1
|
Ren M, Sambuughin N, Mungunshukh O, Edgeworth DB, Hupalo D, Zhang X, Wilkerson MD, Dalgard CL, O’Connor FG, Deuster PA. Genome-Wide Analysis of Exertional Rhabdomyolysis in Sickle Cell Trait Positive African Americans. Genes (Basel) 2024; 15:408. [PMID: 38674343 PMCID: PMC11049803 DOI: 10.3390/genes15040408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Sickle cell trait (SCT), although generally a benign carrier state of hemoglobin S (HbAS), is a risk factor for exertional rhabdomyolysis (ERM), a rare but potentially fatal consequence of highly intense physical exercise, particularly among active-duty military personnel and high-performance athletes. The association between SCT and ERM is poorly understood. The objective of this study was to elucidate the genetic basis of ERM in an SCT-positive African American cohort. SCT-positive African Americans with a personal history of ERM (cases, n = 30) and without history of ERM (controls, n = 53) were enrolled in this study. Whole-genome sequencing was performed on DNA samples isolated from peripheral white blood cells. Participants' demographic, behavioral, and medical history information was obtained. An additional 131 controls were extracted from SCT-positive subjects of African descent from the 1000 Genomes Project. SCT carriers with ERM were characterized by myotoxicity features, significant muscle involvement dominated by muscle weakness, and severe pain and substantial increase in serum creatine kinase, with a mean value of 50,480 U/L. A distinctive feature of the SCT individuals with ERM was exertional collapse, which was reported in 53.3% of the cases in the study cohort. An important factor for the development of ERM was the duration and frequency of strenuous physical activity in the cases compared to the controls. Whole-genome sequencing identified 79,696 protein-coding variants. Genome-wide association analysis revealed that the p.C477R, rs115958260 variant in the SLC44A3 gene was significantly associated with ERM event in SCT-positive African Americans. The study results suggest that a combination of vigorous exercise and a genetic predisposing factor is involved in ERM.
Collapse
Affiliation(s)
- Mingqiang Ren
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Nyamkhishig Sambuughin
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Ognoon Mungunshukh
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Daniel Baxter Edgeworth
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Daniel Hupalo
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Xijun Zhang
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Matthew D. Wilkerson
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Clifton L. Dalgard
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Francis G. O’Connor
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
| |
Collapse
|
2
|
Agharokh L, Zaniletti I, Yu AG, Lee BC, Hall M, Williams DJ, Wilson KM. Trends in Pediatric Rhabdomyolysis and Associated Renal Failure: A 10-Year Population-Based Study. Hosp Pediatr 2022; 12:718-725. [PMID: 35879468 DOI: 10.1542/hpeds.2021-006484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Rhabdomyolysis in children is a highly variable condition with presentations ranging from myalgias to more severe complications like acute renal failure. We sought to explore demographics and incidence of pediatric rhabdomyolysis hospitalizations and rates of associated renal failure, as our current understanding is limited. METHODS This was a retrospective analysis using the Healthcare Cost and Utilization Project Kids' Inpatient Database to identify children hospitalized with a primary diagnosis of rhabdomyolysis. Data were analyzed for demographic characteristics, as well as geographic and temporal trends. Multivariable logistic regression was used to identify characteristics associated with rhabdomyolysis-associated acute renal failure. RESULTS From 2006 to 2016, there were 8599 hospitalized children with a primary diagnosis of rhabdomyolysis. Overall, hospitalizations for pediatric rhabdomyolysis are increasing over time, with geographic peaks in the South and Northeast regions, and seasonal peaks in March and August. Though renal morbidity was diagnosed in 8.5% of children requiring hospitalization for rhabdomyolysis, very few of these patients required renal replacement therapy (0.41%), and death was rare (0.03%). Characteristics associated with renal failure included male sex, age greater than 15 years, and non-Hispanic Black race. CONCLUSIONS Though renal failure occurs at a significant rate in children hospitalized with rhabdomyolysis, severe complications, including death, are rare. The number of children hospitalized with rhabdomyolysis varies by geographic region and month of the year. Future studies are needed to explore etiologies of rhabdomyolysis and laboratory values that predict higher risk of morbidity and mortality in children with rhabdomyolysis.
Collapse
Affiliation(s)
- Ladan Agharokh
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Texas - Southwestern Medical Center, Dallas
| | | | - Andrew G Yu
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Texas - Southwestern Medical Center, Dallas
| | - Benjamin C Lee
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Texas - Southwestern Medical Center, Dallas
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Derek J Williams
- Department of Pediatrics, Division of Hospital Medicine, Vanderbilt University, School of Medicine, Nashville, Tennessee
| | - Karen M Wilson
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Rochester, School of Medicine, Rochester, New York
| |
Collapse
|
3
|
American Football Players in Preseason Training at Risk of Acute Kidney Injury Without Signs of Rhabdomyolysis. Clin J Sport Med 2020; 30:556-561. [PMID: 30119084 DOI: 10.1097/jsm.0000000000000652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study was designed to identify changes in blood biomarkers that would indicate excessive muscle breakdown during the initial 10 days of preseason training in collegiate American football players and subsequently increase their risk of acute kidney injury (AKI). DESIGN Prospective cohort study. SETTING Preseason, heat acclimatization period. PARTICIPANTS Twenty-five Division I American football players. INTERVENTION Clinical biomarkers for muscle damage were measured during a preseason training camp. Samples were obtained before camp and approximately 5 and 10 days into camp after completion of heat acclimatization training. MAIN OUTCOMES Creatine kinase, myoglobin, lactate dehydrogenase, and creatinine were measured. Glomerular filtration rate (GFR) was calculated. Urine was collected at each blood draw to qualitatively identify hematuria and red blood cells. RESULTS A high percentage of athletes had an asymptomatic reduction in kidney function over the 10-day period. Ten of 23 athletes did have a significant, 31.6%, mean reduction in GFR, placing each at risk of AKI according to Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) classification. The plasma myoglobin for the at risk of AKI group had a mean value 8× above their baseline mean on day 5 and statistically significant mean 13× higher on day 10 than baseline. The not at risk of AKI group did not have significant differences between days 0, 5, and 10. CONCLUSIONS A relatively high percentage of athletes had an asymptomatic reduction in kidney function during the intense preseason training period. 43.4% of athletes in this study had a significant 31.6% mean reduction in GFR over the 10 days. According to RIFLE classification, this placed each athlete "at risk" of AKI.
