Skip to main content
Top
Published in: Calcified Tissue International 6/2015

01-12-2015 | Original Research

Vitamin D Receptor Ablation and Vitamin D Deficiency Result in Reduced Grip Strength, Altered Muscle Fibers, and Increased Myostatin in Mice

Authors: Christian M. Girgis, Kuan Minn Cha, Peter J. Houweling, Renuka Rao, Nancy Mokbel, Mike Lin, Roderick J. Clifton-Bligh, Jenny E. Gunton

Published in: Calcified Tissue International | Issue 6/2015

Login to get access

Abstract

Vitamin D deficiency is associated with muscle weakness, pain, and atrophy. Serum vitamin D predicts muscle strength and age-related muscle changes. However, precise mechanisms by which vitamin D affects skeletal muscle are unclear. To address this question, this study characterizes the muscle phenotype and gene expression of mice with deletion of vitamin D receptor (VDRKO) or diet-induced vitamin D deficiency. VDRKO and vitamin D-deficient mice had significantly weaker grip strength than their controls. Weakness progressed with age and duration of vitamin D deficiency, respectively. Histological assessment showed that VDRKO mice had muscle fibers that were significantly smaller in size and displayed hyper-nuclearity. Real-time PCR also indicated muscle developmental changes in VDRKO mice with dysregulation of myogenic regulatory factors (MRFs) and increased myostatin in quadriceps muscle (>2-fold). Vitamin D-deficient mice also showed increases in myostatin and the atrophy marker E3-ubiqutin ligase MuRF1. As a potential explanation for grip strength weakness, both groups of mice had down-regulation of genes encoding calcium-handling and sarco-endoplasmic reticulum calcium transport ATPase (Serca) channels. This is the first report of reduced strength, morphological, and gene expression changes in VDRKO and vitamin D-deficient mice where confounding by calcium, magnesium, and phosphate have been excluded by direct testing. Although suggested in earlier in vitro work, this study is the first to report an in vivo association between vitamin D, myostatin, and the regulation of muscle mass. These findings support a direct role for vitamin D in muscle function and corroborate earlier work on the presence of VDR in this tissue.
Literature
1.
go back to reference Girgis CM, Clifton-Bligh RJ, Hamrick MW, Holick MF, Gunton JE (2013) The roles of vitamin D in skeletal muscle: form, function, and metabolism. Endocr Rev 34:33–83CrossRefPubMed Girgis CM, Clifton-Bligh RJ, Hamrick MW, Holick MF, Gunton JE (2013) The roles of vitamin D in skeletal muscle: form, function, and metabolism. Endocr Rev 34:33–83CrossRefPubMed
2.
go back to reference Visser M, Deeg DJ, Lips P (2003) Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 88:5766–5772CrossRefPubMed Visser M, Deeg DJ, Lips P (2003) Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 88:5766–5772CrossRefPubMed
3.
go back to reference Ward KA, Das G, Roberts SA, Berry JL, Adams JE, Rawer R, Mughal MZ (2010) A randomized, controlled trial of vitamin D supplementation upon musculoskeletal health in postmenarchal females. J Clin Endocrinol Metab 95:4643–4651CrossRefPubMed Ward KA, Das G, Roberts SA, Berry JL, Adams JE, Rawer R, Mughal MZ (2010) A randomized, controlled trial of vitamin D supplementation upon musculoskeletal health in postmenarchal females. J Clin Endocrinol Metab 95:4643–4651CrossRefPubMed
4.
go back to reference Szulc P, Schoppet M, Goettsch C, Rauner M, Dschietzig T, Chapurlat R, Hofbauer LC (2012) Endocrine and clinical correlates of myostatin serum concentration in men—the STRAMBO study. J Clin Endocrinol Metab 97:3700–3708CrossRefPubMed Szulc P, Schoppet M, Goettsch C, Rauner M, Dschietzig T, Chapurlat R, Hofbauer LC (2012) Endocrine and clinical correlates of myostatin serum concentration in men—the STRAMBO study. J Clin Endocrinol Metab 97:3700–3708CrossRefPubMed
5.
go back to reference Girgis CM, Clifton-Bligh RJ, Turner N, Lau SL, Gunton JE (2014) Effects of vitamin D in skeletal muscle: falls, strength, athletic performance and insulin sensitivity. Clin Endocrinol (Oxf) 80:169–181CrossRef Girgis CM, Clifton-Bligh RJ, Turner N, Lau SL, Gunton JE (2014) Effects of vitamin D in skeletal muscle: falls, strength, athletic performance and insulin sensitivity. Clin Endocrinol (Oxf) 80:169–181CrossRef
6.
