Although absence of the cytoskeletal protein dystrophin leads to dilated cardiomyopathy in humans, the functional role of dystrophin in cardiac muscle remains undefined. We have addressed the hypothesis that dystrophin could help protect the heart against injury and contractile dysfunction induced by mechanical stress. In normal and dystrophin‐deficient (mdx) mice, cardiac mechanical stress was first manipulated ex vivo in a perfused working heart preparation. Despite an afterload level in the normal physiologic range, ex vivo perfused mdx hearts developed severe contractile dysfunction and nonischemic tissue damage, as is shown by excessive LDH release without a rise in coronary lactate. Injury to dystrophin‐deficient hearts was significantly correlated with cardiac work, and reducing the afterload level improved contractility and prevented injury in mdx hearts studied ex vivo. The response to mechanical stress in vivo was also assessed by using the vital dye Evans blue, which penetrates into cardiomyocytes with a disrupted sarcolemma. In the mdx group only, cardiomyocyte injury was increased markedly by acute elevations of mechanical stress induced by isoproterenol or brief aortic occlusion. Strikingly accelerated mortality and cardiac necrosis were also observed in the mdx group subjected to chronically increased cardiac mechanical stress via subtotal aortic constriction. Taken together, our results provide the first direct evidence that dystrophin serves to protect cardiomyocytes from mechanical stress and workload‐induced damage. Accordingly, reducing cardiac work in patients with dystrophin deficiency could be beneficial not only in treating established cardiomyopathy, but also in preventing the onset of cardiac disease.

Cystic fibrosis (CF) patients often have reduced mass and strength of skeletal muscles, including the diaphragm, the primary muscle of respiration. Here we show that lack of the CF transmembrane conductance regulator (CFTR) plays an intrinsic role in skeletal muscle atrophy and dysfunction. In normal murine and human skeletal muscle, CFTR is expressed and co-localized with sarcoplasmic reticulum-associated proteins. CFTR–deficient myotubes exhibit augmented levels of intracellular calcium after KCl-induced depolarization, and exposure to an inflammatory milieu induces excessive NF-kB translocation and cytokine/chemokine gene upregulation. To determine the effects of an inflammatory environment in vivo, sustained pulmonary infection with Pseudomonas aeruginosa was produced, and under these conditions diaphragmatic force-generating capacity is selectively reduced in Cftr −/− mice. This is associated with exaggerated pro-inflammatory cytokine expression as well as upregulation of the E3 ubiquitin ligases (MuRF1 and atrogin-1) involved in muscle atrophy. We conclude that an intrinsic alteration of function is linked to the absence of CFTR from skeletal muscle, leading to dysregulated calcium homeostasis, augmented inflammatory/atrophic gene expression signatures, and increased diaphragmatic weakness during pulmonary infection. These findings reveal a previously unrecognized role for CFTR in skeletal muscle function that may have major implications for the pathogenesis of cachexia and respiratory muscle pump failure in CF patients.

Strenuous resistive breathing induces plasma cytokines that do not originate from circulating monocytes. We hypothesized that cytokine production is induced inside the diaphragm in response to resistive loading. Anesthetized, tracheostomized, spontaneously breathing Sprague-Dawley rats were subjected to 1, 3, or 6 hours of inspiratory resistive loading, corresponding to 45-50% of the maximum inspiratory pressure. Unloaded sham-operated rats breathing spontaneously served as control animals. The diaphragm and the gastrocnemius muscles were excised at the end of the loading period, and messenger ribonucleic acid expression of tumor necrosis factor-alpha, tumor necrosis factor-beta, interleukin (IL)-1alpha, IL-1beta, IL-2, IL-3, IL-4, IL-5, IL-6, IL-10, IFN-gamma, and two housekeeping genes was analyzed using multiprobe RNase protection assay. IL-6, IL-1beta, and, to lesser extents, tumor necrosis factor-alpha, IL-10, IFN-gamma, and IL-4 were significantly increased in a time-dependent fashion in the diaphragms but not the gastrocnemius of loaded animals or in the diaphragm of control animals. Elevation of protein levels of IL-6 and IL-1beta in the diaphragm of loaded animals was confirmed with immunoblotting. Immunostaining revealed IL-6 protein localization inside diaphragmatic muscle fibers. We conclude that increased ventilatory muscle activity during resistive loading induces differential elevation of proinflammatory and antiinflammatory cytokine gene expression in the ventilatory muscles.

The aims of this study were to assess the role of nitric oxide (NO) and the contribution of different NO synthase (NOS) isoforms in skeletal muscle contractile dysfunction in septic shock. Four groups of conscious rats were examined. Group 1 served as control; groups 2, 3, and 4 were injected with Escherichia coli endotoxin [lipopolysaccharide (LPS), 20 mg/kg ip] and killed after 6, 12, and 24 h, respectively. Protein expression was assessed by immunoblotting and immunostaining. LPS injection elicited a transient expression of the inducible NOS isoform, which peaked 12 h after LPS injection and disappeared within 24 h. This expression coincided with a significant increase in nitrotyrosine formation (peroxynitrite footprint). Muscle expression of the endothelial and neuronal NOS isoforms, by comparison, rose significantly and remained higher than control levels 24 h after LPS injection. In vitro measurement of muscle contractility 24 h after LPS injection showed that incubation with NOS inhibitor ( S-methyliosothiourea) restored the decline in submaximal force generation, whereas maximal muscle force remained unaffected. We conclude that NO plays a significant role in muscle contractile dysfunction in septic animals and that increased NO production is due to induction of the inducible NOS isoform and upregulation of constitutive NOS isoforms.

