[Nonimmunogenic staphylokinase in the treatment of acute ischemic stroke (FRIDA trial results)]. / Neimmunogennaya stafilokinaza ­ novyi tromboliticheskii preparat v lechenii ishemicheskogo insul'ta (rezul'taty issledovaniya FRIDA).

AIM OF THE STUDY: To investigate the efficacy and safety of non-immunogenic staphylokinase (NS) compared with alteplase (A) in patients with acute ischemic stroke (AIS) within 4.5 h after symptom onset. MATERIAL AND METHODS: 336 patients with IS within 4.5 h after symptom onset were included in a randomized, open-label, multicenter, parallel-group, non-inferiority comparative trial of NS vs A (168 patients in each group). NS was administered as an intravenous bolus in a dose of 10 mg, regardless of body weight, over 10 s, A was administered as a bolus infusion in a dose of 0.9 mg/kg, maximum 90 mg over 1 hour. The primary efficacy endpoint was a favorable outcome, defined as a modified Rankin scale (mRS) score of 0-1 on day 90. Safety endpoints included all-cause mortality on day 90, symptomatic intracranial haemorrhage, and other serious adverse events (SAEs). RESULTS: At day 90, 84 (50%) patients reached the primary endpoint (mRS 0-1) in the NS group, 68 (41%) patients - in the A group (p=0.10, OR=1.47, 95% CI=0.93-2.32). The difference between groups NS and A was 9.5% (95% CI= -1.7-20.7) and the lower limit of the 95% CI did not cross the margin of non-inferiority (pnon-inferiority<0.0001). There were no significant differences in the frequency of deaths between the groups: on day 90, 17 (10%) patients in the NS group and 24 (14%) in the A group had died (p=0.32). There was a trend towards significant differences in the frequency of symptomatic intracranial haemorrhage: NS group - 5 (3%) patients, A group - 13 (8%) patients (p=0.087, OR=0.37, 95% CI=0.1-1.13). There were significant differences in the number of patients with SAEs: in the NS group - 22 (13%) patients, in the A group - 37 (22%) patients (p=0.044, OR=0.53, 95% CI=0.28-0.98). CONCLUSION: The presented results of the FRIDA trial are the first in the world to use a drug based on NS in patients with IS. It has been shown that a single bolus (within 10 s) administration of NS at a standard dose of 10 mg, regardless of body weight, allows to conduct fast, effective and safe thrombolytic therapy in patients with IS within 4.5 h after symptom onset. In further clinical tials of NS, it is planned to expand the therapeutic window beyond 4.5 h after symptom onset in patients with IS.

DNA methylation across the genome in aged human skeletal muscle tissue and muscle-derived cells: the role of HOX genes and physical activity.