7.
go back to reference Bischoff HA, Borchers M, Gudat F, Duermueller U, Theiler R, Stahelin HB, Dick W (2001) In situ detection of 1,25-dihydroxyvitamin D3 receptor in human skeletal muscle tissue. Histochem J 33:19–24CrossRefPubMed Bischoff HA, Borchers M, Gudat F, Duermueller U, Theiler R, Stahelin HB, Dick W (2001) In situ detection of 1,25-dihydroxyvitamin D3 receptor in human skeletal muscle tissue. Histochem J 33:19–24CrossRefPubMed
8.
go back to reference Srikuea R, Zhang X, Park-Sarge OK, Esser KA (2012) VDR and CYP27B1 are expressed in C2C12 cells and regenerating skeletal muscle: potential role in suppression of myoblast proliferation. Am J Physiol Cell Physiol 303:C396–C405PubMedCentralCrossRefPubMed Srikuea R, Zhang X, Park-Sarge OK, Esser KA (2012) VDR and CYP27B1 are expressed in C2C12 cells and regenerating skeletal muscle: potential role in suppression of myoblast proliferation. Am J Physiol Cell Physiol 303:C396–C405PubMedCentralCrossRefPubMed
9.
go back to reference Ceglia L, da Silva Morais M, Park LK, Morris E, Harris SS, Bischoff-Ferrari HA, Fielding RA, Dawson-Hughes B (2010) Multi-step immunofluorescent analysis of vitamin D receptor loci and myosin heavy chain isoforms in human skeletal muscle. J Mol Histol 41:137–142PubMedCentralCrossRefPubMed Ceglia L, da Silva Morais M, Park LK, Morris E, Harris SS, Bischoff-Ferrari HA, Fielding RA, Dawson-Hughes B (2010) Multi-step immunofluorescent analysis of vitamin D receptor loci and myosin heavy chain isoforms in human skeletal muscle. J Mol Histol 41:137–142PubMedCentralCrossRefPubMed
10.
go back to reference Ceglia L, Niramitmahapanya S, Morais MD, Rivas DA, Harris SS, Bischoff-Ferrari H, Fielding RA, Dawson-Hughes B (2013) A randomized study on the effect of vitamin D3 supplementation on skeletal muscle morphology and vitamin D receptor concentration in older women. J Clin Endocrinol Metab 98:E1927–E1935PubMedCentralCrossRefPubMed Ceglia L, Niramitmahapanya S, Morais MD, Rivas DA, Harris SS, Bischoff-Ferrari H, Fielding RA, Dawson-Hughes B (2013) A randomized study on the effect of vitamin D3 supplementation on skeletal muscle morphology and vitamin D receptor concentration in older women. J Clin Endocrinol Metab 98:E1927–E1935PubMedCentralCrossRefPubMed
11.
go back to reference Girgis CM, Mokbel N, Minn Cha K, Houweling PJ, Abboud M, Fraser DR, Mason RS, Clifton-Bligh RJ, Gunton JE (2014) The vitamin D receptor (VDR) is expressed in skeletal muscle of male mice and modulates 25-hydroxyvitamin D (25OHD) uptake in myofibers. Endocrinology 155:3227–3237PubMedCentralCrossRefPubMed Girgis CM, Mokbel N, Minn Cha K, Houweling PJ, Abboud M, Fraser DR, Mason RS, Clifton-Bligh RJ, Gunton JE (2014) The vitamin D receptor (VDR) is expressed in skeletal muscle of male mice and modulates 25-hydroxyvitamin D (25OHD) uptake in myofibers. Endocrinology 155:3227–3237PubMedCentralCrossRefPubMed
12.