Collapse
|
4
|
Ramos-Paesa C, Huguet-Embún L, Arenas-Miquelez AI, de los Mozos-Ruano A. Fiebre de origen no filiado y rabdomiólisis en una inmigrante procedente de África. Enferm Infecc Microbiol Clin 2020; 38:343-344. [DOI: 10.1016/j.eimc.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/13/2019] [Accepted: 10/20/2019] [Indexed: 11/15/2022]
|
5
|
Hu J, Nelson DA, Deuster PA, Marks ES, O'Connor FG, Kurina LM. Sickle cell trait and renal disease among African American U.S. Army soldiers. Br J Haematol 2019; 185:532-540. [PMID: 30859563 DOI: 10.1111/bjh.15820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
Sickle cell trait and certain renal disorders are disproportionately prevalent among African American individuals, so a clear understanding of their association is important. We conducted a longitudinal study using the Stanford Military Data Repository to examine sickle cell trait in relation to the incidence of acute kidney injury (AKI) and chronic kidney disease (CKD). Our study population consisted of African American U.S. Army soldiers on active duty between January 2011 and December 2014. The cumulative incidence was 0·51% for AKI (236 cases out of 45 901 soldiers) and 0·56% for CKD (255 cases out of 45 882 soldiers). Discrete time logistic regression models adjusting for demographic-, military- and healthcare-related covariates showed that sickle cell trait was associated with significantly higher adjusted odds of both AKI [odds ratio (OR): 1·74; 95% confidence interval (CI): 1·17-2·59] and CKD (OR: 2·00; 95% CI: 1·39-2·88). Elevated odds of AKI and CKD were also observed in association with prior CKD and AKI, respectively, and with obesity and prior hypertension. Individuals with sickle cell trait and their providers should be aware of the possibility of increased risk of AKI and CKD to allow for timely intervention and possible prevention.
Collapse
Affiliation(s)
- Jiaqi Hu
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - D Alan Nelson
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance (A DoD Center of Excellence), Military and Emergency Medicine, Hébert School of Medicine, Uniformed Services University, Bethesda, MA, USA
| | - Eric S Marks
- Department of Medicine, Division of Nephrology, Uniformed Services University, Bethesda, MA, USA
| | - Francis G O'Connor
- Consortium for Health and Military Performance (A DoD Center of Excellence), Military and Emergency Medicine, Hébert School of Medicine, Uniformed Services University, Bethesda, MA, USA
| | - Lianne M Kurina
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
6
|
Thompson TL, Nguyen TX, Karodeh CR. Twelve cases of exertional rhabdomyolysis in college football players from the same institution over a 23-year span: a descriptive study. PHYSICIAN SPORTSMED 2018; 46:331-334. [PMID: 29855209 DOI: 10.1080/00913847.2018.1481717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Rhabdomyolysis is a syndrome characterized by muscle necrosis that leads to release of the intracellular contents of muscle cells into the systemic circulation. Rhabdomyolysis due to overexertion is an uncommon but well-known severe complication of strenuous activity. Exertional rhabdomyolysis (ER) is typically described in weight lifters and military recruits undergoing basic training. Few cases have been reported in football players without known predisposing risk factors. We report our experience with this condition in college football players in a single institution. MATERIALS AND METHODS College football players hospitalized for heat illness complicated by rhabdomyolysis were identified over a 23-year period. Clinical and laboratory findings were collected. Clinical course was recorded. RESULTS Twelve patients were identified. All were Black males. One had sickle cell trait. BMI averaged 33 kg/m2 (range 23-45 kg/m2). Peak creatine phosphokinase (CPK) averaged 14,850 IU/L (range 1,021-109,616 IU/L). Serum creatinine averaged 1.9 mg/dl (range 1.2-3.1 mg/dl). Ten of twelve cases occurred in August. All responded to intravenous hydration with normalization of CPK and renal function. All returned to football. CONCLUSIONS ER is a serious complication of strenuous physical activity that can threaten renal function. ER tends to occur in August, which coincides with the start of football practice when athletes are more likely to be detrained. The condition can occur in Black athletes in the absence of sickle cell trait. ER carries a good prognosis when recognized early and treated adequately.