Skeletal muscle tissue demonstrates global hypermethylation with age. However, methylome changes across the time-course of differentiation in aged human muscle derived cells, and larger coverage arrays in aged muscle tissue have not been undertaken. Using 850K DNA methylation arrays we compared the methylomes of young (27 ± 4.4 years) and aged (83 ± 4 years) human skeletal muscle and that of young/aged heterogenous muscle-derived human primary cells (HDMCs) over several time points of differentiation (0, 72 h, 7, 10 days). Aged muscle tissue was hypermethylated compared with young tissue, enriched for; pathways-in-cancer (including; focal adhesion, MAPK signaling, PI3K-Akt-mTOR signaling, p53 signaling, Jak-STAT signaling, TGF-beta and notch signaling), rap1-signaling, axon-guidance and hippo-signalling. Aged cells also demonstrated a hypermethylated profile in pathways; axon-guidance, adherens-junction and calcium-signaling, particularly at later timepoints of myotube formation, corresponding with reduced morphological differentiation and reductions in MyoD/Myogenin gene expression compared with young cells. While young cells showed little alterations in DNA methylation during differentiation, aged cells demonstrated extensive and significantly altered DNA methylation, particularly at 7 days of differentiation and most notably in focal adhesion and PI3K-AKT signalling pathways. While the methylomes were vastly different between muscle tissue and HDMCs, we identified a small number of CpG sites showing a hypermethylated state with age, in both muscle tissue and cells on genes KIF15, DYRK2, FHL2, MRPS33, ABCA17P. Most notably, differential methylation analysis of chromosomal regions identified three locations containing enrichment of 6-8 CpGs in the HOX family of genes altered with age. With HOXD10, HOXD9, HOXD8, HOXA3, HOXC9, HOXB1, HOXB3, HOXC-AS2 and HOXC10 all hypermethylated in aged tissue. In aged cells the same HOX genes (and additionally HOXC-AS3) displayed the most variable methylation at 7 days of differentiation versus young cells, with HOXD8, HOXC9, HOXB1 and HOXC-AS3 hypermethylated and HOXC10 and HOXC-AS2 hypomethylated. We also determined that there was an inverse relationship between DNA methylation and gene expression for HOXB1, HOXA3 and HOXC-AS3. Finally, increased physical activity in young adults was associated with oppositely regulating HOXB1 and HOXA3 methylation compared with age. Overall, we demonstrate that a considerable number of HOX genes are differentially epigenetically regulated in aged human skeletal muscle and HDMCs and increased physical activity may help prevent age-related epigenetic changes in these HOX genes.

[Preparation of Human Skeletal Muscle Samples for Proteomic Analysis with Isobaric iTRAQ Labels].

In the past decade, mass spectrometry studies of skeletal muscles have become common. In this tissue, the abundance of several contractile proteins significantly limits the depth of the panoramic proteome analysis. The use of isobaric labels allows improving assessment of the changes in the protein content, while analyzing up to 10 samples in a single run. Here we present the results of a comparative study of various methods for the fractionation of skeletal muscle peptides labeled with an isobaric label iTRAQ. Samples from m. vastus lateralis of eight young males were collected with a needle biopsy. After digestion into peptides and labeling, the preparations were carried out according to three different protocols: (1) peptide purification, HPLC-MS/MS; (2) peptide purification, isoelectric focusing, HPLC-MS/MS; (3) high pH reverse-phase LC fractionation, HPLC-MS/MS. Fractionation of labeled peptides by high pH reverse-phase LC was the optimal strategy for increasing the depth of the proteome analysis. This approach, in addition to contractile and mitochondrial proteins, allowed us to detect a variety of regulatory molecules, including the nucleic acids binding the proteins, chaperones, receptors, and transcription factors.

Adaptation of Skeletal Muscles to Contractile Activity of Varying Duration and Intensity: The Role of PGC-1α.

A large body of experimental data have shown that aerobic exercise of different duration, intensity, and pattern affect molecular mechanisms regulating mitochondrial biogenesis in skeletal muscles. This review focuses on the effects of exercise duration and intensity on the molecular mechanisms of mitochondrial biogenesis regulation in skeletal muscles, namely PGC-1α-dependent signaling. Studies of the effects of acute exercise and exercise training showed that an increase in the duration of aerobic exercise from 30 to 90 min does not provide additional stimuli to activate signaling pathways regulating post-translational modification of peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) and expression of the PGC-1α gene (PPARGC1A). Conversely, exercise intensity substantially affects mitochondrial biogenesis due to the increase in the recruitment of type II muscle fibers with accompanying pronounced metabolic shift leading to the activation of signaling cascades and expression of genes regulating mitochondrial biogenesis. Therefore, intermittent exercise, which recruits type II muscle fibers, is more efficient in the activation of mitochondrial biogenesis than work-matched continuous exercise. In skeletal muscle adapted to aerobic training, intensity-dependent activation of mitochondrial biogenesis after acute exercise is associated primarily with the AMP-activated protein kinase/PGC-1α pathway, expression of PGC-1α-regulated genes, and expression of PPARGC1A from the alternative (distal) inducible promoter regulated by the cAMP response element-binding protein 1-related transcription factors and their coactivators. Elucidation of the effects of duration and intensity of aerobic exercise on the PGC-1α-dependent and -independent mechanisms of mitochondrial biogenesis is important for treatment of patients with various metabolic disorders, as well as for optimization of training in athletes.