go back to reference Pojednic RM, Ceglia L, Olsson K, Gustafsson T, Lichtenstein AH, Dawson-Hughes B, Fielding RA (2014) Effects of 1,25-dihydroxyvitamin D and vitamin D on the expression of the vitamin D receptor in human skeletal muscle cells. Calcif Tissue Int 96:256–263PubMedCentralCrossRefPubMed Pojednic RM, Ceglia L, Olsson K, Gustafsson T, Lichtenstein AH, Dawson-Hughes B, Fielding RA (2014) Effects of 1,25-dihydroxyvitamin D and vitamin D on the expression of the vitamin D receptor in human skeletal muscle cells. Calcif Tissue Int 96:256–263PubMedCentralCrossRefPubMed
13.
go back to reference Boland RL (2011) VDR activation of intracellular signaling pathways in skeletal muscle. Mol Cell Endocrinol 347:11–16CrossRefPubMed Boland RL (2011) VDR activation of intracellular signaling pathways in skeletal muscle. Mol Cell Endocrinol 347:11–16CrossRefPubMed
14.
go back to reference Abboud M, Puglisi DA, Davies BN, Rybchyn M, Whitehead NP, Brock KE, Cole L, Gordon-Thomson C, Fraser DR, Mason RS (2013) Evidence for a specific uptake and retention mechanism for 25-hydroxyvitamin D (25OHD) in skeletal muscle cells. Endocrinology 154:3022–3030CrossRefPubMed Abboud M, Puglisi DA, Davies BN, Rybchyn M, Whitehead NP, Brock KE, Cole L, Gordon-Thomson C, Fraser DR, Mason RS (2013) Evidence for a specific uptake and retention mechanism for 25-hydroxyvitamin D (25OHD) in skeletal muscle cells. Endocrinology 154:3022–3030CrossRefPubMed
15.
go back to reference Girgis CM, Clifton-Bligh RJ, Mokbel N, Cheng K, Gunton JE (2014) Vitamin D signaling regulates proliferation, differentiation, and myotube size in C2C12 skeletal muscle cells. Endocrinology 155:347–357CrossRefPubMed Girgis CM, Clifton-Bligh RJ, Mokbel N, Cheng K, Gunton JE (2014) Vitamin D signaling regulates proliferation, differentiation, and myotube size in C2C12 skeletal muscle cells. Endocrinology 155:347–357CrossRefPubMed
16.
go back to reference Tanaka M, Kishimoto KN, Okuno H, Saito H, Itoi E (2014) Vitamin D receptor gene silencing effects on differentiation of myogenic cell lines. Muscle Nerve 49:700–708CrossRefPubMed Tanaka M, Kishimoto KN, Okuno H, Saito H, Itoi E (2014) Vitamin D receptor gene silencing effects on differentiation of myogenic cell lines. Muscle Nerve 49:700–708CrossRefPubMed
17.
go back to reference Garcia LA, King KK, Ferrini MG, Norris KC, Artaza JN (2011) 1,25(OH)2vitamin D3 stimulates myogenic differentiation by inhibiting cell proliferation and modulating the expression of promyogenic growth factors and myostatin in C2C12 skeletal muscle cells. Endocrinology 152:2976–2986PubMedCentralCrossRefPubMed Garcia LA, King KK, Ferrini MG, Norris KC, Artaza JN (2011) 1,25(OH)2vitamin D3 stimulates myogenic differentiation by inhibiting cell proliferation and modulating the expression of promyogenic growth factors and myostatin in C2C12 skeletal muscle cells. Endocrinology 152:2976–2986PubMedCentralCrossRefPubMed
18.
go back to reference Amling M, Priemel M, Holzmann T, Chapin K, Rueger JM, Baron R, Demay MB (1999) Rescue of the skeletal phenotype of vitamin D receptor-ablated mice in the setting of normal mineral ion homeostasis: formal histomorphometric and biomechanical analyses. Endocrinology 140:4982–4987PubMed Amling M, Priemel M, Holzmann T, Chapin K, Rueger JM, Baron R, Demay MB (1999) Rescue of the skeletal phenotype of vitamin D receptor-ablated mice in the setting of normal mineral ion homeostasis: formal histomorphometric and biomechanical analyses. Endocrinology 140:4982–4987PubMed
19.