Collapse
Affiliation(s)
- Terry L Thompson
- a Department of Orthopaedic Surgery and Rehabilitation , Howard University College of Medicine , Washington, DC , USA
| | - Thomas X Nguyen
- b Orthopaedic Resident , Howard University Hospital , Washington, DC , USA
| | - Cina R Karodeh
- c Medical Student , Howard University College of Medicine , Washington, DC , USA
| |
Collapse
|
7
|
Nontraumatic Exertional Rhabdomyolysis Leading to Acute Kidney Injury in a Sickle Trait Positive Individual on Renal Biopsy. Case Rep Nephrol 2018; 2018:5841216. [PMID: 29850311 PMCID: PMC5925017 DOI: 10.1155/2018/5841216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/07/2018] [Accepted: 03/04/2018] [Indexed: 01/06/2023] Open
Abstract
A 26-year-old African American male with a history of congenital cerebral palsy, sickle cell trait, and intellectual disability presented with abdominal pain that started four hours prior to the hospital visit. The patient denied fever, chills, diarrhea, or any localized trauma. The patient was at a party at his community center last evening and danced for 2 hours, physically exerting himself more than usual. Labs revealed blood urea nitrogen (BUN) level of 41 mg/dL and creatinine (Cr) of 2.8 mg/dL which later increased to 4.2 mg/dL while still in the emergency room. Urinalysis revealed hematuria with RBC > 50 on high power field. Imaging of the abdomen revealed no acute findings for abdominal pain. With fractional excretion of sodium (FeNa) > 3%, findings suggested nonoliguric acute tubular necrosis. Over the next couple of days, symptoms of dyspepsia resolved; however, BUN/Cr continued to rise to a maximum of 122/14 mg/dL. With these findings, along with stable electrolytes, urine output matching the intake, and prior use of proton pump inhibitors, medical decision was altered for the possibility of acute interstitial nephritis. Steroids were subsequently started and biopsy was taken. Biopsy revealed heavy deposits of myoglobin. Creatinine phosphokinase (CPK) levels drawn ten days later after the admission were found to be elevated at 334 U/dl, presuming the levels would have been much higher during admission. This favored a diagnosis of acute kidney injury (AKI) secondary to exertional rhabdomyolysis. We here describe a case of nontraumatic exertional rhabdomyolysis in a sickle cell trait (SCT) individual that was missed due to findings of microscopic hematuria masking underlying myoglobinuria and fractional excretion of sodium > 3%. As opposed to other causes of ATN, rhabdomyolysis often causes FeNa < 1%. The elevated fractional excretion of sodium in this patient was possibly due to the underlying inability of SCT positive individuals to reabsorb sodium/water and concentrate their urine. Additionally, because of their inability to concentrate urine, SCT positive individuals are prone to intravascular depletion leading to renal failure as seen in this patient. Disease was managed with continuing hydration and tapering steroids. Kidney function improved and the patient was discharged with a creatinine of 3 mg/dL. A month later, renal indices were completely normal with persistence of microscopic hematuria from SCT.
Collapse
|
8
|
Odolini S, Gobbi F, Zammarchi L, Migliore S, Mencarini P, Vecchia M, di Lauria N, Schivazappa S, Sabatini T, Chianura L, Vanino E, Piacentini D, Zanotti P, Bussi A, Bartoloni A, Bisoffi Z, Castelli F. Febrile rhabdomyolysis of unknown origin in refugees coming from West Africa through the Mediterranean. Int J Infect Dis 2017; 62:77-80. [PMID: 28756023 DOI: 10.1016/j.ijid.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Cases of undiagnosed severe febrile rhabdomyolysis in refugees coming from West Africa, mainly from Nigeria, has been observed since May 2014. The aim of this study was to describe this phenomenon. METHODS This was a multicentre retrospective observational study of cases of febrile rhabdomyolysis reported from May 2014 to December 2016 in 12 Italian centres. RESULTS A total of 48 cases were observed, mainly in young males. The mean time interval between the day of departure from Libya and symptom onset was 26.2 days. An average 8.3 further days elapsed before medical care was sought. All patients were hospitalized with fever and very intense muscle aches. Creatine phosphokinase, aspartate aminotransferase, and lactate dehydrogenase values were abnormal in all cases. The rhabdomyolysis was ascribed to an infective agent in 16 (33.3%) cases. In the remaining cases, the aetiology was undefined. Four out of seven patients tested had sickle cell trait. No alcohol abuse or drug intake was reported, apart from a single reported case of khat ingestion. CONCLUSIONS The long incubation period does not support a mechanical cause of rhabdomyolysis. Furthermore, viral infections such as those caused by coxsackievirus are rarely associated with such a severe clinical presentation. It is hypothesized that other predisposing conditions like genetic factors, unknown infections, or unreported non-conventional remedies may be involved. Targeted surveillance of rhabdomyolysis cases is warranted.
Collapse
Affiliation(s)
- Silvia Odolini
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy.
| | - Federico Gobbi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Lorenzo Zammarchi
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Paola Mencarini
- Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Marco Vecchia
- Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicoletta di Lauria
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simona Schivazappa
- Infectious Diseases-IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Tony Sabatini
- Department of Internal Medicine, Gastroenterology and Digestive Endoscopy, Poliambulanza Hospital Clinical Institute, Brescia, Italy
| | - Leonardo Chianura
- Division of Infectious Diseases, AO Niguarda Ca' Granda Hospital, Milan, Italy
| | - Elisa Vanino
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Paola Zanotti
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Anna Bussi
- Clinica di Medicina Interna, Azienda Socio Sanitaria Territoriale del Garda, Manerbio (BS), Italy
| | - Alessandro Bartoloni
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| |
Collapse
|
9
|
Liem RI, Chan C, Vu THT, Fornage M, Thompson AA, Liu K, Carnethon MR. Association among sickle cell trait, fitness, and cardiovascular risk factors in CARDIA. Blood 2017; 129:723-728. [PMID: 27856464 PMCID: PMC5301825 DOI: 10.1182/blood-2016-07-727719] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/14/2016] [Indexed: 01/21/2023] Open
Abstract
The contribution of sickle cell trait (SCT) to racial disparities in cardiopulmonary fitness is not known, despite concerns that SCT is associated with exertion-related sudden death. We evaluated the association of SCT status with cross-sectional and longitudinal changes in fitness and risk for hypertension, diabetes, and metabolic syndrome over the course of 25 years among 1995 African Americans (56% women, 18-30 years old) in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Overall, the prevalence of SCT was 6.8% (136/1995) in CARDIA, and over the course of 25 years, 46% (738/1590), 18% (288/1631), and 40% (645/1,611) of all participants developed hypertension, diabetes, and metabolic syndrome, respectively. Compared with participants without SCT, participants with SCT had similar baseline measures of fitness in cross-section, including exercise duration (535 vs 540 seconds; P = .62), estimated metabolic equivalent of tasks (METs; 11.6 vs 11.7; P = .80), maximum heart rate (174 vs 175 beats/min; P = .41), and heart rate at 2 minutes recovery (44 vs 43 beats/min; P = .28). In our secondary analysis, there was neither an association of SCT status with longitudinal changes in fitness nor an association with development of hypertension, diabetes, or metabolic syndrome after adjustment for sex, baseline age, body mass index, fitness, and physical activity. SCT is not associated with reduced fitness in this longitudinal study of young African American adults, suggesting the increased risk for exertion-related sudden death in SCT carriers is unlikely related to fitness. SCT status also is not an independent risk factor for developing hypertension, diabetes, or metabolic syndrome.
