Exploring adipogenic and myogenic circulatory biomarkers of recurrent pressure injury risk for persons with spinal cord injury

Abstract

Purpose: To investigate linkages between circulatory adipogenic and myogenic biomarkers, gluteal intramuscular adipose tissue (IMAT), and pressure injury (PrI) history following spinal cord injury (SCI).
 Methods: This is an observational repeated-measures study of 30 individuals with SCI. Whole blood was collected regularly over 2-3 years. Circulatory adipogenic and myogenic gene expression was determined. IMAT was defined as above/below 15% (IMATd) or percentage (IMAT%). PrI history was defined as recurrent PrI (RPrI) or PrI number (nPrI). Model development used R packages (version 3.5.1). Univariate analysis screened for discriminating genes for downstream multivariate and combined models of averaged and longitudinal data for binary (RPrI/IMATd) and finer scales (nPrI/IMAT%).
 Results: For adipogenesis, Krüppel-like factor 4 was the top RPrI predictor together with resistin and cyclin D1, and sirtuin 2 was the top IMAT predictor. For myogenesis, the top RPrI predictor was dysferlin 2B, and pyruvate dehydrogenase kinase-4 was the top IMAT predictor together with dystrophin.
 Conclusion: Circulatory adipogenic and myogenic biomarkers have statistically significant relationships with PrI history and IMAT for persons with SCI. Biomarkers of interest may act synergistically or additively. Variable importance rankings can reveal nonlinear correlations among the predictors. Biomarkers of interest may act synergistically or additively, thus multiple genes may need to be included for prediction with finer distinction.

An Exploratory Analysis of the Role of Adipose Characteristics in Fulltime Wheelchair Users’ Pressure Injury History

“…However, there was no relationship between fat infiltration and BMI. This is consistent with Bogie et al (2020) . Time since injury is a much stronger predictor of IMAT, suggesting that the process occurs at some point after injury, likely as a result of disuse and atrophy, in response to myogenic and adipogenic markers identified in ( Bogie et al, 2020 ).…”

“…This is consistent with Bogie et al (2020) . Time since injury is a much stronger predictor of IMAT, suggesting that the process occurs at some point after injury, likely as a result of disuse and atrophy, in response to myogenic and adipogenic markers identified in ( Bogie et al, 2020 ). BMI (i.e., body weight and height) was self-reported in this study, so the accuracy of BMI values is unknown.…”

“…Previous research has identified many risk factors such as age, poor nutrition, and shearing, which significantly add to an individual’s PrI risk ( Braden and Bergstrom, 1987 ; European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance, 2019 ). Investigation into the role of adipose and its relationship to tissue tolerance and PrI risk has been limited, despite considerable evidence on the effect of adipose on an individual’s health ( Garcia and Thomas 2006 ; Lemmer, Alvarado et al, 2019 ; Bogie, Schwartz et al, 2020 ).…”

“…In early studies, IMAT has been found to be directly correlated with PrI history in individuals with a spinal cord injury ( Ogawa, Lester et al, 2017 ; Lemmer, Alvarado et al, 2019 ). A follow-up study on individuals with spinal cord injuries found that IMAT was correlated with circulatory adipogenic and myogenic biomarkers ( Bogie, Schwartz et al, 2020 ). Although IMAT is common, the mechanisms for its development and effects remain unknown.…”

Genomic Biomarkers Can Provide a Deeper Understanding of Recurrent Pressure Injuries

“…This preliminary work has shown the effect of candidate single-nucleotide variants on IMAT accumulation and recurrent PI risk. The authors have previously shown that varying levels of circulatory biomarkers, including FABP4 and FABP3 , may be indicative of recurrent PI risk 24,29–31 . Further, genetic biomarkers, specifically those related to fatty metabolism, may indicate which persons with SCI are at highest risk of recurrent PIs 32 …”