electrophoresis. In the hindlimb muscles, tibialis anterior (TA) and extensor digitorum longus (EDL), type IIX fibers account for approximately one third of the total fiber number, with the superficial portion of the TA (TAS) being composed exclusively of type IIB and IIX fibers. A similar proportion of IIX fibers was found in diaphragm (DIA) while in tongue muscles approximately 40% of the fibers were IIX. Single fiber gel electrophoresis revealed a significant number of fibers in TAS that contain both IIB and IIX myosin heavy chain (MyHC). This was confirmed with immunohistochemistry, which revealed the presence of fibers with various degrees of staining intensity. This suggests that there may exist a degree of plasticity which results in the conversion of IIX fibers to IIB fibers and vice versa. Analysis of myosin light chain (MyLC) composition of type IIX fibers revealed that the ratio of MyLC3f to MyLC1f was significantly lower than in type IIB fibers.

Succinic dehydrogenase activity of forelimb and hindlimb muscles of the dystrophic mouse.

The activity of succinic dehydrogenase (SDH) was determined in muscles of normal and dystrophic mice. In contradistinction to reports based solely upon histochemical examination, we were unable to observe increased activity in fast-twitch muscles of dystrophic mice. Because dystrophic muscles contain large amounts of connective tissue, two reference bases for expression of enzyme activity were compared. SDH activity was expressed either per micromole of creatine or per milligram of "true muscle fibre weight." The latter was obtained by determining the proportion of the whole muscle occupied by muscle fibres using an image analyzer with photographs of muscle cross section. It appears that the use of creatine content as an index of muscle mass may not be valid for pathological tissue, as the concentration of creatine in some dystrophic muscles differed from that of control muscles. Hindlimb muscles of dystrophic mice exhibit continuous spontaneous activity. To determine the effects of this on oxidative enzyme activity two fast-twitch muscles from the forelimb were also examined. Although they showed histochemical changes comparable to those seen in hindlimb muscles, there was no increase in SDH activity. The only dystrophic muscle examined which showed a change in SDH activity was the soleus in which a decrease was observed.