go back to reference Bhat M, Kalam R, Qadri SS, Madabushi S, Ismail A (2013) Vitamin D deficiency induced muscle wasting occurs through the ubiquitin proteasome pathway and is partially corrected by calcium in male rats. Endocrinology 154:4018–4029CrossRefPubMed Bhat M, Kalam R, Qadri SS, Madabushi S, Ismail A (2013) Vitamin D deficiency induced muscle wasting occurs through the ubiquitin proteasome pathway and is partially corrected by calcium in male rats. Endocrinology 154:4018–4029CrossRefPubMed
20.
go back to reference Mokbel N, Hoffman NJ, Girgis CM, Small L, Turner N, Daly RJ, Cooney GJ, Holt LJ (2014) Grb10 deletion enhances muscle cell proliferation, differentiation and GLUT4 plasma membrane translocation. J Cell Physiol 229:1753–1764CrossRefPubMed Mokbel N, Hoffman NJ, Girgis CM, Small L, Turner N, Daly RJ, Cooney GJ, Holt LJ (2014) Grb10 deletion enhances muscle cell proliferation, differentiation and GLUT4 plasma membrane translocation. J Cell Physiol 229:1753–1764CrossRefPubMed
21.
go back to reference Burne TH, Johnston AN, McGrath JJ, Mackay-Sim A (2006) Swimming behaviour and post-swimming activity in vitamin D receptor knockout mice. Brain Res Bull 69:74–78CrossRefPubMed Burne TH, Johnston AN, McGrath JJ, Mackay-Sim A (2006) Swimming behaviour and post-swimming activity in vitamin D receptor knockout mice. Brain Res Bull 69:74–78CrossRefPubMed
22.
go back to reference Kalueff AV, Lou YR, Laaksi I, Tuohimaa P (2004) Impaired motor performance in mice lacking neurosteroid vitamin D receptors. Brain Res Bull 64:25–29CrossRefPubMed Kalueff AV, Lou YR, Laaksi I, Tuohimaa P (2004) Impaired motor performance in mice lacking neurosteroid vitamin D receptors. Brain Res Bull 64:25–29CrossRefPubMed
23.
go back to reference Minasyan A, Keisala T, Zou J, Zhang Y, Toppila E, Syvala H, Lou YR, Kalueff AV, Pyykko I, Tuohimaa P (2009) Vestibular dysfunction in vitamin D receptor mutant mice. J Steroid Biochem Mol Biol 114:161–166CrossRefPubMed Minasyan A, Keisala T, Zou J, Zhang Y, Toppila E, Syvala H, Lou YR, Kalueff AV, Pyykko I, Tuohimaa P (2009) Vestibular dysfunction in vitamin D receptor mutant mice. J Steroid Biochem Mol Biol 114:161–166CrossRefPubMed
24.
go back to reference Rodman JS, Baker T (1978) Changes in the kinetics of muscle contraction in vitamin D-depleted rats. Kidney Int 13:189–193CrossRefPubMed Rodman JS, Baker T (1978) Changes in the kinetics of muscle contraction in vitamin D-depleted rats. Kidney Int 13:189–193CrossRefPubMed
25.
go back to reference Tague SE, Clarke GL, Winter MK, McCarson KE, Wright DE, Smith PG (2011) Vitamin D deficiency promotes skeletal muscle hypersensitivity and sensory hyperinnervation. J Neurosci 31:13728–13738PubMedCentralCrossRefPubMed Tague SE, Clarke GL, Winter MK, McCarson KE, Wright DE, Smith PG (2011) Vitamin D deficiency promotes skeletal muscle hypersensitivity and sensory hyperinnervation. J Neurosci 31:13728–13738PubMedCentralCrossRefPubMed
26.
go back to reference Pleasure D, Wyszynski B, Sumner A, Schotland D, Feldman B, Nugent N, Hitz K, Goodman DB (1979) Skeletal muscle calcium metabolism and contractile force in vitamin D-deficient chicks. J Clin Invest 64:1157–1167PubMedCentralCrossRefPubMed Pleasure D, Wyszynski B, Sumner A, Schotland D, Feldman B, Nugent N, Hitz K, Goodman DB (1979) Skeletal muscle calcium metabolism and contractile force in vitamin D-deficient chicks. J Clin Invest 64:1157–1167PubMedCentralCrossRefPubMed
27.
