Klinik für Kardiologie
 
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Klinik für Kardiologie / Forschung
 
 
Research Lab - Paulien Vinke-Schröter, MSc
 
Nutritional intervention in pulmonary arterial hypertension

Pulmonary arterial hypertension (PAH) is a progressive disease primarily affecting the pulmonary vasculature and heart. PAH patients suffer from exercise intolerance and fatigue, negatively affecting their quality of life.
In a recent review (Vinke et al. 2018), current insights were summarized in the pathophysiological mechanisms underlying PAH. The review zoomed in on the potential involvement of nutritional status and micronutrient deficiencies exercise intolerance and fatigue in PAH patients.
Pathophysiological processes that contribute to exercise intolerance and impaired quality of life of PAH patients include right ventricular dysfunction, inflammation, skeletal muscle alterations, and dysfunctional energy metabolism. PAH-related nutritional deficiencies and metabolic alterations have been linked to fatigue, exercise intolerance, and endothelial dysfunction. Available evidence suggests that exercise interventions can be effective in PAH patients to improve exercise tolerance and decrease fatigue. By contrast, knowledge on the prevalence of micronutrient deficiencies and the possible effects of nutritional interventions in PAH patients is limited. Although data on nutritional status and micronutrient deficiencies in PAH are scarce, the available knowledge, including that from adjacent fields, suggests that nutritional intervention to correct deficiencies and metabolic alterations may contribute to a reduction of disease burden.
Patients have an increased interest in the use of nutritional supplements, but there is a lack of scientific knowledge and guidelines on this field. Future research is therefore focusing on studying micronutrient deficiencies in PAH patients and the effect of correcting deficiencies by nutritional supplementation.
This is a collaborative study between the University Clinic of Cardiology, Heart Center Leipzig (Germany), the Erasmus Medical Center, Rotterdam (the Netherlands), Actelion Pharmaceuticals (the Netherlands) and Wageningen University (the Netherlands).

Nutritional intervention in a mouse model of pulmonary hypertension and cardiac cachexia Cardiac cachexia is characterized by ventricular remodeling that is associated with skeletal muscle wasting. Cardiac cachexia is occurring as a consequence of pulmonary hypertension. However, therapeutic strategies that target both cardiac and skeletal muscle in order to prevent maladaptations remain sparse. In recent studies, we supplied a standard chow supplemented with high protein, leucine, fish oil and oligosaccharides, to determine whether cardiac and skeletal muscle remodeling could be attenuated during cardiac cachexia in a mouse model of pulmonary hypertension. The results showed that this multi-target nutritional intervention significantly attenuated both right ventricular and skeletal muscle maladaptations.

Future studies are focusing on the effect of nutritional intervention with and without exercise training on cardiac and skeletal muscle in the same animal model.
This is a collaborative study between the University Clinic of Cardiology, Heart Center Leipzig (Germany) and Wageningen University (the Netherlands).
 
Publications

  1. Vinke P, Jansen SM, Witkamp RF, van Norren K (2018) Increasing quality of life in pulmonary arterial hypertension: is there a role for nutrition? Heart Fail. Rev. 23:711-722
  2. Bowen TS, Adams V, Werner S, Fischer T, Vinke P, Brogger MN, Mangner N, Linke A, Sehr P, Lewis J, Labeit D, Gasch A, Labeit S (2017) Small-molecule inhibition of MuRF1 attenuates skeletal muscle atrophy and dysfunction in cardiac cachexia. J Cachexia Sarcopenia Muscle. 8(6) 939-953
 

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