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Timeline of the cryotherapy procedure. (a) Standard procedure in which physiological parameters (weight, BMI, fat mass, and waist and thigh circumferences) are measured (MP) before and after cryotherapy (CRYO, duration = 1.33 h) in all procedures (not to scale in (b) and (c)). (b) Group 1 (n=18) underwent the procedure on 3 serial days. (c) Group 2 (n=7) underwent the procedure on 6 serial days; dual-energy X-ray absorptiometry (DXA) scanning was performed as indicated before the procedure and following three and six procedures.
Source publication
Background
Local adipose tissue (AT) cooling is used to manage obesity and overweight, but the mechanism is unclear. The current view is that acute local cooling of AT induces adipocyte cell disruption and inflammation (“cryolipolysis”) that lead to adipocyte cell death, with loss of subcutaneous fat being recorded over a prolonged period of weeks/...
Citations
... Specifically, it has been proposed that cooling therapies could be included as an adjunct therapy to help patients with central sleep apnoea syndrome who do not respond to continuous positive airway pressure (CPAP) treatment-which is supposed to increase air pressure in the pharynx, preventing thereby the collapse of upper airways. WBC has been shown to determine local adipose tissue reduction and redistribution [43]. A reduction in local adipose tissue around the neck might be beneficial on sleep apnoea severity by reducing the upper airway collapsibility. ...
This chapter aims to provide a summary, though not exhaustive, of some topics that have been only marginally, if not at all, covered in published whole-body cryostimulation (WBC) studies, but hold some rationale for its application. Local cold application has been shown to induce prolonged inhibitory effects on spasticity in patients with upper motor neuron involvement. Recent studies on animals seem to suggest that topical application of cold could be a novel and simple-to-use therapeutic strategy for stroke patients. Cold-induced analgesia is achieved by lowering the skin temperature, but research must clarify what the optimal tissue temperature reduction should be and the subsequent effect on treatment outcome. Chronic cold exposure or treatments mimicking the chronic cold exposure, through WAT-BAT transdifferentiation and BAT activation, could represent the prospective therapies for obesity and type 2 diabetes, but larger studies are needed to confirm preliminary evidence. WBC shows a large influence on parasympathetic reactivation, an indicator of systemic recovery and could have beneficial effects on joint range of motion, decrease of neural activation of the muscle and local analgesia, which in turn facilitates joint mobilisation. WBC treatments could also be possibly used as: a method for healthy ageing because of their anti-inflammatory/antioxidant capacity, a therapeutic adjuvant for sleep apnoea, a means to temporarily increase resting energy expenditure and change microbiota composition with potential therapeutic effects. While the benefits of WBC in recovery in sports and exercise are widely acknowledged, the research on its clinical effects remains limited. This chapter aims to provide a summary, although not exhaustive, of some conditions that might benefit from the prescription of WBC but that have not been, or only preliminarily, investigated so far.
... 93 On the other hand, the effects of local cryotherapy should be underlined. Loap et al. 94 used local cryotherapy on overweight patients. Layers of wetted paper were applied to the lower back and hips of the reclining subject, followed by symmetrical application of six probes placed pairwise, and temperature was set to −10 • C, declining to −5 • C over 30 min; the application duration was 40 min. ...
Introduction:
Whole-body cryotherapy (WBC) is a controlled exposure of the whole body to cold to gain health benefits. In recent years, data on potential applications of WBC in multiple clinical settings have emerged.
Sources of data:
PubMed, EBSCO and Clinical Key search using keywords including terms 'whole body', 'cryotherapy' and 'cryostimulation'.
Areas of agreement:
WBC could be applied as adjuvant therapy in multiple conditions involving chronic inflammation because of its potent anti-inflammatory effects. Those might include systemic inflammation as in rheumatoid arthritis. In addition, WBC could serve as adjuvant therapy for chronic inflammation in some patients with obesity.
Areas of controversy:
WBC probably might be applied as an adjuvant treatment in patients with chronic brain disorders including mild cognitive impairment and general anxiety disorder and in patients with depressive episodes and neuroinflammation reduction as in multiple sclerosis. WBC effects in metabolic disorder treatment are yet to be determined. WBC presumably exerts pleiotropic effects and therefore might serve as adjuvant therapy in multi-systemic disorders, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Growing points:
The quality of studies on the effects of WBC in the clinical setting is in general low; hence, randomized controlled trials with adequate sample size and longer follow-up periods are needed.