[Effect of Combined Aerobic and Strength Exercise on Regulation of Mitochondrial Biogenesis, Protein Synthesis and Degradation in Human Skeletal Muscle.]

We tested the hypothesis that strength exercise after intermittent aerobice exercise might activate signalling pathways related to mitochondrial biogenesis (phosphorylation level of AMPK, p38; expression of PGC-1a, NT-PGC-la, TFAM, VEGFA), to protein synthesis (phosphorylation level of p70S6Kl(Thr389) eEF2(Thr56) expression of IGF-lEa, IGF-lEc (MGF), REDDl) and to proteolysis (phosphorylation level of FOXOl(Ser256) and expression of MURFl, MAFbx, Myostatin) in trained skeletal muscle. Nine amateur endurance-trained athletes performed 70-Min bicycle intermittent exercise with both legs (E), followed by one-leg strength exercise (ES: 4 bouts of knee extensions at 75% MVC till exhaustion). Gene expression and protein level were evaluated in samples from m. vastus lateralis before, 40 min, 5 and 22 h after the aerobic exercise. The phosphorylation level of the ACC(Ser79/222)(an endogenous marker of AMPK activity) and expression of PGC-la-related TFAM - marker of mitochondrial biogenesis were increased after E exercise and did not changed after ES. Expression of PGC-lα and truncated isoform NT- PGC-lα was increased in both legs as well. Insulin concentration in blood was dramatically, 7.5-fold diminished after intermittent aerobic exercise. Phosphorylation of FOXO(Ser256) - regulator of ubiquitin-related proteolysis - was decreased after both E and ES exercise, it means it was activated in both cases, while expression of E3-ubiquitin ligase MURFl was increased only after E exercise. Both aerobic and combined exercise did not affect regulation of protein synthesis: neither expression of IGF-lEa and IGF-Ec (MGF) mRNA isoforms nor phosphorylation levels of markers of protein synthesis p70S6Kl(Thr389) and eEF2(Thr56) were changed. Thus effects of aerobic exercise in trained muscles are noticeably suppressed by performing strength exercise immediately after endurance one. In particular, the activity of signalling cascades and expression of genes regulating mitochondrial biogenesis are lessened, but protein synthesis regulation is not affected. And at last strength exercise suppresses induced by aerobic exercise expression of MURF1 gene - marker of ubiquitin proteasome system. It means that strength exercise just after intermittent aerobic exercise might have a negative effect on aerobic performance if used chronically.

[Determination of Aerobic-anaerobic Transition in Working Muscle Using EMG and Near Infrared-Spectroscopy Data].

A method to evaluate aerobic-anaerobic transition (AAT) during exercise is suggested. The subjects performed two tests with incremental increase of load: bicycle exercise and one leg knee extensions. In both tests the relation of deoxygenated hemoglobin (HHb) to EMG-activity of m. vastus lateralis during test has characteristic peak corresponding to AAT. The statistically significant correlation (r = 0.78, p < 0.05) between the load corresponding to AAT and anaerobic threshold (blood [La] = 4 mmol) was found during bicycle test. The method is applicable to determination of AAT during exercise of small muscle group.

[The study of the efficacy of Botulinum toxin type A in patients with poststroke upper-limb spasticity ULIS-II: an analysis of Russian patients].

