Skeletal Muscle Regeneration in Survivors of Critical Illness: How to Prevent Satellite Cell Failure?

NCT ID: NCT05671614

Last Updated: 2025-01-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

RECRUITING

Total Enrollment

50 participants

Study Classification

OBSERVATIONAL

Study Start Date

2022-08-17

Study Completion Date

2025-06-30

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Modern intensive care enables patients to survive insults that in the past would have been supralethal. Nonetheless, increased number of survivors suffer from failed functional outcomes associated with prolonged muscle weakness and fatiguability. Whilst alterations of skeletal muscle biology that occur during critical illness slowly disappear over the period of months, muscle weakness remains. Recent pilot studies have shown that muscle weakness is associated with loss and alteration of satellite skeletal muscle cells, which are supposed to proliferate and repair damaged muscle tissue. The pathogenesis of this phenomenon has not been fully understood. In this grant project, we will study function and structure of satellite cells and their organelles (particularly mitochondria) using both classical bioenergetics and advanced microscopic techniques. Satellite cells will be isolated from biopsies taken from critically ill patients with developed muscle weakness in the acute and protracted phase of a disease and after 6 months. In time points, an ultrasound examination of muscle mass will be performed, and metabolism will be assessed using insulin clamps. In an in vitro experiments, we will test also effect of nutritional and anabolic factors and drugs, commonly used in ICU, on satellite cells. In a control branch, cells will be isolated from skeletal muscle of volunteers undergoing elective hip replacement surgery. Results of this study could significantly contribute to understanding of mechanisms leading to ICU acquired muscle weakness and to identify therapeutic strategy in future.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Background:

Muscle weakness is a common complication in patients who survived a serious critical illness or trauma. Altered muscle strength and functional ability significantly worsens the patients' performance and quality of life. Specific treatment does not exist and the pathogenesis is not yet fully understood. Acute sepsis or extensive inflammatory response are the main risk factors for the muscle weakness development in critically ill patients. Recent studies have shown that muscle weakness can be caused by the loss of ability of skeletal muscle cells to react to the injury and regenerate. Skeletal muscle satellite cells, which are localized beneath the basal lamina of individual muscle fibers, are responsible for muscle regeneration. After the muscle damage, satellite cells are activated from quiescent state (G0 phase) and enter the cell cycle (G1 phase). Subsequently, they proliferate and differentiate into the myoblasts which then fuse and form multinucleated cylindrical myotubes. The cells then merge into the myofibrils and join the muscle fibers that were not damaged. Some satellite cells return to the G0 state to replenish the pool of quiescent skeletal muscle cells. In response to satellite cell damage, mitochondrial biogenesis and synthesis of new myofibrillar proteins are activated to build the new muscle mass containing new intracellular content. Thus, satellite cells have a crucial role for muscle fiber regeneration. Pilot studies performed on animal models (e. g. laboratory mice that developed the acute sepsis) demonstrated a reduction in mitochondrial content and DNA, increased production of reactive oxygen species and changes in oxidative phosphorylation. The abnormalities in the bioenergetic profile of satellite cells are considered a cause of their reduced ability to regenerate. However, the exact mechanism has not yet been fully elucidated. Changes in the mitochondrial structure and dynamics of satellite cells in critically ill patients are also unknown. In last years, the association of mitochondrial functions with mitochondrial dynamics has been investigated in various pathological conditions and diseases. Depending on external insults and metabolic demands, mitochondria undergo dramatic shape changes that can have a very significant impact on cellular metabolism. The balanced process of mitochondrial fission and fusion plays a key role in the mitochondrial biogenesis and removal of damaged mitochondria. The process is absolutely necessary for the proper growth and function of the muscle tissue. Mitochondrial dynamics and morphology can be altered under pathological circumstances: under the mild stress and starvation, mitochondrial morphology can change from small spheres or short rods to long tubules with an increased capacity for oxidative phosphorylation. On the other hand, acute severe stress leads to a mitochondrial fission and defective oxidative phosphorylation. Several studies performed on animal models demonstrated that proteins responsible for the process of mitochondrial fusion and fission are absolutely crucial for the proper growth and function of skeletal muscle cells. Therefore, alterations in mitochondrial dynamics often play a crucial role in skeletal muscle dysfunction and have been recently extensively studied in several myopathies.

