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Skeletal muscle has a remarkable intrinsic capacity for repair in response to injury or disease1,2. Experimentally, the robustness of this regenerative response has been well documented in animal models by studying, for example, the time course of skeletal muscle damage, repair and regeneration after application of myotoxins (e.g., cardiotoxin)3-7. More specifically, following extensive cardiotoxin-induced muscle damage (38-67% of muscle fibers8), regeneration is mediated by satellite cells, the resident stem cells that mature to ultimately become functional muscle fibers4,9-13. The end result is increased post-damage functional regeneration of healthy, force-producing muscle tissue14-16. Although the details are well beyond the scope of this report, the mechanistic basis for muscle regeneration reflects the carefully orchestrated events of numerous cell types from multiple lineages utilizing canonical signaling pathways critical to both tissue development and morphogenesis5,17-21. Importantly, myotoxin-induced regeneration is enabled by the fact that the extracellular matrix, neuronal innervation and blood vessel perfusion remain structurally intact following cardiotoxin-induced muscle damage3,8,22. In stark contrast, these key tissue structures and components are, by definition, entirely absent in the context of VML injury; where frank loss of tissue, due to a variety of causes, results in permanent functional and cosmetic deficits23-25.
Regardless of the additional challenges associated with muscle repair and regeneration following VML injury in comparison with myotoxin-induced muscle damage, improved understanding of the mechanistic basis for skeletal muscle regeneration and repair, in a variety of contexts, would be well served by utilization of biologically relevant animal models in combination with longitudinal assessments of pertinent functional measures. As discussed herein, studies of the rat hindlimb provide an excellent model system to this end. More specifically, the muscles of the anterior crural compartment (tibialis anterior, extensor digitorum longus (EDL) and hallicus longus (HL)), which are responsible for dorsiflexion of the foot, are easily identified and manipulated. Moreover, they are served by major blood vessels (iliac and branches), and are innervated by nerves (sciatic and branches, including peroneal) running the length of the leg26-28. As such, one can use the rat hindlimb model to directly assess skeletal muscle function/pathology in vivo, or to evaluate the more indirect impact of pathology-related alterations in blood vessels or nerves on corresponding skeletal muscle function. In either scenario, the severity of disease, as well as the efficacy of treatment can be determined as a function of muscle force production (torque) and corresponding foot movement29-34.
Ideally, force measurements are accompanied by histological studies and gene expression analyses to more rigorously evaluate the structural and molecular status of skeletal muscle. Basic histology and immunohistochemistry, for example, are able to answer questions about muscle size, muscle fiber alignment, extracellular matrix composition, location of nuclei, cell number, and protein localization. Gene expression analysis, in turn, is necessary for identifying the molecular mechanisms that may influence/modulate the maturity of the muscle fibers, disease states, and metabolic activity. While these methods provide crucial information, they generally represent terminal endpoints, and most importantly, they fail to directly address the functional capacity of skeletal muscle, and thus, are correlative rather than causative. However, when histological studies and gene expression analyses are evaluated in conjunction with functional measures, then, mechanisms of force production and functional regeneration can be most accurately identified.
In this regard, the force producing abilities of a muscle can be measured in vitro, in situ, or in vivo. All three approaches have both advantages and limitations. In an in vitro experiment, for example, the muscle is completely isolated and removed from the body of the animal. By removing the influences of the blood vessels and nerves that supply the muscle, the contractile ability of the tissue can be determined in a tightly controlled external environment35. In situ muscle testing allows the muscle to be isolated, as with in vitro preparations, however, the innervation and blood supply remain intact. The benefit of the in situ experimental model is that it allows an individual muscle to be studied while the innervation and blood supply is minimally perturbed36. In both in vitro and in situ experiments, pharmacological treatments may be applied more directly without having to account for the effects of any surrounding tissues or the impact of the circulatory system on the measured contractile responses37. However, in vivo function testing, as described herein, is the least invasive technique for evaluating muscle function in its native environment38, and can be performed repeatedly over time (i.e., longitudinally). As such, it will be the focal point of the discussion below.
In this regard, percutaneous electrodes inserted near the muscle of interest, or the motor nerve that serves it, provide an electrical signal to the muscle. A transducer then measures the resultant length or force changes in the activated muscle as directed by a predetermined, customized software protocol. From these data, the physical properties of the muscle can be determined. These include force-frequency, maximal tetanus, force-velocity, stiffness, length tension, and fatigue. Muscle length or force may also be held constant so that the muscle contracts isometrically or isotonically. Importantly, these experimental protocols can be rapidly performed, easily repeated, and customized- all while the animal is anaesthetized and with a recovery period of hours to days. A single animal can undergo in vivo force testing multiple times, thus enabling longitudinal studies of disease models or evaluation of therapeutic platforms/technologies.
As described herein, a commercial muscle lever system in conjunction with a high power, bi-phase stimulator is used to perform in vivo muscle function testing to evaluate the contribution of the tibialis anterior muscle of the rat hindlimb to dorsiflexion of the foot via stimulation of the peroneal nerve. We have developed a protocol that is specifically designed to evaluate regenerative medicine/tissue engineering technologies for muscle repair following traumatic VML injury of the rat TA muscle. It should be noted; the EDL and HL need to be dissected out of the anterior crural compartment in order to specifically evaluate the TA muscle (they account for approximately 15-20% of the total tibialis anterior torque measured following peroneal nerve stimulation (Corona et al., 2013)). Because this approach provides comprehensive longitudinal analysis of muscle physiology/function, it can shed important mechanistic insight on numerous other types of physiological investigations as well as a variety of disease or therapeutic areas39. For example, in vivo muscle function testing is applicable to studies of exercise physiology, ischemia/reperfusion research, myopathy, nerve damage/neuropathy and vasculopathy, sarcopenia, and muscular dystrophies40.