Blessures musculaires : contribution des mastocytes au processus de réparation et identification d'un mécanisme alternatif contribuant à l'accumulation des macrophages

Les blessures musculaires sont fréquentes et engendrent un coût social élevé en hausse constante. Suite à une blessure, une réadaptation musculaire efficace s'appuyant sur des évidences scientifiques est souhaitable. Les processus de résolution de l'inflammation et de réparation sont loin d'être compris dans leur ensemble. Le but de cette thèse était donc de contribuer à l'élargissement des connaissances se rapportant aux mécanismes moléculaires et cellulaires utilisés par les différents acteurs impliqués dans ces processus. Dans un premier temps, nous avons démontré in vitro que les mastocytes, reconnus pour leurs rôles inflammatoires, stimulent la prolifération des cellules musculaires. De façon plus précise, il a été établi que la tryptase exogène stimule la prolifération des myoblastes L6 via l'activation du récepteur activé par une protease de type 2 {protease-activated receptor, PAR-2) et la modulation subséquente de l'activité de la cyclooxygénase-2 (COX-2). De plus, la production de la prostaglandine 15-deoxy-delta-¹², ¹⁴-prostaglandine h (I5A-PGJ₂) serait potentiellement impliquée. Ensuite, l'effet direct des mastocytes sur la stimulation de la prolifération des myoblastes L6 a été confirmé in vitro. Parallèlement, il a été établi in vivo que les mastocytes sont activés suite à une blessure musculaire induite par l'injection intramusculaire de bupivacaïne et qu'en plus d'être modulée immédiatement après la blessure, l'expression de la tryptase augmente ultérieurement à un stade correspondant au début de la myogenèse. Contrairement à nos observations in vitro, l'inhibition de l'activité des mastocytes a induit une stimulation de la prolifération des myoblastes in vivo associée à une augmentation de la densité de cellules immunitaires (neutrophiles, macrophages Ml et M2) dont certaines sont reconnues pour stimuler la myogenèse. Les mastocytes sont impliqués dans plusieurs processus inter-reliés et l'isolation d'un seul effet est expérimentalement difficile. Finalement, les mécanismes assurant l'accumulation des macrophages dans le muscle post-blessure ont été investigués. Il a été établi que les macrophages Ml prolifèrent davantage lorsque leurs précurseurs sanguins sont éliminés alors que l'accumulation des macrophages M2 repose autant sur la prolifération locale que sur l'infiltration de précurseurs. En conclusion, plusieurs acteurs présents dans la phase inflammatoire jouent également un rôle essentiel dans la réparation musculaire

Monocyte depletion increases local proliferation of macrophage subsets after skeletal muscle injury

Background : Sequential accumulation of M1 and M2 macrophages is critical for skeletal muscle recovery after an acute injury. While M1 accumulation is believed to rely on monocyte infiltration, the mechanisms of M2 accumulation remain controversial, but could involve an infiltrating precursor. Yet, strong depletion of monocytes only partiallt impairs skeletal muscle healing, supporting the existence of alternative mechanisms to palliate the loss of infiltrating macrophage progenitors. The aims of this study are thus to investigate if proliferation occurs in macrophage subsets within injured skeletal muscles; and to determine if monocyte depletion leads to increased proliferation of macrophages after injury. Methods : Injury was induced by bupivacaine injection in the tibialis anterior muscle of rats. Blood monocytes were depleted by daily intravenous injections of liposome-encapsulated clodronate, starting 24 h prior to injury. In separate experiments, irradiation of hind limb was also performed to prevent resident cell proliferation. Upon euthanasia, blood and muscles were collected for flow cytometric analyses of macrophage/monocyte subsets. Results : Clodronate induced a 80%-90% depletion of monocyte but only led to 57% and 41% decrease of M1 and M2 macrophage accumulation, respectively, 2 d following injury. Conversely, the number of M1 macrophages in monocyte-depleted rats was 2.4-fold higher than in non-depleted rats 4 d after injury. This was associated with a 16-fold increase in the number of proliferative M1 macrophages, which was reduced by 46% in irradiated animals. Proliferation of M2 macrophages was increased tenfold by clodronate treatment 4 d post injury. The accumulation of M2 macrophages was partially impaired by irradiation, regardless of monocyte depletion. Conclusions : M1 and M2 subsets proliferate after skeletal muscle injury and their proliferation is enhanced under condition of monocyte depletion. Our study supports the conclusion that both infiltrating and resident precursors could contribute to M1 or M2 macrophage accumulation in muscle injury