In this project, the investigators would like to investigate the causal relationships between mitochondrial function and their shape in satellite cells obtained from critically ill patients in the acute, protracted and post-ICU phase of critical illness.

Hypotheses and aims of the project:

In light of this, the investigators hypothesize that critical illness induces damage to satellite cells in skeletal muscle that later impairs skeletal muscle structural and functional recovery and contributes to persistent weakness and failed functional outcome.

First, structural and functional (incl. bioenergetic) characteristics of satellite cells will be compared in acute, protracted and post-ICU phase in critically ill patients vs. control subjects. Second, the investigators will test the hypothesis that structural and/or functional alteration of satellite cells corelate with gross muscle mass and power in survivors of critical illness. Third, the factors that influence bioenergetics and mitochondrial morphology of satellite cells will be studied (such as extracellular inflammatory milieu, drugs common in ICU as well as nutritional and anabolic factors).

Design:

Prospective cohort study with exploratory physiological end-points.

Study subjects:

Critically ill patients: receiving mechanical ventilation to be enrolled within 72 hours of admission, who are likely to need 7 days or more of ICU stay; sudden onset of disease, which can be determined in time (such as trauma, stroke, sudden cardiac arrest etc.).

Control subjects: orthopedic patients undergoing elective hip replacement surgery with a very good to excellent performance status, only limited to joint pain (ECOG 0).

Informed consent procedure:

All patients with capacity will be asked to provide a prospective written informed consent. For patients without capacity, a deferred consent procedure will take a place. In this case, an independent clinician will review and sign that the patient is lacking capacity and he/she fulfills all criteria to be enrolled to the study. The patient's next of kin will be informed about the study as soon as practical with the aid of information leaflet. The patient will be asked to provide and sign informed consent as soon as he/she regains the capacity to do so. In case of consent refusal, patient's data will not be used in per-protocol analysis.

Methods:

General methodological approaches to be used are as follows. Time points: Eligible patients will be assessed at the baseline, after 7 days and after 6 months by clinical tests, metabolic tests and muscle biopsies. Briefly, on day 0 muscle mass will be assessed using diagnostic ultrasound (a measurement of rectus muscle cross-sectional area) and biopsy of musculus vastus lateralis will be performed using Bergström needle. Baseline blood samples will be taken, plasma will be separated and frozen at -80° C for the later analysis of cytokines and hormone levels. Urine samples will be collected daily, surfaced with toluene and stored in a deep freeze facility for later determination of nitrogen content and 3-methyl histidine levels (to calculate muscle catabolism rate and nitrogen balance). On day 7, all above mentioned procedures will be performed again. In addition, whenever the patient regains consciousness, also muscle power by Medical Research Council (MRC) score will be assessed (standardized testing of muscle power \[0-5\] on 12 muscle groups on all 4 limbs, giving the score 0-60 (60 suggesting normal muscle power)). At ICU discharge, the patients and relatives will be asked to provide contact details for 6 months follow up. On day 180, all the procedures will be repeated. Furthermore, insulin sensitivity will be measured after overnight fasting by hyperinsulinaemic euglycemic clamp on days 7 and 180.

Clinical outcomes: will be assessed by objective validated tests such as SF-36 questionnaire for the quality of life assessment, Medical Research Council Score of muscle power and 6-minutes walking test to measure aerobic performance.

Metabolic characteristics: will be assessed at the whole body level by hyperinsulinaemic euglycaemic clamps and at the tissue level by vastus lateralis biopsies. Insulin sensitivity and substrate oxidation will be measured after overnight fasting by hyperinsulinaemic euglycemic clamp.

Laboratory procedures: mitochondrial research: muscle tissue biopsies will be performed from vastus lateralis muscle by Bergström needle biopsy technique. The sample from each biopsy will be separated into three parts (from 25-100mg per each). One part will be immediately frozen in liquid nitrogen-cooled isopentane for later analysis of muscle fibres typing and immunohistochemistry analysis. The second part will be placed into the respiration medium on ice for the preparation of homogenates and measurement on high-resolution respirometry which enables to determine the function of individual respiratory complexes in the cytosolic context and measure basic functional metabolic indices. Mainly, ATP production, mitochondrial uncoupling, electron transport chain capacity and respiration linked to individual complexes will be assessed. The third part will be used for isolation and culture of skeletal muscle cells. Firstly, satellite cells from biopsies using FACS or magnetic beads will be isolated. The satellite cells will be cultivated and global mitochondrial indices will be assessed by measurement of oxygen consumption rate. This will be processed with extracellular flux analyzer or high resolution respirometry which enables measurement of oxygen consumption rate and lactate production in a real time. This enables to determine ATP production in living cells, uncoupling of inner mitochondrial membrane, maximal respiratory capacity of respiratory chain, glycolytic capacity and fatty acid oxidation or respiration linked to individual complexes of respiratory chain. Simultaneously, reactive oxygen species and mitochondrial membrane potential will be measured. Additionally, shape and size of mitochondria, density of mitochondrial network and dynamic arrangement of these interconnected organelles will be analyzed using confocal laser scanning microscopy in live-cell imaging. All the parameters will be studied in the acute, protracted and post-ICU phase of critical illness.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Intensive Care Unit-acquired Weakness