Areas are timely for developing research:
Further studies should examine the mechanism underlying the clinical efficacy of WBC. Multiple conditions might involve chronic inflammation, which in turn could be a potential target of WBC. Further research on the application of WBC in neurodegenerative disorders, neuropsychiatric disorders and ME/CFS should be conducted.
... In this investigation, weight was measured between 0 and 30 days, a short period of time compared to that generally described to obtain the effects of the cryolipolysis on the reduction in body measurements. The choice of a 30-day period was based on the hypothesis proposed by Loap and Lathe [52] that the reduction in adipose tissue through cryolipolysis can be mediated by thermogenic fat metabolism without adipocyte apoptosis. However, the results of this study, regarding weight, WC and BMI, were different from those described by Loap and Lathe [52] using a different protocol, which consisted of performing six daily sessions of cryolipolysis. ...
... The choice of a 30-day period was based on the hypothesis proposed by Loap and Lathe [52] that the reduction in adipose tissue through cryolipolysis can be mediated by thermogenic fat metabolism without adipocyte apoptosis. However, the results of this study, regarding weight, WC and BMI, were different from those described by Loap and Lathe [52] using a different protocol, which consisted of performing six daily sessions of cryolipolysis. ...
... In this study, although one of the groups was subjected to cryolipolysis on three areas (group B), which could cause higher acute inflammatory changes with subsequent adipocyte death, which could induce changes in the lipid profile, no changes in the lipidogram were found. Similarly, Loap and Lathe [52], when submitting women to cryolipolysis in the lower regions of the back and abdomen, as well as the hip, also did not identify acute changes in the lipid profile, although the authors performed the evaluation after only 3 days with 6 daily cryolipolysis sessions. ...
In the present study, the effects of cryolipolysis on one and multiple body areas, assessing body composition, lipid profile and peroxidation and inflammatory markers were investigated. Twenty-five women aged between 20 and 59 years were randomly assigned to three groups: (1) control, (2) cryolipolysis on the abdomen and (3) cryolipolysis on the abdomen + flanks. Anthropometric measurements, bioimpedance and ultrasound were performed, as well serum lipid profile, lipid peroxidation markers (malondialdehyde and myeloperoxidase) and inflammatory markers (C-reactive
protein and Interleukin-1β) were determined. In addition, food consumption and physical activity level were evaluated. Data were obtained at 0, 10 and 30 days (t0, t10 and t30) after cryolipolysis. Cryolipolysis did not change anthropometric measurements, body composition or lipid profile. Interestingly, the abdomen + flanks group had significantly increased plasma myeloperoxidase activity at t0, t10 and t30, and increased malondialdehyde levels at t0 and t10 when compared to the other
groups. Furthermore, there were no differences between macronutrient intake and total energy value, physical activity level, malondialdehyde and interleukin-1β at t30. Cryolipolysis did not change body composition, lipid profile or inflammatory markers investigated. On the other hand, when used on the abdomen and flanks, it produced an increase in lipid peroxidation markers, malondialdehyde and myeloperoxidase.
Keywords: cryolipolysis; oxidative stress; inflammation; body composition; subcutaneous fat; adipose tissue
... [198] Moreover, FGF21 expression is cold-inducible, [199] and has been a target for novel therapeutic treatments such as "cool sculpting" procedures designed to elevate the metabolic activity of adipose to cold-exposed tissue in order to induce cryolipolysis. [200] Early research identified FGF21 as an important regulator of lipolysis in adipocytes, [201] and subsequent studies demonstrated that FGF21 treatment induced extracellular signal-related kinase (ERK) phosphorylation and tenfold activation in WAT compared with liver tissue, [202] which suggests that adipose is highly sensitive to FGF21 signaling. Additionally, FGF21 treatment, which has been shown to have beneficial effects such as increased glucose tolerance and prevention of hyperinsulinemia, [203] failed to produce a significant reduction in insulin secretion or improved glucose tolerance in a transgenic lipodystrophic mouse model. ...