go back to reference Schubert L, DeLuca HF (2010) Hypophosphatemia is responsible for skeletal muscle weakness of vitamin D deficiency. Arch Biochem Biophys 500:157–161CrossRefPubMed Schubert L, DeLuca HF (2010) Hypophosphatemia is responsible for skeletal muscle weakness of vitamin D deficiency. Arch Biochem Biophys 500:157–161CrossRefPubMed
28.
go back to reference Boland R, de Boland AR, Ritz E, Hasselbach W (1983) Effect of 1,25-dihydroxycholecalciferol on sarcoplasmic reticulum calcium transport in strontium-fed chicks. Calcif Tissue Int 35:190–194CrossRefPubMed Boland R, de Boland AR, Ritz E, Hasselbach W (1983) Effect of 1,25-dihydroxycholecalciferol on sarcoplasmic reticulum calcium transport in strontium-fed chicks. Calcif Tissue Int 35:190–194CrossRefPubMed
29.
go back to reference Boland R, Matthews C, de Boland AR, Ritz E, Hasselbach W (1983) Reversal of decreased phosphorylation of sarcoplasmic reticulum calcium transport ATPase by 1,25-dihydroxycholecalciferol in experimental uremia. Calcif Tissue Int 35:195–201CrossRefPubMed Boland R, Matthews C, de Boland AR, Ritz E, Hasselbach W (1983) Reversal of decreased phosphorylation of sarcoplasmic reticulum calcium transport ATPase by 1,25-dihydroxycholecalciferol in experimental uremia. Calcif Tissue Int 35:195–201CrossRefPubMed
30.
go back to reference Li YC, Pirro AE, Demay MB (1998) Analysis of vitamin D-dependent calcium-binding protein messenger ribonucleic acid expression in mice lacking the vitamin D receptor. Endocrinology 139:847–851PubMed Li YC, Pirro AE, Demay MB (1998) Analysis of vitamin D-dependent calcium-binding protein messenger ribonucleic acid expression in mice lacking the vitamin D receptor. Endocrinology 139:847–851PubMed
31.
go back to reference Funai K, Song H, Yin L, Lodhi IJ, Wei X, Yoshino J, Coleman T, Semenkovich CF (2013) Muscle lipogenesis balances insulin sensitivity and strength through calcium signaling. J Clin Invest 123:1229–1240PubMedCentralCrossRefPubMed Funai K, Song H, Yin L, Lodhi IJ, Wei X, Yoshino J, Coleman T, Semenkovich CF (2013) Muscle lipogenesis balances insulin sensitivity and strength through calcium signaling. J Clin Invest 123:1229–1240PubMedCentralCrossRefPubMed
32.
go back to reference Endo I, Inoue D, Mitsui T, Umaki Y, Akaike M, Yoshizawa T, Kato S, Matsumoto T (2003) Deletion of vitamin D receptor gene in mice results in abnormal skeletal muscle development with deregulated expression of myoregulatory transcription factors. Endocrinology 144:5138–5144CrossRefPubMed Endo I, Inoue D, Mitsui T, Umaki Y, Akaike M, Yoshizawa T, Kato S, Matsumoto T (2003) Deletion of vitamin D receptor gene in mice results in abnormal skeletal muscle development with deregulated expression of myoregulatory transcription factors. Endocrinology 144:5138–5144CrossRefPubMed
33.
go back to reference Koyama S, Hata S, Witt CC, Ono Y, Lerche S, Ojima K, Chiba T, Doi N, Kitamura F, Tanaka K, Abe K, Witt SH, Rybin V, Gasch A, Franz T, Labeit S, Sorimachi H (2008) Muscle RING-finger protein-1 (MuRF1) as a connector of muscle energy metabolism and protein synthesis. J Mol Biol 376:1224–1236CrossRefPubMed Koyama S, Hata S, Witt CC, Ono Y, Lerche S, Ojima K, Chiba T, Doi N, Kitamura F, Tanaka K, Abe K, Witt SH, Rybin V, Gasch A, Franz T, Labeit S, Sorimachi H (2008) Muscle RING-finger protein-1 (MuRF1) as a connector of muscle energy metabolism and protein synthesis. J Mol Biol 376:1224–1236CrossRefPubMed
34.