Collapse
Affiliation(s)
- Robert I Liem
- Hematology, Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, and
| | - Cheeling Chan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; and
| | - Thanh-Huyen T Vu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; and
| | - Myriam Fornage
- Institute of Molecular Medicine, Research Center for Human Genetics, University of Texas School of Medicine, Houston, TX
| | - Alexis A Thompson
- Hematology, Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, and
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; and
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; and
| |
Collapse
|
10
|
Potential factors involved in the causation of rhabdomyolysis following status asthmaticus. Allergy Asthma Clin Immunol 2016; 12:43. [PMID: 27555875 PMCID: PMC4994408 DOI: 10.1186/s13223-016-0149-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 08/09/2016] [Indexed: 12/18/2022] Open
Abstract
Rhabdomyolysis is a rare but potentially fatal complication of status asthmaticus. Since the first case was reported in 1978, only a few dozen cases have been described till date. We performed a literature review with the aim to characterize the pathophysiological basis of the occurrence of rhabdomyolysis in patients with status asthmaticus. Excessive exertion of respiratory muscles, hypoxia and acidosis, electrolyte imbalance, infections, some drugs used for asthma control, use of mechanical ventilation, prolonged cardiopulmonary resuscitation, higher age of the patient and some underlying diseases or genetic factors appear to be involved in its causation. In patients with status asthmaticus, it is important to pay more attention to these factors and to closely monitor creatine kinase levels in blood so as to ensure early detection of rhabdomyolysis.
Collapse
|
11
|
Nelson DA, Deuster PA, Carter R, Hill OT, Wolcott VL, Kurina LM. Sickle Cell Trait, Rhabdomyolysis, and Mortality among U.S. Army Soldiers. N Engl J Med 2016; 375:435-42. [PMID: 27518662 PMCID: PMC5026312 DOI: 10.1056/nejmoa1516257] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies have suggested that sickle cell trait elevates the risks of exertional rhabdomyolysis and death. We conducted a study of sickle cell trait in relation to these outcomes, controlling for known risk factors for exertional rhabdomyolysis, in a large population of active persons who had undergone laboratory tests for hemoglobin AS (HbAS) and who were subject to exertional-injury precautions. METHODS We used Cox proportional-hazards models to test whether the risks of exertional rhabdomyolysis and death varied according to sickle cell trait status among 47,944 black soldiers who had undergone testing for HbAS and who were on active duty in the U.S. Army between January 2011 and December 2014. We used the Stanford Military Data Repository, which contains comprehensive medical and administrative data on all active-duty soldiers. RESULTS There was no significant difference in the risk of death among soldiers with sickle cell trait, as compared with those without the trait (hazard ratio, 0.99; 95% confidence interval [CI], 0.46 to 2.13; P=0.97), but the trait was associated with a significantly higher adjusted risk of exertional rhabdomyolysis (hazard ratio, 1.54; 95% CI, 1.12 to 2.12; P=0.008). This effect was similar in magnitude to that associated with tobacco use, as compared with no use (hazard ratio, 1.54; 95% CI, 1.23 to 1.94; P<0.001), and to that associated with having a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 30.0 or more, as compared with a BMI of less than 25.0 (hazard ratio, 1.39; 95% CI, 1.04 to 1.86; P=0.03). The effect was less than that associated with recent use of a statin, as compared with no use (hazard ratio, 2.89; 95% CI, 1.51 to 5.55; P=0.001), or an antipsychotic agent (hazard ratio, 3.02; 95% CI, 1.34 to 6.82; P=0.008). CONCLUSIONS Sickle cell trait was not associated with a higher risk of death than absence of the trait, but it was associated with a significantly higher risk of exertional rhabdomyolysis. (Funded by the National Heart, Lung, and Blood Institute and the Uniformed Services University of the Health Sciences.).
Collapse
Affiliation(s)
- D Alan Nelson
- From the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.A.N., L.M.K.); the Consortium for Health and Military Performance, Department of Defense Center of Excellence, and the Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD (P.A.D.); and the U.S. Army Institute of Surgical Research (R.C.), the Extremity Trauma and Amputation Center of Excellence, Center for the Intrepid, Brooke Army Medical Center (O.T.H.), and the Army-Baylor University Graduate Program in Health and Business Administration (V.L.W.), Fort Sam Houston, and the Department of Emergency Medicine, University of Texas Health Science Center at San Antonio (R.C.) - all in San Antonio, TX
| | - Patricia A Deuster
- From the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.A.N., L.M.K.); the Consortium for Health and Military Performance, Department of Defense Center of Excellence, and the Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD (P.A.D.); and the U.S. Army Institute of Surgical Research (R.C.), the Extremity Trauma and Amputation Center of Excellence, Center for the Intrepid, Brooke Army Medical Center (O.T.H.), and the Army-Baylor University Graduate Program in Health and Business Administration (V.L.W.), Fort Sam Houston, and the Department of Emergency Medicine, University of Texas Health Science Center at San Antonio (R.C.) - all in San Antonio, TX
| | - Robert Carter
- From the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.A.N., L.M.K.); the Consortium for Health and Military Performance, Department of Defense Center of Excellence, and the Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD (P.A.D.); and the U.S. Army Institute of Surgical Research (R.C.), the Extremity Trauma and Amputation Center of Excellence, Center for the Intrepid, Brooke Army Medical Center (O.T.H.), and the Army-Baylor University Graduate Program in Health and Business Administration (V.L.W.), Fort Sam Houston, and the Department of Emergency Medicine, University of Texas Health Science Center at San Antonio (R.C.) - all in San Antonio, TX