Obesity and hypertension are intimately linked due to the various ways that the important cell types such as vascular smooth muscle cells (VSMC), endothelial cells (EC), immune cells, and adipocytes, communicate with one another to contribute to these two pathologies. Adipose tissue is a very dynamic organ comprised primarily of adipocytes, which are well known for their role in energy storage. More recently adipose tissue has been recognized as the largest endocrine organ because of its ability to produce a vast number of signaling molecules called adipokines. These signaling molecules stimulate specific types of cells or tissues with many adipokines acting as indicators of adipocyte healthy function, such as adiponectin, omentin, and FGF21, which show anti-inflammatory or cardioprotective effects, acting as regulators of healthy physiological function. Others, like visfatin, chemerin, resistin, and leptin are often altered during pathophysiological circumstances like obesity and lipodystrophy, demonstrating negative cardiovascular outcomes when produced in excess. This review aims to explore the role of adipocytes and their derived products as well as the impacts of these adipokines on blood pressure regulation and cardiovascular homeostasis.
... 21 Previous studies have shown the successful use of this technique to quantify adipose tissue changes in patients after surgical and nonsurgical fat reduction procedures. 14,18,20,22 The current case series study evaluates changes in body composition (lean and fat mass) using DEXA in patients following cryolipolysis treatment. ...
... A previous study observed systemic reductions in fat, even in nonexposed sites, after cryotherapy treatment. 22 Although this study evaluates the use of DEXA analysis after cryolipolysis treatment, previous studies have reported its utility in assessing fat changes after surgical and nonsurgical fat reduction procedures. 14,18,20,22 One advantage of DEXA scanning is the ability to quantitatively assess region-specific changes in fat content and distribution. ...
... 22 Although this study evaluates the use of DEXA analysis after cryolipolysis treatment, previous studies have reported its utility in assessing fat changes after surgical and nonsurgical fat reduction procedures. 14,18,20,22 One advantage of DEXA scanning is the ability to quantitatively assess region-specific changes in fat content and distribution. The images obtained by DEXA allow objective and visible evidence of improvement after cryolipolysis. ...
Objectives: Cryolipolysis provides a nonsurgical treatment option for reducing excess subcutaneous fat. Although widely used, clinical outcomes such as photographs, patient questionnaires, and caliper measurements may be affected by subjectivity and operator- dependency. The current case series study evaluated changes in body composition using dual-energy X-ray absorptiometry (DEXA) in patients who underwent cryolipolysis treatment. Methods: between 2019 and 2020, 5 patients underwent cryolipolysis at a dermatology practice in São Paulo, Brazil. Patients were treated in different body regions using a cryolipolysis medical device (CoolSculpting®; ZELTIQ Aesthetics, Inc., Pleasanton, CA, USA) with the CoolAdvantage™ or CoolAdvantage Plus™ vacuum applicators (ZELTIQ Aesthetics, Inc). Pre- and post-treatment, body weight and abdominal circumference were recorded. Fat and lean mass measurements were also obtained using a total body scanner. Results: five patients (4 females, 1 male; mean age, 34 years) were treated in a total of 8 areas (2 cases in the flank, 3 cases in the abdomen, and 3 cases in the back). Three months post-treatment, body weight was reduced in 3 out of 5 (60.0%) patients, and abdominal circumference was reduced in 2 out of 3 (66.7%) patients. Most patients showed reductions in total fat mass (80.0%) and lean mass (60.0%). The percentage change in body weight was also correlated with the percentage change in total fat mass (R=0.81). Region-specific alterations in fat content were also observed. Conclusions: most patients showed changes in body composition, including lower fat mass (5%-36% reductions) 3 months after cryolipolysis treatment. The results suggest that DEXA can be used to objectively visualize and quantify body composition changes following cryolipolysis treatment.
... The short time window (<2 h) in which modulation of EBI2 activity was able to affect EE might be interesting from a therapeutic point of view for the treatment of obese human subjects. Recent studies showed that cryotherapy applied to obese patients for <2 h was able to significantly reduce BMI and body fat 34 . Further studies will address whether inhibition of EBI2 in obese human subjects might be beneficial for increasing the effects of cold therapy for the treatment of obesity. ...
