Low-frequency electrical stimulation with variable intensity preserves torque.

The neuromuscular electrical stimulation (NMES) parameters that optimally modulate torque output during prolonged stimulation protocols are not well-established. The purpose of this study was to compare torque output between low-frequency and high-frequency NMES protocols while increasing stimulation intensity. Eleven healthy young individuals received a repetitive, intermittent low-frequency (20 Hz) and high-frequency (60 Hz) NMES over the quadriceps muscles. Stimulation intensity was increased throughout the protocol to achieve a submaximal target torque output. Mean torque, peak torque and torque-time integral (TTI) were measured. The 20 Hz protocol produced a higher mean torque (P = 0.001) and TTI (P = 0.008) compared to the 60 Hz protocol. The stimulation intensity required to achieve target torque during NMES was not different between frequencies (P > 0.0001). When the goal is to optimize torque output during prolonged submaximal NMES, such as during functional electrical stimulation, low-frequency stimulation may be preferred.

High-Frequency Neuromuscular Electrical Stimulation Increases Anabolic Signaling.

PURPOSE: Neuromuscular electrical stimulation (NMES) is commonly used in rehabilitation settings to increase muscle mass and strength. However, the effects of NMES on muscle growth are not clear and no human studies have compared anabolic signaling between low-frequency (LF) and high-frequency (HF) NMES. The purpose of this study was to determine the skeletal muscle anabolic signaling response to an acute bout of LF- and HF-NMES. METHODS: Eleven young healthy volunteers (6 men, 5 women) received an acute bout of LF-NMES (20 Hz) and HF-NMES (60 Hz). Muscle biopsies were obtained from the vastus lateralis muscle before the first NMES treatment and 30 min after each NMES treatment. Phosphorylation of the following key anabolic signaling proteins was measured by Western blot, and proteins are expressed as a ratio of phosphorylated to total: mammalian target of rapamycin, p70-S6 kinase 1, and eukaryotic initiation factor 4E binding protein 1. RESULTS: Compared with pre-NMES, phosphorylation of mammalian target of rapamycin was upregulated 40.2% for LF-NMES (P = 0.018) and 68.4% for HF-NMES (P < 0.0001), and HF-NMES was 29.3% greater than LF-NMES (P = 0.026). Phosphorylation of p70-S6 kinase 1 after HF-NMES was 96.6% higher than pre-NMES (P = 0.001) and was not different between pre-NMES and LF-NMES (although it was 50.4% higher after LF-NMES) or LF- and HF-NMES (P > 0.05). There were no differences between treatment conditions for eukaryotic initiation factor 4E binding protein 1 phosphorylation (P > 0.05). CONCLUSIONS: An acute bout of LF- and HF-NMES upregulated anabolic signaling with HF-NMES producing a greater anabolic response compared with LF-NMES, suggesting that HF stimulation may provide a stronger stimulus for processes that initiate muscle hypertrophy. In addition, the stimulation frequency parameter should be considered by clinicians in the design of optimal NMES treatment protocols.

Neuromuscular Electrical Stimulation and Anabolic Signaling in Patients with Stroke.

INTRODUCTION: Stroke results in limited ability to produce voluntary muscle contraction and movement on one side of the body, leading to further muscle wasting and weakness. Neuromuscular electrical stimulation is often used to facilitate involuntary muscle contraction; however, the effect of neuromuscular electrical stimulation on muscle growth and strengthening processes in hemiparetic muscle is not clear. This study examined the skeletal muscle anabolic response of an acute bout of neuromuscular electrical stimulation in individuals with chronic stroke and healthy older adults. METHODS: Eleven individuals (59.8 ± 2.7 years old) were divided into a chronic stroke group (n = 5) and a healthy older adult control group (n = 6). Muscle biopsies were obtained before and after stimulation from the vastus lateralis of the hemiparetic leg for the stroke group and the right leg for the control group. The neuromuscular electrical stimulation protocol consisted of a 60-minute, intermittent stimulation train at 60 Hz. Phosphorylation of mammalian target of rapamycin and ribosomal protein S6 kinase beta-1 were analyzed by Western blot. FINDINGS: An acute bout of neuromuscular electrical stimulation increased phosphorylation of mammalian target of rapamycin (stroke: 56.0%; control: 51.4%; P = .002) and ribosomal protein S6 kinase beta-1 (stroke: 131.2%; control: 156.3%; P = .002) from resting levels to post-neuromuscular electrical stimulation treatment, respectively. Phosphorylated protein content was similar between stroke and control groups at both time points. CONCLUSION: Findings suggest that paretic muscles of patients with chronic stroke may maintain ability to stimulate protein synthesis machinery in response to neuromuscular electrical stimulation.

Interleukin-17A Promotes Lung Tumor Progression through Neutrophil Attraction to Tumor Sites and Mediating Resistance to PD-1 Blockade.

INTRODUCTION: Proinflammatory cytokine interleukin-17A (IL-17A) is overexpressed in a subset of patients with lung cancer. We hypothesized that IL-17A promotes a protumorigenic inflammatory phenotype and inhibits antitumor immune responses. METHODS: We generated bitransgenic mice expressing a conditional IL-17A allele along with conditional KrasG12D and performed immune phenotyping of mouse lungs, a survival analysis, and treatment studies with antibodies either blocking programmed cell death 1 (PD-1) or IL-6 or depleting neutrophils. To support the preclinical findings, we analyzed human gene expression data sets and immune profiled patient lung tumors. RESULTS: Tumors in IL-17:KrasG12D mice grew more rapidly, resulting in a significantly shorter survival as compared with that of KrasG12D mice. IL-6, granulocyte colony-stimulating factor (G-CSF), milk fat globule-EGF factor 8 protein, and C-X-C motif chemokine ligand 1 were increased in the lungs of IL17:Kras mice. Time course analysis revealed that levels of tumor-associated neutrophils were significantly increased, and lymphocyte recruitment was significantly reduced in IL17:KrasG12D mice as compared with in KrasG12D mice. In therapeutic studies PD-1 blockade was not effective in treating IL-17:KrasG12D tumors. In contrast, blocking IL-6 or depleting neutrophils with an anti-Ly-6G antibody in the IL17:KrasG12D tumors resulted in a clinical response associated with T-cell activation. In tumors from patients with lung cancer with KRAS mutation we found a correlation between higher levels of IL-17A and colony- stimulating factor 3 and a significant correlation among high neutrophil and lower T-cell numbers. CONCLUSIONS: Here we have shown that an increase in a single cytokine, IL-17A, without additional mutations can promote lung cancer growth by promoting inflammation, which contributes to resistance to PD-1 blockade and sensitizes tumors to cytokine and neutrophil depletion.