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The Effect of Osteopathic Manipulative Treatment on Reactive Oxygen Species in Parkinson Disease
Docherty, J. [10]
Chu, K. [1]
Orshan, D. [1]
Kulason, K. [1]
Leder, A. [15]
Cheriyan, G. [6]
DiFrancisco-Donoghue, J. [9]
Mancini, J. [25]
Leheste, J. [5]
Yao, S. C. [54]

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e173-e174. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

biomarkers [10]
OMT [2951]
osteopathic manipulative treatment [2973]
randomized controlled trial [710]
reactive oxidative species [1]

Abstract:

Introduction: Parkinson disease (PD) is the second most common neurodegenerative disorder and causes many symptoms, including bradykinesia, tremor, postural instability, and musculoskeletal stiffness. Neurodegeneration is commonly associated with an increase in inflammation and oxidative stress, demonstrated by higher systemic levels of reactive oxidative species (ROS) thought to originate from mitochondria in underused skeletal muscle tissue. ROS are characterized by an unpaired electron, produced by both exogenous and endogenous sources and involved in pathological processes. Due to their reactivity, they modify cellular components such as nucleic acids, proteins, and lipids. Lack of homeostatic balance between production and defense mechanisms is detrimental. The effects of ROS, cumulatively known as oxidative stress, are often measured by the interactions of ROS on specific molecules. Dityrosine (DT), a cross-linked dimer form of tyrosine, is a stable molecular result of oxidation by ROS, lending to its use as a clinical biomarker. Another biomarker, malondialdehyde (MDA), is used to demonstrate the effect of free radical oxidation on lipids. Osteopathic manipulative treatment (OMT) aims to reduce somatic dysfunctions, free musculoskeletal restrictions, and increase fluid circulation. The goals of OMT use in PD are reducing stiffness, increasing muscular activity, and decreasing inflammation. These changes may lead to decreased ROS production and increased ROS clearance. Hypothesis: Biweekly OMT over 6 weeks will reduce oxidative stress in PD compared with biweekly counseling by decreasing the processes that generate DT and MDA. Statement of Significance: OMT may reduce molecular damage caused by excess oxidative species generated in PD. Methods: This study was approved by the NYIT institutional review board. PD subjects with balance and motor deficits were randomly assigned to the intervention arm (n=10) or control arm (n=9). The treatment group received a biweekly OMT protocol for 6 weeks. The OMT protocol focused on reducing somatic dysfunctions in the head, spine, and extremities and used primarily muscle energy and articulatory techniques. The control group received biweekly counseling sessions for 6 weeks to account for physician face-to-face time in the treatment arm. Subjects returned after a 4-week washout at week 10 for measurements once again. Blood samples were taken before and after the intervention at visit 1, week 3, week 6, and week 10. Oxidative stress was quantified by detecting plasma concentrations of DT and MDA via ELISAs. Data Analysis: Mean (SE) concentrations of DT and MDA were compared temporally and between OMT and counselling groups via a 2×5 mixed ANOVA and t test approaches. Results: Week 1 presession concentrations of DT for the OMT group and counselling group were 3.7 (0.29) nm/dL and 3.6 (0.55) nm/dL. Week 1 postsession concentrations of DT for the OMT group and counselling group were 3.8 (0.43) nm/dL and 3.5 (0.53) nm/dL. Week 3 concentrations of DT for the OMT group and counselling group were 3.5 (0.66) nm/dL and 3.8 (0.84) nm/dL. Week 6 concentrations of DT for the OMT group and counselling group were 3.8 (0.32) nm/dL and 3.0 (0.2) nm/dL. Week 10 concentrations of DT for the OMT group and counselling group were 2.8 (0.32) nm/dL and 2.9 (0.33) nm/dL. No significant differences were found between groups or weeks (P=.18). Week 1 presession concentrations of MDA for the OMT group and counselling group were 1.6 (0.43) nm/dL and 1.8 (0.53) nm/dL. Week 1 postsession concentrations of MDA for the OMT group and counselling group were 1.5 (0.43) nm/dL and 2.1 (0.68) nm/dL. The OMT group had lower MDA in the acute setting compared with counselling (P=.337). Week 3 concentrations of MDA for the OMT group and counselling group were 2.0 (0.56) nm/dL and 2.1 (0.55) nm/dL. Week 6 concentrations of MDA for the OMT group and counselling group were 1.9 (0.60) nm/dL and 1.8 (0.48) nm/dL. Week 10 concentrations of MDA for the OMT group and counselling group were 2.7 (1.1) nm/dL and 1.8 (0.60) nm/dL. No significant differences were found between groups or weeks (P=.536). Conclusions: This study suggests OMT did not affect the plasma concentrations of DT and MDA in our sample population, however, OMT may have a beneficial effect on MDA concentrations acutely. Limitations of this project include that blood samples were drawn at different times of the morning between and within subjects. Another aspect not controlled for is the morning activities of the subjects before blood draw. The sample size is also small. Further studies should be completed to overcome these limitations and perhaps investigate other biomarkers of oxidative stress.

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