Pharmacological activation of brown adipose tissue (BAT) is an attractive approach for increasing energy expenditure to counteract obesity. Given the side-effects of known activators of BAT, we studied inhibitors of BAT as a novel, alternative concept to regulate energy expenditure. We focused on G-protein-coupled receptors that are one of the major targets of clinically used drugs. Here, we identify GPR183, also known as EBI2, as the most highly expressed inhibitory G-protein-coupled receptor in BAT among the receptors examined. Activation of EBI2 using its endogenous ligand 7α,25-dihydroxycholesterol significantly decreases BAT-mediated energy expenditure in mice. In contrast, mice deficient for EBI2 show increased energy dissipation in response to cold. Interestingly, only thermogenic adipose tissue depots — BAT and subcutaneous white adipose tissue —respond to 7α,25-dihydroxycholesterol treatment/EBI2 activation but not gonadal white fat, which has the lowest thermogenic capacity. EBI2 activation in brown adipocytes significantly reduces norepinephrine-induced cAMP production, whereas pharmacological inhibition or genetic ablation of EBI2 results in an increased response. Importantly, EBI2 significantly inhibits norepinephrine-induced activation of human brown adipocytes. Our data identify the 7α,25-dihydroxycholesterol/EBI2 signaling pathway as a so far unknown BAT inhibitor. Understanding the inhibitory regulation of BAT might lead to novel pharmacological approaches to increase the activity of thermogenic adipose tissue and whole body energy expenditure in humans. Francesca Copperi et al. evaluate the role of the Gi-protein coupled receptor, EBI2, on regulation of thermogenic activity in murine and human adipocytes. They report that loss of Ebi2 in mice increases brown adipocyte energy expenditure in response to cold exposure, providing insight into ways to potentially modulate energy expenditure in humans.
... Орошение поверхности кожи газовой струей при температуре около -140°С в проекции патологического очага облегчает течение болевого синдрома, способствует повышению подвижности в мышцах и суставах, уменьшению отека, удлинению периода ремиссии. Интересно, что позитивные влияния локальной ЭАКТ при коррекции фигуры у пациентов с ожирением связывают с активацией высвобождения разобщающих белков UPC, хотя процедуры не оказывают заметного влияния на основной обмен [58]. Положительные клинические результаты реабилитации пациентов также достигаются при курсовом применении локальной ЭАКТ. ...
The mechanisms of increasing the resistance of cells to significant temperature and damaging effects are typical, and cellular tolerance, ensuring the effectiveness of systemic regulation, is an important part of increasing the adaptive and rehabilitative potential of the entire organism. The expression of early genes encoding a wide range of stress-protective proteins increases the resistance of cells not only to significant temperature stimuli, but also to ischemia, hypoxia, and other damaging factors, forming the effects of cross-adaptation. Even a small change in temperature is significant enough to trigger the processes of genomic reprogramming. It seems to us important to consider the mechanisms of low-temperature therapeutic and rehabilitation technologies from the standpoint of cellular response to temperature stimuli. Currently, a large number of low temperature technologies (HT) are used in medical rehabilitation, which can be divided into two groups: moderately low temperature effects (from 30C to +20C) and extremely low temperature effects (from 30C to 180C), which includes the technology of extreme aerocriotherapy (EACT). The purpose of the review is to analyze the systemic and local mechanisms of EACT implemented with the participation of the main known stress-protective proteins.
... Another insight comes from cryogenic therapy, Essential role of systemic iron mobilization and redistribution for adaptive thermogenesis through HIF2-α/hepcidin axis which involves exposure to extreme cold vapor for a short duration (57). Cryogenic therapy reduces fat mass due to augmented thermogenic energy loss from the subcutaneous fat, a coldinduced thermogenic process (58). Interestingly enough, cryogenic therapy is associated with reduced hepcidin levels (59), suggesting a similar signaling association between iron mobilization and adaptive thermogenesis in humans. ...
Significance
Adaptive thermogenesis is a metabolic switch that converts the metabolic status of fat tissue from energy conservation to energy release into heat, thereby significantly attenuating the energy burden of obesity and diabetes. It is well known that increased iron content and subsequent mitochondrial formation are required for thermogenic activation. However, no information is available on how iron is mobilized from storage sites into thermogenic fat. Here, we show that acute hypoxia and stress-erythropoiesis responses facilitate securing iron required for white-to-beige fat conversion. Our study revealed that hepcidin down-regulation is a fundamental mechanism required for beige fat development. It also suggests that systemic iron modulation could be a promising strategy to curb obesity and metabolic complications by augmenting adaptive thermogenesis.
