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Measuring Diaphragm Thickness and Function Using Point-of-Care Ultrasound
Published on: November 3, 2023
[Postnatal maturation of the diaphragm muscle: ultrastructural and functional aspects]
G Orliaguet1, B Riou, M Leguen
1Département d'anesthésie-réanimation chirurgicale, CHU Necker-Enfants-Malades, AP-HP, 7574 Paris cedex 15, France. gilles.orliaguet@nck.ap-hop-paris.fr
Insights
Postnatal maturation improves diaphragm contractility through changes in muscle fiber types and myosin heavy chains (MHC). Other factors like ryanodine receptor maturation and cross-bridge properties also contribute to this developmental improvement.
Area of Science:
- Muscle physiology
- Developmental biology
- Skeletal muscle research
Context:
- Postnatal development of the diaphragm involves significant histological and biochemical changes.
- Sarcoplasmic reticulum (SR) development is crucial for improving diaphragmatic contractility after birth.
- The precise mechanisms driving postnatal improvements in diaphragm contractility are not fully understood.
Purpose:
- To review and analyze existing literature on the mechanisms underlying postnatal improvement in diaphragmatic contractility.
- To explore the roles of fiber type transitions, myosin heavy chain (MHC) expression, and other factors in diaphragm maturation.
- To synthesize current understanding and highlight areas of ongoing debate regarding diaphragm postnatal development.
Summary:
- Diaphragm muscle maturation involves shifts in fiber type proportions (increase in type I and IIB, decrease in type IIA) and myosin heavy chain (MHC) isoform expression.
- A progressive transition from embryonic/neonatal MHC isoforms to adult isoforms is proposed by some to explain enhanced contractility.
- Alternative hypotheses suggest the postnatal maturation of the ryanodine receptor (RyR) or developmental changes in cross-bridge (CB) properties are key.
- Recent theories also consider the role of structural proteins in sarcomer stability and force generation during postnatal development.
Impact:
- Provides a comprehensive overview of the factors influencing diaphragm contractility during postnatal development.
- Highlights the complexities and controversies surrounding the mechanisms of diaphragm maturation.
- Informs future research directions in pediatric respiratory physiology and muscle development.
Objective:
In the diaphragm muscle, postnatal maturation is associated with major histological and biochemical modifications, as well as a progressive development of the sarcoplasmic reticulum (SR), which in turn are responsible for the progressive postnatal improvement in diaphragmatic contractility. However, the mechanisms by which postnatal maturation induces this improvement in diaphragmatic contractility remain poorly understood and controversial. The aim of this review is to analyze the data from the literature regarding the process involved in the postnatal improvement in diaphragmatic contractility.
Data Sources:
References obtained from Pubmed((R)) databank using keywords (diaphragm muscle, postnatal maturation, contractility, muscular fatigue, cross-bridge).
Data Synthesis:
From a cytological point of view, the postnatal development of the diaphragm muscle is processed in two successive generations of fiber types, corresponding to the progressive adaptation of the diaphragm muscle to its physiological function. Indeed, the proportion in type I (slow, aerobic) and type IIB fibers (fast, anaerobic) progressively increases with postnatal maturation, while the proportion in type IIA fibers (fast, intermediate) progressively decreases. The histochemical classification of the type of fiber corresponds to the expression of the different isoforms of myosin heavy chains (MHC). Two types of MHC: MHC embryologic (MCH-emb) and MHC neonatal (MCH-neo), and one type of myosin light chains (MLC) are expressed in the foetal skeletal muscles, then are progressively eliminated during postnatal maturation. For many authors, this progressive transition from immature MHC (MCH-emb and neo) to adult MHC (by chronological order of appearance: MHC-2A, MHC-lente, MHC-2X, MHC-2B) could be responsible for the progressive improvement in postnatal diaphragmatic contractility. This transition could be modulated by external factors, mainly including neural and hormonal stimuli. For others, this transition in MHC expression do not play a major role, and other factors, including the postnatal maturation of the ryanodine receptor (RyR) or developmental changes in cross-bridges (CB) properties should play a central role. The most recent hypotheses proposed included the possibility of a postnatal transition in the expression of structural proteins, which are playing a major role in the maintenance of the stability of the sarcomer, and therefore in force generation.
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