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Critically ill patients

Critically ill patients with sudden onset of disease receiving mechanical ventilation, to be enrolled within 72 hours of admission, who are likely to need 7 days or more of ICU stay.

No interventions assigned to this group

Volunteers with a very good to excellent performance status

Elective hip surgery patients with a very good to excellent performance status, only limited to joint pain (ECOG 0)

No interventions assigned to this group

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Critically ill patients receiving mechanical ventilation, to be enrolled within 72 hours of admission, who are likely to need 7 days or more of ICU stay
* Sudden onset of disease, which can be determined in time (such as trauma, stroke, sudden cardiac arrest etc.)
* Informed consent signed by patient or patient's representative

Exclusion Criteria

* Unlikely to survive 6 months
* Premorbid downslope functional trajectory or poor performance status (ECOG Gr. 3 or worse) or baseline functional status unknown
* Bleeding disorder (INR≥1.5 or PLT\< that would preclude muscle biopsies)
* Known mitochondrial disease
* Endocrine crisis as a reason for admission
* Pregnant women

Eligibility Criteria for a control group:

Elective hip surgery patients with a very good to excellent performance status, only limited to joint pain (ECOG 0)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Faculty Hospital Kralovske Vinohrady

OTHER_GOV

Sponsor Role collaborator

Charles University, Czech Republic

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Adéla Krajčová, MD, PhD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Charles University

Prague, Czech Republic, Czechia

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

Czechia

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Adéla Krajčová, MD, PhD

Role: CONTACT

00420774732499

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Adéla Krajčová, MD, PhD

Role: primary

References

Explore related publications, articles, or registry entries linked to this study.

Hermans G, Van den Berghe G. Clinical review: intensive care unit acquired weakness. Crit Care. 2015 Aug 5;19(1):274. doi: 10.1186/s13054-015-0993-7.

Reference Type BACKGROUND
PMID: 26242743 (View on PubMed)

Horn J, Hermans G. Intensive care unit-acquired weakness. Handb Clin Neurol. 2017;141:531-543. doi: 10.1016/B978-0-444-63599-0.00029-6.

Reference Type BACKGROUND
PMID: 28190434 (View on PubMed)

Powers SK, Lynch GS, Murphy KT, Reid MB, Zijdewind I. Disease-Induced Skeletal Muscle Atrophy and Fatigue. Med Sci Sports Exerc. 2016 Nov;48(11):2307-2319. doi: 10.1249/MSS.0000000000000975.

Reference Type BACKGROUND
PMID: 27128663 (View on PubMed)

Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med. 2011 Feb;39(2):371-9. doi: 10.1097/CCM.0b013e3181fd66e5.

Reference Type BACKGROUND
PMID: 20959786 (View on PubMed)

Dos Santos C, Hussain SN, Mathur S, Picard M, Herridge M, Correa J, Bain A, Guo Y, Advani A, Advani SL, Tomlinson G, Katzberg H, Streutker CJ, Cameron JI, Schols A, Gosker HR, Batt J; MEND ICU Group; RECOVER Program Investigators; Canadian Critical Care Translational Biology Group. Mechanisms of Chronic Muscle Wasting and Dysfunction after an Intensive Care Unit Stay. A Pilot Study. Am J Respir Crit Care Med. 2016 Oct 1;194(7):821-830. doi: 10.1164/rccm.201512-2344OC.

Reference Type BACKGROUND
PMID: 27058306 (View on PubMed)

Zammit PS, Relaix F, Nagata Y, Ruiz AP, Collins CA, Partridge TA, Beauchamp JR. Pax7 and myogenic progression in skeletal muscle satellite cells. J Cell Sci. 2006 May 1;119(Pt 9):1824-32. doi: 10.1242/jcs.02908. Epub 2006 Apr 11.