| | - Owen T Hill
- From the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.A.N., L.M.K.); the Consortium for Health and Military Performance, Department of Defense Center of Excellence, and the Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD (P.A.D.); and the U.S. Army Institute of Surgical Research (R.C.), the Extremity Trauma and Amputation Center of Excellence, Center for the Intrepid, Brooke Army Medical Center (O.T.H.), and the Army-Baylor University Graduate Program in Health and Business Administration (V.L.W.), Fort Sam Houston, and the Department of Emergency Medicine, University of Texas Health Science Center at San Antonio (R.C.) - all in San Antonio, TX
| | - Vickee L Wolcott
- From the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.A.N., L.M.K.); the Consortium for Health and Military Performance, Department of Defense Center of Excellence, and the Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD (P.A.D.); and the U.S. Army Institute of Surgical Research (R.C.), the Extremity Trauma and Amputation Center of Excellence, Center for the Intrepid, Brooke Army Medical Center (O.T.H.), and the Army-Baylor University Graduate Program in Health and Business Administration (V.L.W.), Fort Sam Houston, and the Department of Emergency Medicine, University of Texas Health Science Center at San Antonio (R.C.) - all in San Antonio, TX
| | - Lianne M Kurina
- From the Department of Medicine, Stanford University School of Medicine, Stanford, CA (D.A.N., L.M.K.); the Consortium for Health and Military Performance, Department of Defense Center of Excellence, and the Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD (P.A.D.); and the U.S. Army Institute of Surgical Research (R.C.), the Extremity Trauma and Amputation Center of Excellence, Center for the Intrepid, Brooke Army Medical Center (O.T.H.), and the Army-Baylor University Graduate Program in Health and Business Administration (V.L.W.), Fort Sam Houston, and the Department of Emergency Medicine, University of Texas Health Science Center at San Antonio (R.C.) - all in San Antonio, TX
| |
Collapse
|
12
|
Rubio MÁ, Díez L, Álvarez N, Munteis E. [Muscle involvement in sickle cell disease]. Med Clin (Barc) 2015; 145:413-4. [PMID: 25662725 DOI: 10.1016/j.medcli.2014.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Miguel Ángel Rubio
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital del Mar, Barcelona, España.
| | - Laura Díez
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital del Mar, Barcelona, España
| | - Nuria Álvarez
- Sección de Neurofisiología, Servicio de Neurología, Hospital del Mar, Barcelona, España
| | - Elvira Munteis
- Unidad de Enfermedades Neuromusculares, Servicio de Neurología, Hospital del Mar, Barcelona, España
| |
Collapse
|
13
|
|
14
|
Nnadi E, Manafa P, Okocha E, Chukwuma G, Aneke J. Evaluation of creatine kinase activity and inorganic phosphate concentration in adult nigerian homozygous and heterozygous hemoglobin phenotypes. Ann Med Health Sci Res 2014; 4:697-700. [PMID: 25328777 PMCID: PMC4199158 DOI: 10.4103/2141-9248.141518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Biochemical parameters vary in subjects with different hemoglobin phenotypes, compared with normal controls. Aim: The aim was to evaluate serum creatine kinase (CK) activity and inorganic phosphate concentrations in Nigerian adults with homozygous and heterozygous hemoglobin phenotypes. Subjects and Methods: A prospective study, carried out at the hematology out-patient clinic of our hospital, a community health center and a private hospital, all in Anambra state. Subjects included hemoglobin phenotypes AA, AS, and SS, in steady state and vaso-occlusive crisis (VOC). Samples were collected for serum CK activity and inorganic phosphate concentrations. Data obtained were analyzed using SPSS 16.0 (SPSS Inc., Chicago IL, USA). Means were compared using the Student's t-test and statistical significance was set at P < 0.05. Results: A total of 100 subjects participated in the study. There was a statistically significant difference in the means of serum CK activity in hemoglobin SS (HbSS) in VOC versus hemoglobin AA (HbAA) (P = 0.01) and HbSS in steady state versus HbAA (P = 0.02) but not in hemoglobin AS (HbAS) versus HbAA (P = 0.79) and HbSS in VOC versus HbSS in steady state (P = 0.06). A statistically significant difference was noted in the means of serum inorganic phosphate concentration in HbSS in VOC versus HbAA (P = 0.01), but not in HbSS in steady state versus HbAA (P = 0.43), HbSS in VOC versus HbSS in steady state (P = 0.09) and HbAS versus HbAA (P = 0.20). Conclusion: Sickle cell disease is a predictor for high serum CK activity and low serum concentration of inorganic phosphate, particularly in VOC. There may be a need to monitor serum CK activity in HbSS subjects presenting with major VOC.
Collapse
Affiliation(s)
- Ee Nnadi
- Department of Medical Laboratory Science, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
| | - Po Manafa
- Department of Medical Laboratory Science, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
| | - Ec Okocha
- Department of Hematology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Go Chukwuma
- Department of Medical Laboratory Science, Nnamdi Azikiwe University, Nnewi, Anambra State, Nigeria
| | - Jc Aneke
- Department of Hematology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| |
Collapse
|
15
|
Mok Y, Quah J, Siau C. A rare but potentially lethal complication of dengue. ASIAN PAC J TROP MED 2014; 6:500-1. [PMID: 23711715 DOI: 10.1016/s1995-7645(13)60083-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 04/15/2013] [Accepted: 05/15/2013] [Indexed: 11/24/2022] Open
Abstract
Severe rhabdomyolysis is an uncommon but potentially fatal complication of dengue fever that is not well characterised and may be underreported. With the resurgence and continued rise of dengue cases worldwide, physicians must be aware of the less common but serious complications of dengue. Here, we report a patient who presented with severe rhabdomyolysis secondary to dengue fever with a serum creatine kinase of 742 900 U/L.