Identification of New Targets Used by 15-deoxy-delta-12,14-Prostaglandin J2 to Stimulate Skeletal Muscle Cell Proliferation

Introduction: Clinical conduct can influence the healing of injured tissue. Eradication of inflammation seemed a promising strategy to promote musculoskeletal healing until studies showed a delayed/incomplete recovery from partial or complete elimination of inflammation. Endogenous lipid mediators biosynthesized from omega-3 and some from -6 fatty acids are molecules potentially playing important roles in the resolution of inflammation. Using such lipid mediators to treat injuries represents an attractive approach due to their anti-inflammatory and pro-resolving roles. Our goal was to identify the intracellular and/or extracellular targets used by 15-deoxy-delta-12,14-Prostaglandin J2(15Δ-PGJ2) to stimulate myoblast proliferation. Methods: Expression of D prostanoid (DP) 1 and 2 receptors was evaluated by western blotting. Proliferation of L6 myoblasts incubated with agonists and antagonists of prostaglandin (PG) D2 receptors DP1 and DP2 and of the peroxisome proliferator-activated receptor (PPAR) δ was assessed. Intracellular and extracellular concentrations of 15Δ-PGJ2 following L6 cell activation with protease-activated receptor (PAR)-2 agonist were measured by liquid chromatography coupled to tandem mass spectrometry. Results: Both DP1 and DP2 receptors are present in myoblasts. DP1 agonist did not modulate L6 myoblast proliferation, but DP2 and PPARδ agonists induced an increase. DP1 and DP2 antagonists both significantly inhibited 15Δ-PGJ2-induced stimulating effect of L6 cell proliferation (60% and 75%, respectively). 15Δ-PGJ2was present in the intracellular and extracellular compartments under basal conditions, but was not modulated by PAR-2 receptor activation. Conclusion: L6 muscle cell can produce 15Δ-PGJ2 and its effect on cell proliferation likely relies on both DP1 and DP2 receptor activation

Intra-rater reliability and concurrent validity of quantified muscle testing for maximal knee extensors strength in men with myotonic dystrophy type 1

Background : Myotonic dystrophy type 1 (DM1) is the most prevalent degenerative neuromuscular disease in adults. Knee extensor (KE) maximal strength loss is a strong indicator of physical limitations in DM1. A reliable, precise and accessible maximal strength evaluation method needs to be validated for this slowly progressive disease. Objective : This paper aims to assess the intra-rater reliability, the standard error of measurement (SEM), the minimal detectable change (MDC), and the concurrent validity of quantified muscle testing (QMT) using a handheld dynamometer with a gold standard: the Biodex isokinetic device. Methods:Nineteen men with the adult form of DM1 participated in this study by attending 2 visits spaced by one week. The evaluation of KE muscle strength with QMT was completed on the first visit and the same QMT evaluation in addition to the maximal muscle strength evaluation using an isokinetic device were performed on the second visit. Results : The intra-rater reliability was excellent with an intraclass correlation coefficient (ICC) of 0.98 (0.96–0.99 : 95% confidence interval). SEM and MDC values were 1.05 Nm and 2.92 Nm, respectively. Concurrent validity of QMT of KE muscle group with the Biodex was also excellent with a Spearman’s correlation of ρ= 0.98. Conclusions : The excellent concurrent validity and intra-rater reliability, and the small SEM and MDC of the QMT make this test a method of choice, in either a clinical or research setting, to precisely evaluate muscle strength impairments of the KE in men with DM1

Impact of inflammation and anti-inflammatory modalities on skeletal muscle healing : from fundamental research to the clinic.