Reference Type BACKGROUND
PMID: 16608873 (View on PubMed)

Schultz E, McCormick KM. Skeletal muscle satellite cells. Rev Physiol Biochem Pharmacol. 1994;123:213-57. doi: 10.1007/BFb0030904.

Reference Type BACKGROUND
PMID: 8209136 (View on PubMed)

Monge C, DiStasio N, Rossi T, Sebastien M, Sakai H, Kalman B, Boudou T, Tajbakhsh S, Marty I, Bigot A, Mouly V, Picart C. Quiescence of human muscle stem cells is favored by culture on natural biopolymeric films. Stem Cell Res Ther. 2017 May 2;8(1):104. doi: 10.1186/s13287-017-0556-8.

Reference Type BACKGROUND
PMID: 28464938 (View on PubMed)

Bentzinger CF, Wang YX, Rudnicki MA. Building muscle: molecular regulation of myogenesis. Cold Spring Harb Perspect Biol. 2012 Feb 1;4(2):a008342. doi: 10.1101/cshperspect.a008342.

Reference Type BACKGROUND
PMID: 22300977 (View on PubMed)

Yin H, Price F, Rudnicki MA. Satellite cells and the muscle stem cell niche. Physiol Rev. 2013 Jan;93(1):23-67. doi: 10.1152/physrev.00043.2011.

Reference Type BACKGROUND
PMID: 23303905 (View on PubMed)

Sin J, Andres AM, Taylor DJ, Weston T, Hiraumi Y, Stotland A, Kim BJ, Huang C, Doran KS, Gottlieb RA. Mitophagy is required for mitochondrial biogenesis and myogenic differentiation of C2C12 myoblasts. Autophagy. 2016;12(2):369-80. doi: 10.1080/15548627.2015.1115172.

Reference Type BACKGROUND
PMID: 26566717 (View on PubMed)

Pham AH, McCaffery JM, Chan DC. Mouse lines with photo-activatable mitochondria to study mitochondrial dynamics. Genesis. 2012 Nov;50(11):833-43. doi: 10.1002/dvg.22050. Epub 2012 Aug 11.

Reference Type BACKGROUND
PMID: 22821887 (View on PubMed)

Wagatsuma A, Sakuma K. Mitochondria as a potential regulator of myogenesis. ScientificWorldJournal. 2013;2013:593267. doi: 10.1155/2013/593267. Epub 2013 Feb 3.

Reference Type BACKGROUND
PMID: 23431256 (View on PubMed)

Chen H, Vermulst M, Wang YE, Chomyn A, Prolla TA, McCaffery JM, Chan DC. Mitochondrial fusion is required for mtDNA stability in skeletal muscle and tolerance of mtDNA mutations. Cell. 2010 Apr 16;141(2):280-9. doi: 10.1016/j.cell.2010.02.026.

Reference Type BACKGROUND
PMID: 20403324 (View on PubMed)

Mohiuddin M, Lee NH, Moon JY, Han WM, Anderson SE, Choi JJ, Shin E, Nakhai SA, Tran T, Aliya B, Kim DY, Gerold A, Hansen LM, Taylor WR, Jang YC. Critical Limb Ischemia Induces Remodeling of Skeletal Muscle Motor Unit, Myonuclear-, and Mitochondrial-Domains. Sci Rep. 2019 Jul 2;9(1):9551. doi: 10.1038/s41598-019-45923-4.

Reference Type BACKGROUND
PMID: 31266969 (View on PubMed)

Krajcova A, Ziak J, Jiroutkova K, Patkova J, Elkalaf M, Dzupa V, Trnka J, Duska F. Normalizing glutamine concentration causes mitochondrial uncoupling in an in vitro model of human skeletal muscle. JPEN J Parenter Enteral Nutr. 2015 Feb;39(2):180-9. doi: 10.1177/0148607113513801. Epub 2013 Nov 29.

Reference Type BACKGROUND
PMID: 24291738 (View on PubMed)

Jiroutkova K, Krajcova A, Ziak J, Fric M, Gojda J, Dzupa V, Kalous M, Tumova J, Trnka J, Duska F. Mitochondrial Function in an In Vitro Model of Skeletal Muscle of Patients With Protracted Critical Illness and Intensive Care Unit-Acquired Weakness. JPEN J Parenter Enteral Nutr. 2017 Sep;41(7):1213-1221. doi: 10.1177/0148607116657649. Epub 2016 Jun 29.