AIM: To assess the efficacy of Botulinum toxin type A (BoNT-A) injections in routine practice. MATERIAL AND METHODS: An international, post-marketing, multi-center, observational, prospective, longitudinal study included patients ≥18 years with poststroke upper-limb spasticity in whom a decision to inject BoNT-A had already been made, and who had no previous treatment with BoNT-A or BoNT-B within the last 12 weeks. The responder rate was assessed by the patient-centered goal attainment scaling (GAS). RESULTS AND CONCLUSION: The study included 7 Russian research centers (41 patients). Sixteen patients (39%) received BoNT-A injections prior to entering the study. During the treatment, 29 patients (70.7%) received dysport injections; 2 (4.9%) botox injections, 8 (19.5%) xeomin injections and 2 (4.9%) other BoNT-A agents. The primary treatment goals were successfully attained in 87.8%, secondary treatment goals in 88.3%. An improvement in passive function as primary goal and as secondary goal were achieved in 100%, in the range of movement in 94.9%, pain reduction in 82.4%, improvement in active function of the upper limb in 76.5%, reduction in involuntary movements (associated reactions) in 83.3% of cases. Investigators' global assessment of benefits revealed that 97.6% of patients showed positive effects from BoNT-A injections. Pateitnts' assessment of global benefits was slightly lower - 90,2% of patients reported positive treatment effects When assessed by patients, the rate of global benefits was 90.2%. Botulinum-toxin therapy is an effective treatment option. In the vast majority of patients, it allows both for reduction in muscle tone and functional benefits that could improve quality of life of the patients.

[The Effect of Single Aerobic Training on the Regulation of Mitochondrial Biogenesis in Skeletal Muscles of Trained Men: a Time-Course Study].

Adaptation of skeletal muscles to physical training depends on intensity and duration of exercise sessions. The purpose of this study was to investigate the effect of the duration of moderately intensive single aerobic exercise session (60% V(O2max)) on the activation of signalling kinases which regulate PGC-1α gene expression and on the expression of regulatory genes of mitochondrial biogenesis and muscle catabolism. Nine athletes (V(O2max)) 59 mL/min/kg) performed 30-, 60-, and 90-min cycling sessions. An exercise-induced increase in PGC-1α gene expression was proved to occur without activation of AM PK, p38 MAPK and CAMKII. It was found that 60- and 90-min sessions result in comparable increases of PGC-lα gene expression, while VEGFA gene expression increased only after 90-min session. Even 90-min exercise did not induce the activation of FOXO1-E3 ubiquitin ligase pathway and did not result in an increase of expression of exercise-induced catabolic genes.

Regulation of PGC-1α Isoform Expression in Skeletal Muscles.

The coactivator PGC-1α is the key regulator of mitochondrial biogenesis in skeletal muscle. Skeletal muscle expresses several PGC-1α isoforms. This review covers the functional role of PGC-1α isoforms and the regulation of their exercise-associated expression in skeletal muscle. The patterns of PGC-1α mRNA expression may markedly differ at rest and after muscle activity. Different signaling pathways are activated by different physiological stimuli, which regulate the expression of the PGC-1α gene from the canonical and alternative promoters: expression from a canonical (proximal) promoter is regulated by activation of the AMPK; expression from an alternative promoter, via a ß2-adrenergic receptor. All transcripts from both promoters are subject to alternative splicing. As a result, truncated isoforms that possess different properties are translated: truncated isoforms are more stable and predominantly activate angiogenesis, whereas full-length isoforms manly regulate mitochondrial biogenesis. The existence of several isoforms partially explains the broad-spectrum function of this protein and allows the organism to adapt to different physiological stimuli. Regulation of the PGC-1α gene expression by different signaling pathways provides ample opportunity for pharmacological influence on the expression of this gene. Those opportunities might be important for the treatment and prevention of various diseases, such as metabolic syndrome and diabetes mellitus. Elucidation of the regulatory mechanisms of the PGC-1α gene expression and their functional role may provide an opportunity to control the expression of different isoforms through exercise and/or pharmacological intervention.

[Dynamics of systemic and local physiological indices while changing intensity of physical load].

