H S M Kort, J-W J Lammers, S N W Vorrink, T Troosters
Chronic Obstructive Pulmonary Disease (COPD) is a disabling airway disease with variable extrapulmonary effects that may contribute to disease severity in individual patients (Rabe et al. 2007). The world health organization predicts that COPD will become the third leading cause of death worldwide by 2030. Patients with COPD demonstrate reduced levels of spontaneous daily physical activity (DPA) compared with healthy controls (Pitta et al. 2005). This results in a higher risk of hospital admission and shorter survival (Pitta et al. 2006). Pulmonary rehabilitation can help to improve the DPA level, however, obtained benefits decline after 1â€“2 years (Foglio et al. 2007).
In order to maintain DPA in COPD patients after rehabilitation, we developed a mobile phone application. This application measures DPA as steps per day, measured by the accelerometer of the smartphone, and shows the information to the patient via the display of the mobile phone. A physiotherapist can monitor the patient via a secure website where DPA measurements are visible for all patients. Here, DPA goals can be adjusted and text messages sent.
Three pilot studies were performed with healthy students and COPD patients to test the application for usability, user friendliness and reliability with questionnaires and focus groups. Subjects also wore a validated accelerometer. For the Randomized Controlled Trial (RCT) 140 COPD patients will be recruited in Dutch physiotherapy practises. They will be randomised in an intervention group that receives the smartphone for 6 months and a control group. Measurements include lungfunction, dyspnea, and exercise capacity and are held at 0, 3, 6 and 12 months.
Results and Discussion
The application was found to be useful, easy to learn and use. Subjects had no problems with health care professionals seeing information on their physical activity performance. They do find it important to be able to determine who can see the information. Correlations between the accelerometer and the measurements on DPA of the smartphone for steps per hour were 0.69 and 0.70 for pilot studies 1 (students) and 2 (COPD patients) respectively. The version of the application in pilot study 3 contained an error, which made correlations with the accelerometer unusable. The RCT study is now being executed.
Aswath Balakrishnan, Kapaettu Satyamoorthy and Manjunath B Joshi
Insulin resistance is a hall mark of metabolic disorders such as diabetes. Reduced insulin response in vasculature leads to disruption of IR/Akt/eNOS signaling pathway resulting in vasoconstriction and subsequently to cardiovascular diseases. Recent studies have demonstrated that inflammatory regulator interleukin-6 (IL-6), as one of the potential mediators that can link chronic inflammation with insulin resistance. Accumulating evidences suggest a significant role of epigenetic mechanisms such as DNA methylation in progression of metabolic disorders. Hence the present study aimed to understand the role of epigenetic mechanisms involved during IL-6 induced vascular insulin resistance and its consequences in cardiovascular diseases.
Materials and Methods
Human umbilical vein endothelial cells (HUVEC) and Human dermal microvascular endothelial cells (HDMEC) were used for this study. Endothelial cells were treated in presence or absence of IL-6 (20ng/ml) for 36 hours and followed by insulin (100nM) stimulation for 15 minutes. Using immunoblotting, cell lysates were stained for phosphor- and total Akt levels to measure insulin resistance. To investigate changes in DNA methylation, cells were treated with or without neutrophil conditioned medium (NCM) as a physiological source of inflammation or IL-6 (at various concentrations) for 36 hours. Genomic DNA was processed for HPLC analysis for methyl cytosine content and cell lysates were analyzed for DNMT1 (DNA (cytosine-5)-methyltransferase 1) and DNMT3A (DNA (cytosine-5)-methyltransferase 3A) levels using immunoblotting.
Endothelial cells stimulated with insulin exhibited an increase in phosphorylation of Aktser 473 in serum free conditions but such insulin response was not observed in cells treated with IL-6, suggesting chronic exposure of endothelial cells to IL-6 leads to insulin resistance. HPLC analysis for global DNA methylation resulted in decreased levels of 5-methyl cytosine in cells treated with pro-inflammatory molecules (both by NCM and IL-6) as compared to untreated controls. Subsequently, analysis in cells treated with IL-6 showed a significant decrease in DNMT1 levels but not in DNMT3A. Other pro-inflammatory marker such as TNF-Î± did not exhibit such changes.
Our study suggests: a) Chronic treatment of endothelial cells with IL-6 results in insulin resistance b) Neutrophil conditioned medium and IL-6 decreases methyl cytosine levels c) DNMT1 but not DNMT3a levels are reduced in cells treated with IL-6.