go back to reference McPherron AC, Lawler AM, Lee SJ (1997) Regulation of skeletal muscle mass in mice by a new TGF-beta superfamily member. Nature 387:83–90CrossRefPubMed McPherron AC, Lawler AM, Lee SJ (1997) Regulation of skeletal muscle mass in mice by a new TGF-beta superfamily member. Nature 387:83–90CrossRefPubMed
35.
go back to reference Girgis C, Mokbel N, Digirolamo DJ (2014) Therapies for musculoskeletal disease: can we treat two birds with one stone? Curr Osteoporos Rep 12:142–153PubMedCentralCrossRefPubMed Girgis C, Mokbel N, Digirolamo DJ (2014) Therapies for musculoskeletal disease: can we treat two birds with one stone? Curr Osteoporos Rep 12:142–153PubMedCentralCrossRefPubMed
36.
go back to reference Grossmann M (2014) Myostatin inhibition: a new treatment for androgen deprivation-induced sarcopenia? J Clin Endocrinol Metab 99:3625–3628CrossRefPubMed Grossmann M (2014) Myostatin inhibition: a new treatment for androgen deprivation-induced sarcopenia? J Clin Endocrinol Metab 99:3625–3628CrossRefPubMed
37.
go back to reference Bischoff-Ferrari HA, Borchers M, Gudat F, Durmuller U, Stahelin HB, Dick W (2004) Vitamin D receptor expression in human muscle tissue decreases with age. J Bone Miner Res 19:265–269CrossRefPubMed Bischoff-Ferrari HA, Borchers M, Gudat F, Durmuller U, Stahelin HB, Dick W (2004) Vitamin D receptor expression in human muscle tissue decreases with age. J Bone Miner Res 19:265–269CrossRefPubMed
38.
go back to reference Max D, Brandsch C, Schumann S, Kuhne H, Frommhagen M, Schutkowski A, Hirche F, Staege MS, Stangl GI (2013) Maternal vitamin D deficiency causes smaller muscle fibers and altered transcript levels of genes involved in protein degradation, myogenesis, and cytoskeleton organization in the newborn rat. Mol Nutr Food Res 48:973–984 Max D, Brandsch C, Schumann S, Kuhne H, Frommhagen M, Schutkowski A, Hirche F, Staege MS, Stangl GI (2013) Maternal vitamin D deficiency causes smaller muscle fibers and altered transcript levels of genes involved in protein degradation, myogenesis, and cytoskeleton organization in the newborn rat. Mol Nutr Food Res 48:973–984
39.
go back to reference Krishnaveni GV, Veena SR, Winder NR, Hill JC, Noonan K, Boucher BJ, Karat SC, Fall CH (2011) Maternal vitamin D status during pregnancy and body composition and cardiovascular risk markers in Indian children: the Mysore Parthenon Study. Am J Clin Nutr 93:628–635PubMedCentralCrossRefPubMed Krishnaveni GV, Veena SR, Winder NR, Hill JC, Noonan K, Boucher BJ, Karat SC, Fall CH (2011) Maternal vitamin D status during pregnancy and body composition and cardiovascular risk markers in Indian children: the Mysore Parthenon Study. Am J Clin Nutr 93:628–635PubMedCentralCrossRefPubMed
Metadata
Title
Vitamin D Receptor Ablation and Vitamin D Deficiency Result in Reduced Grip Strength, Altered Muscle Fibers, and Increased Myostatin in Mice
Authors
Christian M. Girgis
Kuan Minn Cha
Peter J. Houweling
Renuka Rao
Nancy Mokbel
Mike Lin
Roderick J. Clifton-Bligh
Jenny E. Gunton
Publication date
01-12-2015
Publisher
Springer US
Published in
Calcified Tissue International / Issue 6/2015
Print ISSN: 0171-967X
Electronic ISSN: 1432-0827
DOI
https://doi.org/10.1007/s00223-015-0054-x

Other articles of this Issue 6/2015

Calcified Tissue International 6/2015 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.