It is well known that metabolic, cardiovascular and respiratory indices during exercise of moderate intensity are linearly related to exercise power. After the load reaches the definite level this relationship changes for nonlinear. Different methods of evaluating the intensity of load at which this transition takes place are discussed. The methods for investigation of transient process dynamics in energy supply of muscle contractions with changing intensity of contractions is described. The dependence of dynamic characteristics of physiological indices from fitness level and in its turn from age and level of physical activity is discussed.

[Optimization of training: development of a new partial load mode of strength training].

Hypertrophic effect of strength training is known to originate from mechanical and metabolic stimuli. During exercise with restricted blood supply ofworking muscles, that is under conditions of intensified metabolic shifts, training effect may be achieved with much lower external loads (20% of one repetition maximum (1 RM)). The aim of the study was to compare the effects of 8 wks high-intensity (80-85% MVC) strength training and low-intensity (50% 1 RM) training without relaxation. The high-intensity strength training leads to somewhat higher increments in strength and size of trained muscles than training without relaxation. During high-intensity training an increase of area occupied by type II fibers at muscle cross section prevails while during training without relaxation - an increase of area occupied by type I fibers takes place. An exercise session without relaxation leads to a more pronounced increase in secretion of growth hormone, IGF-1 and cortisol. Expression of gene regulating myogenesis (Myostatin) is changed in different ways after high-intensity strength exercise session and after exercise session without relaxation. Low-intensity strength training (50% 1 RM) without relaxation is an effective way for inducing increases of strength and size of trained muscles. This low intensive type of training may be used in restorative medicine, sports and physical culture.

[Comparison of aerobic performance of leg and arm muscles in cross country skiers].

Recently there was a tendency to increase usage of double poling during cross country skiing and accordingly to increase loading of the arm muscles. The aim of the study was to compare the aerobic performance of cross country skiers in the incremental double poling and running tests till exhaustion. Eight junior subnational level cross country skiers ( V(O)2max 70 (66-72) ml/min/kg) have participated in the study. The rate of blood lactate increase during double poling test was higher than during running test. Double poling V(O)2peak was 88 (84-93)% from running V(O)2max. Relative anaerobic threshold (% V(O)2max at AT), closely linked to the current aerobic performance, was substantially lower in double poling test compared with running test: 79 (57-83)% and 94 (90-98)% respectively. We suggest that the main reserve for further increase of aerobic performance of cross country skiers lies in an increase of double poling aerobic capacity.

[Aerobic performance: role of oxygen delivery and utilization, glycolytic flux].

Oxygen delivery to muscle, its consumption and glycolytic flux, all of each affect and restrict aerobic performance, are discussed. Energy supply of intensive exercise till exhaustion lasting 3 to 4 min is provided mainly by oxidative metabolism, simultaneously glycolytic flux may be increased considerably. Other conditions being equal, capacity of oxygen delivery determines oxygen partial pressure in myoplasm of exercising/contracting muscle. With PO2 in myoplasm increasing from 0 to 1-2 mm Hg oxygen consumption (VO2) in mitochondria enhances dramatically, with further increase of PO2 its rise slows down. At the ascending part of VO2-PO2 relationship for mitochondria the increase of VO2 is noticeably restricted by oxygen delivery to contracting muscle. When PO2 approaches plateau of the VO2-PO2 relationship, an increase of VO2 is restricted by mitochondria capacity to accumulate oxygen and augmented oxygen delivery will not lead to a significant increase of muscle VO2. On the other hand considerable accumulation of glycolytic metabolites in contracting muscle causes a decrease of contractility which in its turn may restrict aerobic performance. Noteworthy no strict relationship between glycolytic flux and PO2 in myoplasm exists. That is why correct evaluation of factors limiting aerobic performance presupposes simultaneous evaluation of both glycolytic flux and oxygen consumption in muscle which in its turn depends on oxygen delivery to mitochondria and its utilization.

[Association of the muscle-specific creatine kinase (CKMM) gene polymorphism with physical performance of athletes].