Reference Type BACKGROUND
PMID: 27358332 (View on PubMed)

Krajcova A, Lovsletten NG, Waldauf P, Fric V, Elkalaf M, Urban T, Andel M, Trnka J, Thoresen GH, Duska F. Effects of Propofol on Cellular Bioenergetics in Human Skeletal Muscle Cells. Crit Care Med. 2018 Mar;46(3):e206-e212. doi: 10.1097/CCM.0000000000002875.

Reference Type BACKGROUND
PMID: 29240609 (View on PubMed)

Urban T, Waldauf P, Krajcova A, Jiroutkova K, Halacova M, Dzupa V, Janousek L, Pokorna E, Duska F. Kinetic characteristics of propofol-induced inhibition of electron-transfer chain and fatty acid oxidation in human and rodent skeletal and cardiac muscles. PLoS One. 2019 Oct 4;14(10):e0217254. doi: 10.1371/journal.pone.0217254. eCollection 2019.

Reference Type BACKGROUND
PMID: 31584947 (View on PubMed)

Aguer C, Foretz M, Lantier L, Hebrard S, Viollet B, Mercier J, Kitzmann M. Increased FAT/CD36 cycling and lipid accumulation in myotubes derived from obese type 2 diabetic patients. PLoS One. 2011;6(12):e28981. doi: 10.1371/journal.pone.0028981. Epub 2011 Dec 16.

Reference Type BACKGROUND
PMID: 22194967 (View on PubMed)

Kuznetsov AV, Kehrer I, Kozlov AV, Haller M, Redl H, Hermann M, Grimm M, Troppmair J. Mitochondrial ROS production under cellular stress: comparison of different detection methods. Anal Bioanal Chem. 2011 Jun;400(8):2383-90. doi: 10.1007/s00216-011-4764-2. Epub 2011 Feb 20.

Reference Type BACKGROUND
PMID: 21336935 (View on PubMed)

Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, Hopkinson NS, Phadke R, Dew T, Sidhu PS, Velloso C, Seymour J, Agley CC, Selby A, Limb M, Edwards LM, Smith K, Rowlerson A, Rennie MJ, Moxham J, Harridge SD, Hart N, Montgomery HE. Acute skeletal muscle wasting in critical illness. JAMA. 2013 Oct 16;310(15):1591-600. doi: 10.1001/jama.2013.278481.

Reference Type BACKGROUND
PMID: 24108501 (View on PubMed)

Ziak J, Krajcova A, Jiroutkova K, Nemcova V, Dzupa V, Duska F. Assessing the function of mitochondria in cytosolic context in human skeletal muscle: adopting high-resolution respirometry to homogenate of needle biopsy tissue samples. Mitochondrion. 2015 Mar;21:106-12. doi: 10.1016/j.mito.2015.02.002. Epub 2015 Feb 17.

Reference Type BACKGROUND
PMID: 25701243 (View on PubMed)

Jiroutkova K, Krajcova A, Ziak J, Fric M, Waldauf P, Dzupa V, Gojda J, Nemcova-Furstova V, Kovar J, Elkalaf M, Trnka J, Duska F. Mitochondrial function in skeletal muscle of patients with protracted critical illness and ICU-acquired weakness. Crit Care. 2015 Dec 24;19:448. doi: 10.1186/s13054-015-1160-x.

Reference Type BACKGROUND
PMID: 26699134 (View on PubMed)

Genserova L, Duska F, Krajcova A. beta-hydroxybutyrate exposure restores mitochondrial function in skeletal muscle satellite cells of critically ill patients. Clin Nutr. 2024 Jun;43(6):1250-1260. doi: 10.1016/j.clnu.2024.04.009. Epub 2024 Apr 9.

Reference Type DERIVED
PMID: 38653008 (View on PubMed)

Provided Documents

Download supplemental materials such as informed consent forms, study protocols, or participant manuals.

Document Type: Study Protocol and Informed Consent Form

View Document

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

NU21J-06-00078

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Nutrition to Support Postoperative Recovery
NCT07109505 NOT_YET_RECRUITING NA
Postoperative Electrical Muscle Stimulation Two
NCT06964438 NOT_YET_RECRUITING NA