Anti-inflammatory modalities are commonly used for the treatment of various musculoskeletal injuries. Although inflammation was originally believed to interfere with skeletal muscle regeneration, several recent studies have highlighted the beneficial effects of inflammatory cells on muscle healing. This discrepancy is attributable to an evolving understanding of the complex inflammatory process. To better appreciate the paradoxical roles of inflammation, clinicians must have a better comprehension of the fundamental mechanisms regulating the inflammatory response. In this perspective article, cellular, animal, and human studies were analyzed to summarize recent knowledge regarding the impact of inflammation on muscle regeneration in acute or chronic conditions. The effect of anti-inflammatory drugs on the treatment of various muscle injuries was also considered. Overall, this work aims to summarize the current state of the literature on the inflammatory process associated with muscle healing in order to give clinicians the necessary tools to have a more efficient and evidence-based approach to the treatment of muscle injuries and disorders

A rehabilitation program to increase balance and mobility in ataxia of Charlevoix-Saguenay: An exploratory study

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is characterized by balance impairment and mobility limitations, which both increase the risk of falling. The objective of this study was to explore the effects of a rehabilitation program aimed at increasing trunk and lower limb motor control on balance and walking abilities, and accomplishment of activities of daily living. In this exploratory study, a group-supervised rehabilitation program was performed three times a week for 8 weeks (two sessions at a rehabilitation gym and one pool session). Outcome measures included the Ottawa Sitting Scale, Berg Balance Scale, modified Activities-specific Balance Confidence Scale, 30-Second Chair Stand Test, 10-Meter Walk Test, Barthel Index, and Scale for the Assessment and Rating of Ataxia. Significant improvements in balance, trunk control, maximal and self-selected walking speed difference, ataxia severity and accomplishment of specific activities of daily living were noted for the whole group at the end of the program. At the individual level, all participants improved beyond the standard error of measurement in at least two outcome measures. Also, most participants reported many perceived improvements related to balance, posture and functional mobility. This study provides encouraging results on the effects of a rehabilitation program for ambulatory people with ARSACS. Group intervention could have a positive impact on their daily lives and improve the health care service offered to this population. Future studies with larger sample sizes including control groups and other forms of ataxia are necessary to validate our results to generalize them

The effects of a 12-week strength training program on skeletal muscle impairments and physical limitations in men with myotonic dystrophy type 1

Background/rationale: Myotonic dystrophy type 1 (DM1) is a genetic multisystemic degenerative disease and represents the most prevalent myopathy in adults. Skeletal muscles are particularly affected, as demonstrated by muscle weakness and atrophy experienced by affected people, which limit their social participation. Purpose/research objectives: The aim of this project is to determine the effects of a 12-week strength training program on skeletal muscle impairments and physical limitations in men with DM1. Relevance: Strength training has been shown to be safe in this population, but it remains unknown if it can trigger muscle hypertrophy process, thus slowing or reversing the significant muscle impairments that characterize this disease. Methods: In this before-after study, a 12-week strength training program (twice a week) of 6 to 8 maximal repetitions (RM) of five different lower limb exercises was completed by 11 men with DM1. The evaluation included: 10 meter walk test (comfortable and maximal speed), 30 second sit-to-stand test, quantitative muscle strength assessment of knee extensors muscle group, 1-RM test for all exercises and an interview about perceived changes. Results: Results showed significant maximal muscle strength increases as well as improvement in all functional tests (p<0.05). Patients also reported many positive changes after the training program such as an improved confidence in their legs and that they had ceased falling. Conclusion: Many positive changes have resulted from this training program showing that a well standardized strength training is an efficient and promising treatment option to reduce skeletal muscle impairments and physical limitations in people with DM1

Effets d’un entraînement en résistance de 1 semaines sur le muscle squelettique d’hommes atteints de dystrophie myotonique de type 1

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