The aim of the study was to investigate allele and genotype distributions of the muscle-specific creatine kinase gene (CKMM) A/G polymorphism in athletes (n = 384) and controls (n = 1116), and to find interrelation between genotypes and aerobic capacity in rowers (n = 85). Genotyping was performed by restriction fragment length polymorphism analysis. Aerobic capacity (maximal oxygen consumption (VO2(max)) and maximal power production capacity (W(max was determined using an incremental test to exhaustion by rower ergometer. The frequencies of CKMM A allele and AA genotype were significantly higher in endurance-oriented athletes (n = 176) than in controls (A allele: 78.7% vs. 65.4%; p < 0.0001; AA genotype: 59.7% vs. 44.2%; p = 0.0003). On the other hand, GG genotype was more prevalent in weightlifters (n = 74) in comparison with controls (31.1% vs. 13.4%; p = 0.0001). Furthermore, CKMM AA genotype was associated with high values of VO2(max) (AA - 58.98 (3.44) ml/kg/min, GA - 56.99 (4.36) ml/kg/min, GG - 52.87 (4.32) ml/kg/min, p = 0.0097). Thus, CKMM gene A/G polymorphism is associated with physical performance of athletes.

[Application of alpha1-adrenoblockers in treatment of ureteral calculi].

The results of evaluation of the efficacy of alpha1-adrenoblockers in treatment of ureteral calculi are presented. Comparative, prospective, placebo-uncontrolled nonrandomized single-center study was performed, which included 118 patients with solitary diagnosed calculi in various parts of ureter. After the pain relief, all the patients underwent conservative therapy aimed at spontaneous discharge of concretions. The maximum duration of conservative treatment was 28 days. Ultrasound monitoring was performed every week in all patients. The control group of patients received only Drotaverinum 40 mg three times a day, and analgesics. The main group received alpha1-adrenoblocker tamsulosin at a standard dose of 0.4 mg once a day along with Drotaverinum and analgesics. The overall probability of a discharge of concrements localized in the distal ureter was significantly (P = 0.02) higher in the patients treated with alpha1-adrenoblockers. Treatment regimen in main group of patients allowed better control of pain during all periods of observation, even if the discharge of concretions was not registered. The overall probability of migration of concrements from the proximal to the distal ureter in main group of patients was 52% versus 32% in controls (P = 0.17). The frequency of adverse effects was comparable in both groups. Vertigo, postural hypotension, and weakness were significantly more frequent in the main group of patients. Univariate and multivariate analyses of the proportional hazards model have demonstrated that the administration of alpha1-adrenoblocker increased the likelihood of a discharge of concrement from the distal ureter. It is shown that the nature of the applied therapy has directly influence on the risk of an earlier discharge of concretions. Inclusion of alpha1-adrenoblockers in the treatment scheme increased the probability of discharge of concrements at 4.11 times.

[Wavelet analysis of m. vastus lateralis surface EMG activity in incremental tests till exhaustion using bicycle and knee extension exercises].

Continuous wavelet analyses was applied to investigate the spectral characteristics of m. vastus lateralis EMG activity in two incremental tests till exhaustion: rhythmic knee-joint extensions and cycling. Wavelet analysis of surface EMG revealed differences in the dynamics of time-frequency characteristics of the signal during single cycle of two types of movements with different loads, as well as differences in the slow variations of spectral characteristics associated with the development of muscle fatigue during the tests. It was shown that during cycling with low loads (beginning of the test) maximum of EMG activity was confined within the second half of muscle contraction (the angle in the knee joint approximately 140 degrees), increase of load at the end of the test led to a shift of the peak to the beginning of the active phase of movement, while the median frequency of the "instant" wavelet spectra during muscle contraction remained almost unchanged. During knee-joint extensions the maximum of EMG activity was observed at the end of the active phase of movement for all loads, median frequency increased significantly with increasing the angle at the knee joint. Long-term dynamics of EMG intensity growth during these tests differed as well, whereas dynamics of wavelet-spectra median frequencies were practically the same--during both tests their growths were observed.