Endotoxemia is associated with impaired diaphragm contractility, and increased nitric oxide (NO) production has recently been implicated in this phenomenon. However, the precise nature of sepsis-related alterations in diaphragm myofiber function remains unclear. We tested the hypothesis that enhanced NO synthesis during sepsis produces diaphragm sarcolemmal injury with attendant abnormalities of myofiber membrane electrophysiology. Two different rat sepsis models were employed: acute (4 h) intraarterial endotoxin (LPS; 20 mg/kg) and subacute (24 h) peritonitis induced by cecal ligation and perforation (CLP). Diaphragm damage occurred after both LPS and CLP, as indicated by hyperpermeability of myofibers to a low molecular weight tracer dye, which is normally unable to penetrate the sarcolemma. Sarcolemmal injury was significantly correlated with reductions in the resting membrane potential (Em) of single diaphragm myofibers. Western analysis revealed increased diaphragmatic expression of the inducible isoform of NO synthase (iNOS) after LPS and CLP. An inhibitor of NOS activity, LNMMA, significantly decreased morphologic as well as electrophysiologic signs of myofiber membrane injury and dysfunction. Therefore, we conclude that both acute endotoxemia and subacute peritonitis models of sepsis lead to significant sarcolemmal damage and altered Em in diaphragm myofibers. These changes appear to be mediated, at least in part, through the pathway of increased nitric oxide production.

1. The purpose of this study was to determine whether ATP-sensitive K+ (KATP) channels are activated and contribute to the decrease in force during fatigue development in the sartorius muscle of the frog, Rana pipiens. Tetanic force (elicited by field stimulation), action potential and membrane conductance (using conventional microelectrodes), were measured in the presence and absence of glibenclamide, a KATP channel antagonist. Experiments were performed in bicarbonate-buffered solutions at pH 7-2.2. In unfatigued muscle 100 ,umol I-' glibenclamide had no effect on the resting potential, the overshoot, the half-depolarization time or the maximum rate of depolarization of action potentials, while the mean half-repolarization time increased by 19 ± 4 % (± S.E.M.) and the maximum rate of repolarization decreased by 17 + 5 %. 3. Fatigue was elicited using 100 ms tetanic contractions every I s for 3 min. In the absence of glibenclamide the mean half-repolarization time increased from 057 + 005 to 089 + 0 05 ms during fatigue. The mean half-repolarization times after fatigue, when muscle fibres were exposed to 100 ,umol I1 glibenclamide either 60 min prior to fatigue or 60 s before the end of fatigue, were 1-16 + 0-08 and 1t17 + 0 07 ms respectively.Application of 100 #smol I-' glibenclamide after 5 min of recovery did not increase the half-repolarization time, but decreased the rate of recovery compared to control values.4. In unfatigued muscles, 100 jumol I' glibenclamide did not affect the tetanic contraction. In the absence of glibenclamide, the mean tetanic force after fatigue was 11 0 + 0 9 % of prefatigue values. Application of 100 umol I' glibenclamide 60 min before fatigue increased the rate of fatigue development as the mean tetanic force was 4-8 + 0-8 % after 3 min of stimulation. The addition of 100 ,umol I-' glibenclamide 60 s before the end of fatigue had no effect on tetanic force during this time compared to control. 5. In the absence of glibenclamide, muscles recovered 90-1 + 1-6 % of their tetanic force after 100 min. Addition of 100,umol I' glibenclamide 60 min prior to fatigue significantly reduced the capacity of muscles to recover their tetanic force: after 100 min of recovery tetanic force was only 47-3 + 9.4 % of the pre-fatigue value. Application of 100 jumol I' glibenclamide 60 s prior to the end of fatigue had a much smaller effect on the recovery as 79.4 + 6'2 % of the tetanic force was recovered in 100 min. Addition of glibenclamide after 5 min of recovery had no effect. 6. The results from this study support the proposal that KATP channels are activated during fatigue and they contribute to the repolarization phase of the action potential. Although no evidence was found that activation of KATP channels during fatigue contributes to the force decrease during fatigue development, the impairment of force recovery following fatigue in the presence of glibenclamide supports the notion that KATP channels play an important protective role.

Dystonia musculorum (dt) was originally described as a hereditary sensory neurodegeneration syndrome of the mouse. The gene defective in dt encodes a cytoskeletal linker protein, dystonin, that is essential for maintaining neuronal cytoskeletal integrity. In addition to the nervous system, dystonin is expressed in a variety of other tissues, including muscle. We now show that dystonin cross-links actin and desmin filaments and that its levels are increased during myogenesis, coinciding with the progressive reorganization of the intermediate filament network. A disorganization of cytoarchitecture in skeletal muscle from dt/dt mice was observed in ultrastructural studies. Myoblasts from dt/dt mice fused to form myotubes in culture; however, terminally differentiated myotubes contained incompletely assembled myofibrils. Another feature observed in dt/dt myotubes in culture and in skeletal muscle in situ was an accumulation and abnormal distribution of mitochondria. The diaphragm muscle from dt/dt mice was weak in isometric contractility measurements in vitro and was susceptible to contraction-induced sarcolemmal damage. Altogether, our data indicate that dystonin is a cross-linker of actin and desmin filaments in muscle and that it is essential for establishing and maintaining proper cytoarchitecture in mature muscle.

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