I recently
found an article about a study at the University of São Paulo in Brazil that was working toward
eliminating or lessening the loss of skeletal muscle. I found this extremely
relevant towards what is happening today because so many individuals with
COVID19 are confined to a hospital bed and are losing muscle mass every day. It is estimated that ten days in the ICU can
cause a loss of up to 20% of a person’s muscle mass in the legs (Silveira,
2020). It is also common for people to have declining muscle mass as
they age or if they have inflammatory diseases. This recent study using mice,
found that when they stimulated the expression of protein kinase A, also known
as PKA, it resulted in an increase in muscle resistance for fatigue (Silveira,
2020). The researchers believe this occurs because FoxO proteins are
suppressed by PKA (Silveira, 2020). FoxO proteins are transcription factors
that regulate cell growth and proliferation and it is known to active genes
that are correlated with atrophy by causing atrogin-1 transcription (Sandri et al., 2004). The researchers also argue that PKA boosts
muscle fiber formation and in turn supports resistance of fatigue and increases
hypertrophy (Silveira,
2020). Unlike other attempts to combat loss of skeletal muscle mass, this
strategy thus far has not caused any server adverse side-effects and it focuses
on a unique target protein (Silveira, 2020).
Although this
study is still in its early stages, it appears to be promising and works
towards beneficence. The researcher’s goal is to do what is best for
individuals that experience muscle mass loss because this muscle loss can not
only affect the person physically but it can also be detrimental/damaging to
the person’s mental health. I have seen this firsthand with my late grandmother
because she began to lose muscle mass, confining her to a wheelchair. Due to
her inability to move around on her own, she quickly became depressed which
further affected her health and her motivation to try and gain back muscle
mass. Therefore, this research is hopeful because it would greatly better the
lives both physically and mentally of people experiencing the loss of muscle
mass.
Sandri, M., Sandri, C., Gilbert, A., Skurk, C.,
Calabria, E., Picard, A., … Goldberg, A. L. (2004). Foxo transcription factors
induce the atrophy-related ubiquitin ligase atrogin-1 and cause skeletal muscle
atrophy. Cell, 117(3), 399–412.
https://doi.org/10.1016/S0092-8674(04)00400-3
Silveira, W. A., et al. (2020) cAMP‐dependent protein kinase
inhibits FoxO activity and regulates skeletal muscle
plasticity in mice. FASEB Journal. doi.org/10.1096/fj.201902102RR.
Hi Elyse, thanks for sharing this study! Do you think this same mechanism of increased expression of protein kinaseA can some day have applications outside of purely clinical cases? This definitely has the opportunity to improve upon a very significant issue among long-term hospital patients, but do you think this could be used further, possibly in the sports world. I understand a large number of athletes are faced with teh problem of weakening muscles after an injury has occurred, which at timeshas the possibility of ruining a person's athletic career. If the same or a similar mechanism can be used in preventing muscle loss during breaks from weight training, then I believe this could be a tremendous feat for athletic development in the future.
ReplyDeleteHi Elyse,
ReplyDeleteI think this is a great topic to research. Losing muscle mass from ICU stays, injuries, surgical procedures, etc. can be a major detriment to one’s health and quality of life. I worked on a general surgery and trauma floor as Patient Care Technician and preventing hypotrophy was a part of my job responsibilities. For faster recovery times, the surgeons and nursing staff encouraged patients to sit up in their chair, take 5 walks per day, and attempt to do their activities of daily living (like brushing their teeth, bathing, etc.) with minimal assist following surgery. As a Patient Care Technician, I helped these patients adhere to post-op protocols to reduce recovery time and ensure that patients could return back to their normal life as soon as possible. This aspect of my job was especially difficult; majority of these patients were in an immense amount of pain following surgery and the last thing they wanted was to get out of their hospital bed and go on a walk!
Enhanced Recovery After Surgery (ERAS) program contains pre-op, operative, and post-op protocols for patients and healthcare teams to abide by in order to reduce hospital stay length, improve clinical outcomes, and overall allow individuals to maintain their quality of life (Ljungqvist, Scott, Fearon, 2017). In my position as Patient Care Technician, many patients chose to follow this protocol as it has shown to improve clinical outcomes and lower costs (Ljungqvist, Scott, Fearon, 2017). In this protocol, patients are required to move very early following surgery, eat a clear liquid or soft diet the day after surgery, and the healthcare team provides management of fluids for balance instead of large amounts of intravenous fluids, as well as other clinical requirements (Ljungvqist, Scott, Fearon, 2017). From my own experience, I think it is very important to strongly encourage patients to move as soon as possible following surgery, which is a major aspect of the ERAS protocol. As we have learned throughout physiology the “use it or lose it” concept, I think the best way for patients to reduce hypotrophy is to move! In an ICU, this movement may be limited depending on the patient’s state of consciousness, their current health state, and a variety of other factors. But for surgical patients who are able, I think it is our duty as healthcare providers to strongly encourage patients to be as active as they can in order to prevent hypotrophy, reduce complications, and overall allow patients to have the highest quality of life following their surgical procedure. Ethically, we must do no harm, non-malfeasance, by providing patients with the most current research and information regarding their recovery, like ERAS, and encourage them to do everything possible to maintain their quality of life.
Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1;152(3):292-298. doi: 10.1001/jamasurg.2016.4952. PMID: 28097305.