Collapse
Affiliation(s)
- Yingjuan Mok
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
| | | | | |
Collapse
|
16
|
Vila Bou J, Juncà Piera J, Torrent Catarineu A, Rodríguez Fernández I. Rabdomiólisis y rasgo drepanocítico. Med Clin (Barc) 2013; 141:136-7. [DOI: 10.1016/j.medcli.2012.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
|
17
|
Genetic polymorphisms associated with exertional rhabdomyolysis. Eur J Appl Physiol 2013; 113:1997-2004. [PMID: 23543093 DOI: 10.1007/s00421-013-2622-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/27/2013] [Indexed: 01/09/2023]
Abstract
Exertional rhabdomyolysis (ER) occurs in young, otherwise healthy, individuals principally during strenuous exercise, athletic, and military training. Although many risk factors have been offered, it is unclear why some individuals develop ER when participating in comparable levels of physical exertion under identical environmental conditions and others do not. This study investigated possible genetic polymorphisms that might help explain ER. DNA samples derived from a laboratory-based study of persons who had never experienced an episode of ER (controls) and clinical ER cases referred for testing over the past several years were analyzed for single nucleotide polymorphisms (SNPs) in candidate genes. These included angiotensin I converting enzyme (ACE), α-actinin-3 (ACTN3), creatine kinase muscle isoform (CKMM), heat shock protein A1B (HSPA1B), interleukin 6 (IL6), myosin light chain kinase (MYLK), adenosine monophosphate deaminase 1 (AMPD1), and sickle cell trait (HbS). Population included 134 controls and 47 ER cases. The majority of ER cases were men (n = 42/47, 89.4 %); the five women with ER were Caucasian. Eighteen African Americans (56.3 %) were ER cases. Three SNPs were associated with ER: CKMM Ncol, ACTN3 R577X, and MYLK C37885A. ER cases were 3.1 times more likely to have the GG genotype of CKMM (odds ratio/OR = 3.1, confidence interval/CI 1.33-7.10), 3.0 times for the XX genotype of ACTN3 SNP (OR = 2.97, CI 1.30-3.37), and 5.7 times for an A allele of MYLK (OR = 21.35, CI 2.60-12.30). All persons with HbS were also ER cases. Three distinct polymorphisms were associated with ER. Further work will be required to replicate these findings and determine the mechanism(s) whereby these variants might confer susceptibility.
Collapse
|
18
|
Yusuf HR, Lloyd-Puryear MA, Grant AM, Parker CS, Creary MS, Atrash HK. Sickle cell disease: the need for a public health agenda. Am J Prev Med 2011; 41:S376-83. [PMID: 22099361 DOI: 10.1016/j.amepre.2011.09.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 08/13/2011] [Accepted: 09/07/2011] [Indexed: 12/01/2022]
Abstract
Sickle cell disease (SCD) is a collection of inherited blood disorders that affect a substantial number of people in the U.S., particularly African Americans. People with SCD have an abnormal type of hemoglobin, Hb S, which polymerizes when deoxygenated, causing the red blood cells to become misshapen and rigid. Individuals with SCD are at higher risk of morbidity and mortality from infections, vaso-occlusive pain crises, acute chest syndrome, and other complications. Addressing the public health needs related to SCD is an important step toward improving outcomes and maintaining health for those affected by the disorder. The objective of this study was to review public health activities focusing on SCD and define the need to address it more comprehensively from a public health perspective. We found that there has been some progress in the development of SCD-related public health activities. Such activities include establishing newborn screening (NBS) for SCD with all states currently having universal NBS programs. However, additional areas needing focus include strengthening surveillance and monitoring of disease occurrence and health outcomes, enhancing adherence to health maintenance guidelines, increasing knowledge and awareness among those affected, and improving healthcare access and utilization. These and other activities discussed in this paper can help strengthen public health efforts to address SCD.
Collapse
Affiliation(s)
- Hussain R Yusuf
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia 30333, USA.
| | | | | | | | | | | |
Collapse
|
19
|
Screening U.S. college athletes for their sickle cell disease carrier status. Am J Prev Med 2011; 41:S406-12. [PMID: 22099365 DOI: 10.1016/j.amepre.2011.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 08/22/2011] [Accepted: 09/12/2011] [Indexed: 11/23/2022]
Abstract
There are many issues surrounding the screening of collegiate athletes for their sickle cell disease carrier status (or sickle cell trait), a genetic condition. This paper summarizes the establishment of expert advice given to the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC) on the issue. The SACHDNC has developed a report to advise the Secretary of the USDHHS about the 2010 rule of the National Collegiate Athletic Association (NCAA) requiring testing for sickle cell trait in all incoming Division I student athletes. The SACHDNC does not support the NCAA's rule to screen collegiate athletes for sickle cell trait.
Collapse
|
20
|
Jung AP, Selmon PB, Lett JL, Petrella JK. Survey of sickle cell trait screening in NCAA and NAIA institutions. PHYSICIAN SPORTSMED 2011; 39:158-65. [PMID: 21378498 DOI: 10.3810/psm.2011.02.1873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Screening for sickle cell trait (SCT) in athletes has been recommended by several professional organizations; however, it is not known how many colleges and universities have implemented such screening in athletes. AIMS This study examines factors related to policies and procedures of SCT screening at colleges and universities, including all divisions of the National Collegiate Athletic Association (NCAA) and the National Association of Intercollegiate Athletics (NAIA) programs. METHODS A total of 375 head athletic trainers or directors of sports medicine from NCAA and NAIA schools responded to an online survey. RESULTS 21.8% of the respondent institutions screened all of their athletes for SCT, with Division I institutions having the highest rate of screening at 44.6%. A total of 30.1% of the respondent institutions indicated that they screened some of their athletes, with 66.9% of Division I institutions having the highest incidence. Over 26% of respondent institutions did not know if any of their athletes had SCT. Overall, 57% of the institutions counsel athletes about complications of SCT, and 40% of the institutions modify workouts for the athletes. Division I institutions had the highest incidences, with 87.7% providing counseling and 66.1% modifying workouts. The most common criteria for screening are race/ethnicity and family history of SCT. When asked to provide reasons for not screening all athletes, 71.6% of all respondent institutions indicated cost was the primary reason. CONCLUSION Screening for SCT remains a relatively uncommon practice in colleges and universities, particularly in NCAA Divisions II and III, and NAIA institutions. From the institutions' perspective, the cost of testing is overwhelmingly the primary reason for not screening all athletes for SCT.
