Bone Loss and Muscle Atrophy in Spinal Cord Injury: Epidemiology,Fracture Prediction,and Rehabilitation Strategies

Abstract

Summary: Individuals with spinal cord injury (SCI) often experience bone loss and muscle atrophy. Muscle atrophy can result in reduced metabolic rate and increase the risk of metabolic disorders. Sublesional osteoporosis predisposes individuals with SCI to an increased risk of low-trauma fracture. Fractures in people with SCI have been reported during transfers from bed to chair, and while being turned in bed. The bone loss and muscle atrophy that occur after SCI are substantial and may be influenced by factors such as completeness of injury or time postinjury. A number of interventions, including standing, electrically stimulated cycling or resistance training, and walking exercises have been explored with the aim of reducing bone loss and/or increasing bone mass and muscle mass in individuals with SCI. Exercise with electrical stimulation appears to increase muscle mass and/or prevent atrophy, but studies investigating its effect on bone are conflicting. Several methodological limitations in exercise studies with individuals with SCI to date limit our ability to confirm the utility of exercise for improving skeletal status. The impact of standing or walking exercises on muscle and bone has not been well established. Future research should carefully consider the study design, skeletal measurement sites, and the measurement techniques used in order to facilitate sound conclusions.     

Herpes zoster in kidney transplant recipients: protective effect of anti‐cytomegalovirus prophylaxis and natural killer cell count. A single‐center cohort study

Despite its impact on quality of life and potential for complications, specific risk and protective factors for herpes zoster (HZ) after kidney transplantation (KT) remain to be clarified. We included 444 patients undergoing KT between November 2008 and March 2013. Peripheral blood lymphocyte subpopulations were measured at baseline and months 1 and 6. The risk factors for early (first post‐transplant year) and late HZ (years 1–5) were separately assessed. We observed 35 episodes of post‐transplant HZ after a median follow‐up of 48.3 months (incidence rate: 0.057 per 1000 transplant‐days). Median interval from transplantation was 18.3 months. Six patients (17.1%) developed disseminated infection. Postherpetic neuralgia occurred in 10 cases (28.6%). The receipt of anti‐cytomegalovirus (CMV) prophylaxis with (val)ganciclovir decreased the risk of early HZ [adjusted hazard ratio (aHR): 0.08; 95% CI: 0.01–1.13; P‐value = 0.062], whereas the natural killer (NK) cell at month 6 was protective for the occurrence of late HZ [aHR (per 10‐cells/μl increase): 0.94; 95% CI: 0.88–1.00; P‐value = 0.054]. In conclusion, two easily ascertainable factors (whether the patient is receiving anti‐CMV prophylaxis and the NK cell count at month 6) might be potentially useful to tailor preventive strategies according to individual susceptibility to post‐transplant HZ.     

Calcitonin release system in the treatment of experimental osteoporosis. Histomorphometric evaluation.

Bioabsorbable polyphosphazene matrices charged with 250 microg calcitonin were evaluated as calcitonin delivery systems for the controlled release of this drug in an in vivo experimental model. Matrices were implanted under general anesthesia in osteopenic female rats, while a group of osteopenic animals (control group) received unloaded matrices. After 30 days a second series of matrices, loaded and unloaded was, respectively, implanted in both groups. In a third group of osteopenic female rats (positive control), 10 IU calcitonin were injected daily for two months. A baseline group and a sham operated group of animals were also included in the study. The explanted matrices were histologically evaluated together with the surrounding tissues, and bone histomorphometry was performed on undecalcified sections from femurs. The results showed the good biocompatibility of the matrices. Bone histomorphometry revealed that bone architecture in the treatment group was improved and results were not different from those observed after calcitonin injection. These data confirm a good in vivo behavior of the system, as well as a therapeutic effect of the released calcitonin in the osteopenic condition.     

Brush cells fine-tune neurogenic inflammation in the airways

Airway epithelial cells, once considered a simple barrier layer, are now recognized as providing an active site for antigen sensing and immune response initiation. Most mucosal sites contain chemosensory epithelial cells, rare and specialized cells gaining recognition for their unique functions in sensing and directing the immune response symphony. In this issue of the JCI, Hollenhorst, Nandigama, et al. demonstrated that tracheal chemosensory brush cells detected bitter-tasting substances, including quorum-sensing molecules (QSMs) generated by pathogenic Pseudomonas aeruginosa. The authors used various techniques, including genetic deletion of brush cells, genetic manipulation of brush cell signaling, deletion of sensory neurons, in vivo imaging, and infection models with P. aeruginosa, to show that QSMs increased vascular permeability and innate immune cell influx into the trachea. These findings link the recognition of bacterial QSMs to the innate immune response in the airways, with translational implications for airway inflammation and infectious pathology.