Collapse
|
21
|
George M, Delgaudio A, Salhanick SD. Exertional rhabdomyolysis--when should we start worrying? Case reports and literature review. Pediatr Emerg Care 2010; 26:864-6. [PMID: 21057287 DOI: 10.1097/pec.0b013e3181f9dcd1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Exertional rhabdomyolysis (ER) is a serious medical issue usually seen in individuals or patients after engaging in heavy exertion and physical activity. The incidence, natural course, and recurrence of ER are, by and large, unknown. Given the lack of rigorous scientific data that are specific for ER, most of the patients with ER receive treatment in an inpatient setting even with only a mild elevation of creatine phosphokinase (CPK) level. Often, patients receive inpatient treatment solely on the basis of elevated CPK (<3000 IU) even in the absence of other serious signs and symptoms of ER. We intent to describe 2 case reports that involve patients who developed ER after an intense physical exertion and were managed in an outpatient setting with close follow-up. In the discussion part, we point suggest that in patients with a relatively mild CPK elevation (<15,000 IU) and normal creatinine value and in the absence of factors such as profound dehydration, sickle cell trait, concomitant infectious cause, underlying metabolic syndrome, and current and ongoing use of analgesics, the complications after ER are low. Patients who develop ER, who can be reliably followed up, and who fulfills these criteria can be managed as outpatients.
Collapse
|
22
|
Varma H, Yamamoto A, Sarantos MR, Hughes RE, Stockwell BR. Mutant huntingtin alters cell fate in response to microtubule depolymerization via the GEF-H1-RhoA-ERK pathway. J Biol Chem 2010; 285:37445-57. [PMID: 20858895 PMCID: PMC2988350 DOI: 10.1074/jbc.m110.125542] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cellular responses to drug treatment show tremendous variations. Elucidating mechanisms underlying these variations is critical for predicting therapeutic responses and developing personalized therapeutics. Using a small molecule screening approach, we discovered how a disease causing allele leads to opposing cell fates upon pharmacological perturbation. Diverse microtubule-depolymerizing agents protected mutant huntingtin-expressing cells from cell death, while being toxic to cells lacking mutant huntingtin or those expressing wild-type huntingtin. Additional neuronal cell lines and primary neurons from Huntington disease mice also showed altered survival upon microtubule depolymerization. Transcription profiling revealed that microtubule depolymerization induced the autocrine growth factor connective tissue growth factor and activated ERK survival signaling. The genotype-selective rescue was dependent upon increased RhoA protein levels in mutant huntingtin-expressing cells, because inhibition of RhoA, its downstream effector, Rho-associated kinase (ROCK), or a microtubule-associated RhoA activator, guanine nucleotide exchange factor-H1 (GEF-H1), all attenuated the rescue. Conversely, RhoA overexpression in cells lacking mutant huntingtin conferred resistance to microtubule-depolymerizer toxicity. This study elucidates a novel pathway linking microtubule stability to cell survival and provides insight into how genetic context can dramatically alter cellular responses to pharmacological interventions.
Collapse
Affiliation(s)
- Hemant Varma
- Department of Biological Sciences, Howard Hughes Medical Institute, New York, New York 10027, USA
| | | | | | | | | |
Collapse
|
23
|
Abstract
Muscle tissue may be damaged following intense prolonged training as a consequence of both metabolic and mechanical factors. Serum levels of skeletal muscle enzymes or proteins are markers of the functional status of muscle tissue, and vary widely in both pathological and physiological conditions. Creatine kinase, lactate dehydrogenase, aldolase, myoglobin, troponin, aspartate aminotransferase, and carbonic anhydrase CAIII are the most useful serum markers of muscle injury, but apoptosis in muscle tissues subsequent to strenuous exercise may be also triggered by increased oxidative stress. Therefore, total antioxidant status can be used to evaluate the level of stress in muscle by other markers, such as thiobarbituric acid-reactive substances, malondialdehyde, sulfhydril groups, reduced glutathione, oxidized glutathione, superoxide dismutase, catalase and others. As the various markers provide a composite picture of muscle status, we recommend using more than one to provide a better estimation of muscle stress.
Collapse
Affiliation(s)
- Paola Brancaccio
- Servizio di Medicina dello Sport, Seconda Università di Napoli, Napoli, Italy
| | | | | |
Collapse
|
24
|
Tripette J, Loko G, Samb A, Gogh BD, Sewade E, Seck D, Hue O, Romana M, Diop S, Diaw M, Brudey K, Bogui P, Cissé F, Hardy-Dessources MD, Connes P. Effects of hydration and dehydration on blood rheology in sickle cell trait carriers during exercise. Am J Physiol Heart Circ Physiol 2010; 299:H908-14. [DOI: 10.1152/ajpheart.00298.2010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study compared the hemorheological responses of a group of sickle cell trait (SCT) carriers with those of a control (Cont) group in response to 40 min of submaximal exercise (exercise intensity, 55% aerobic peak power) performed in two conditions: one with water offered ad libitum, i.e., the hydration (Hyd) condition, and one without water, i.e., the dehydration (Dehyd) condition. Blood and plasma viscosities, as well as red blood cell rigidity, were determined at rest, at the end of exercise, and at 2 h recovery with a cone plate viscometer at high shear rate and 37°C. The SCT and Cont groups lost 1 ± 0.7 and 1.6 ± 0.6 kg of body weight, respectively, in the Dehyd condition, indicating a significant effect of water deprivation compared with the Hyd condition, in which body weight remained unchanged. Plasma viscosity increased with exercise and returned to baseline during recovery independently of the group and condition. As previously demonstrated, resting blood viscosity was greater in the SCT carriers than in the Cont group. Blood viscosity increased by the end of exercise and returned to baseline at 2 h recovery in the Cont group in both conditions. The blood viscosity of SCT carriers did not change in response to exercise in the Dehyd condition and remained elevated at 2 h recovery. This extended hyperviscosity, in association with other biological changes induced by exercise, could be considered as a risk factor for exercise-related events in SCT carriers, similar to vasoocclusive crises, notably during the recovery. In contrast, the Hyd condition normalized the hyperviscosity and red blood cell rigidity of the SCT carriers, with blood viscosity values reaching the same lower values as those found in the Cont group during the recovery. Adequate hydration of SCT carriers should be strongly promoted to reduce the clinical risk associated with potential hyperviscosity complications.
Collapse
Affiliation(s)
- Julien Tripette
- Laboratoire Acclimation au Climat Tropical, Exercice et Santé (EA 3596), Département de Physiologie, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
- Institut National de la Sante et de la Recherche Medicale U763, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
| | - Gylna Loko
- Laboratoire Acclimation au Climat Tropical, Exercice et Santé (EA 3596), Département de Physiologie, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
- Centre Intégré de la Drépanocytose, CH du Lamentin, Martinique-Centre de Références Maladies Rares Antilles-Guyane
| | - Abdoulaye Samb
- Laboratoire de Physiologie, Faculté de Médecine et de Pharmacie, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Bertin Doubi Gogh
- Laboratoire de Physiologie et d'Explorations Fonctionnelles, Unité de Formation et de Recherche en Sciences Médicales, Université de Cocody, Abidjan, Côte d'Ivoire
| | - Estelle Sewade
- Laboratoire de Physiologie, Faculté de Médecine et de Pharmacie, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Djibril Seck
- Institut National Supérieur de l'Education Populaire et du Sport, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Olivier Hue
- Laboratoire Acclimation au Climat Tropical, Exercice et Santé (EA 3596), Département de Physiologie, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
| | - Marc Romana
- Institut National de la Sante et de la Recherche Medicale U763, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
| | - Saliou Diop
- Centre National de Transfusion Sanguine, Dakar, Sénégal
| | - Mor Diaw
- Laboratoire de Physiologie, Faculté de Médecine et de Pharmacie, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Karine Brudey
- Unité Transversale de la Drépanocytose, Centre Hospitalier Universitaire, Pointe-à-Pitre, Guadeloupe-Centre de Références Maladies Rares Antilles-Guyane
| | - Pascal Bogui
- Laboratoire de Physiologie et d'Explorations Fonctionnelles, Unité de Formation et de Recherche en Sciences Médicales, Université de Cocody, Abidjan, Côte d'Ivoire
| | - Fallou Cissé
- Laboratoire de Physiologie, Faculté de Médecine et de Pharmacie, Université Cheikh Anta Diop, Dakar, Sénégal
| | - Marie-Dominique Hardy-Dessources
- Institut National de la Sante et de la Recherche Medicale U763, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
| | - Philippe Connes
- Laboratoire Acclimation au Climat Tropical, Exercice et Santé (EA 3596), Département de Physiologie, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
- Institut National de la Sante et de la Recherche Medicale U763, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe
| |
Collapse
|
25
|
Hooper WC, Miller CH, Key NS. Complications associated with carrier status among people with blood disorders: a commentary. Am J Prev Med 2010; 38:S456-8. [PMID: 20331943 DOI: 10.1016/j.amepre.2010.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 12/17/2009] [Accepted: 01/07/2010] [Indexed: 11/19/2022]
Affiliation(s)
- W Craig Hooper
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA 30333, USA.
| | | | | |
Collapse
|
26
|
Affiliation(s)
- Carlos E Sanchez
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, Ohio 43214-3998, USA.
| | | |
Collapse
|
27
|
ANZALONE MARYL, GREEN VALERIES, BUJA MAXIMILLIAN, SANCHEZ LUISA, HARRYKISSOON RAJESHI, EICHNER ERANDY. Sickle Cell Trait and Fatal Rhabdomyolysis in Football Training. Med Sci Sports Exerc 2010; 42:3-7. [DOI: 10.1249/mss.0b013e3181ae0700] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
28
|
Abstract
Skeletal muscle breakdown occurs normally with exercise, followed by muscle repair and physiologic adaptation. Strenuous, unaccustomed, prolonged, and repetitive exercise, particularly when associated with other risk factors such as hot and humid climate or sickle cell trait can cause clinically significant exertional rhabdomyolysis (ER). Although most cases are asymptomatic and resolve without sequelae, ER is the most common cause of exercise-related myoglobinuric acute renal injury and acute renal failure in athletes. Exercise-related muscle pain, elevated serum creatine kinase (CK), and "cola-colored" urine have been described as a classic presentation of ER. The exact mechanism of ER has not been clearly elucidated. Most studies suggest a cascade of events that include depletion of adenosine triphosphate (ATP), impaired function of the Na+- K+ ATPase system, intracellular excess calcium accumulation, sarcolemma damage, and release of intracellular proteins and other substances into blood. Excess myoglobin that is filtered at the glomerulus can lead to myoglobinuric acute renal injury. Cessation of physical activity, relative rest during clinical recovery, and early aggressive fluid replacement are mainstays of treatment. Return to play after recovery from ER is influenced by associated risk factors that may predispose the athlete to recurrence and is guided by signs, symptoms, and CK levels. This article reviews the definitions, pathophysiology, diagnosis, and management of ER with specific relevance to acute kidney injury.
Collapse
Affiliation(s)
- Dilip R Patel
- Primary Care Sports Medicine Program, Michigan State University, Kalamazoo, MI 49008, USA.
| | | | | |
Collapse
|
29
|
Connes P, Reid H, Hardy-Dessources MD, Morrison E, Hue O. Physiological Responses of Sickle Cell Trait Carriers during Exercise. Sports Med 2008; 38:931-46. [DOI: 10.2165/00007256-200838110-00004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|