... Diversified cold applications elicit an incremental thermogenic effect. This is in accordance with interventions demonstrating adipose tissue loss upon repeated sessions of local cooling [24]. Our results can be seen as a step further in the comprehension of body response to PBC, as to substantiate its utilization in clinical practice. ...
... Since food habits did not change during intervention, RQ variation is attributable to cold-induced substrate shifting. The shifting to CHO oxidation is consistent with previous studies on controlled cold exposure [15,31] and investigations showing a scarce lipid mobilization upon local cooling [24]. BAT contains a significant quota of endogenous glycogen [4] and cold exposure in murine model was demonstrated to significantly increase BAT glucose uptake [47]. ...
... Conversely, in longer exposures CHO utilization can be replaced by lipid oxidation as suggested by Blondin et al. [30]. These findings then indicate that probably cold exposure exerts only a modest effect on triglyceride cleavage and mobilization in WAT, as suggested by other authors [24]. The higher RQ shifting in obese women (lean and obese women presented the same baseline RQ value) suggests a preferential relative CHO oxidation in obesity. ...
Cryostimulation is currently seen as a potential adjuvant strategy to tackle obesity and dysmetabolism by triggering cold-induced thermogenesis. Although suggestive, the underlying mechanisms are still poorly elucidated. We tested whether single or repeated applications of partial-body cryostimulation (PBC) could influence resting energy expenditure (REE) in exposed individuals. Fifteen middle-aged obese and sixteen control lean women (body mass index 31 ± 1.6 kg/m2 and 22 ± 1.7 kg/m2) underwent a daily PBC (−130 °C × 150 s) for five consecutive days. Resting energy metabolism (REE) was assessed by indirect calorimetry pre- and post-PBC on day 1 and day 5. As concerns REE, the linear mixed model revealed that REE changes were explained by session and time (F1,29 = 5.58; p = 0.02; ƞp2 = 0.16) independent of the group (F1,29 = 2.9; p = 0.09; ƞp2 = 0.09). REE pre-PBC increased from day 1 to day 5 either in leans (by 8.2%, from 1538 ± 111 to 1665 ± 106 kcal/day) or in obese women (by 5.5%, from 1610 ± 110 to 1698 ± 142 vs kcal/day). Respiratory quotient was significantly affected by the time (F1,29 = 51.61; p < 0.000001, ƞp2 = 0.64), as it increased from pre- to post-PBC, suggesting a shift in substrate oxidation. According to these preliminary data, cold-induced thermogenesis could be explored as a strategy to elevate REE in obese subjects. Longitudinal studies could test whether chronic PBC effects may entail favorable metabolic adaptations.
... [16][17][18][19] A partir do conhecimento dos eventos fisiológicos endógenos e rotineiros em nosso organismo e do crescente avanço da obesidade de forma alarmante, as grandes empresas de equipamentos eletromédicos começaram a investir em ciência e tecnologia para o desenvolvimento de equipamentos que poderiam estimular a lipólise e/ou apoptose da célula adiposa por meio de recursos extracorpóreos de forma a contribuir no auxílio ao processo de perda de peso e redução das comorbidades associadas à doença. [19][20][21] Segundo Loap e Lathe, 2018, a crioterapia foi um dos primeiros recursos a ser investigado para o tratamento da obesidade. Isso porque os adipócitos são mais sensíveis ao frio. ...
... Assim, surgiram os primeiros equipamentos de criolipólise, técnica que possibilita o resfriamento do tecido adiposo pela extração de temperatura estimulando o processo de morte do adipócito. [20][21] Tais como a criolipólise, vários outros recursos, como ultrassom focalizado e radiofrequência, possuem evidências científicas que comprovam seus efeitos no estímulo extracorpóreo da lipólise e/ou apoptose da célula adiposa, sem causar danos ao metabolismo. Assim sendo, a tecnologia de ESWT também foi adaptada para o mesmo objetivo terapêutico. ...
Introdução: a obesidade é uma doença que afeta a saúde pública em nível mundial devido a suas
comorbidades e ao risco de morte prematura. Diante disso, a tecnologia de terapia de ondas de choque
extracorpóreas (ESWT) pode ser útil em seu tratamento e na prevenção de suas comorbidades.
Objetivos: o objetivo foi avaliar se a ESWT é capaz de estimular a lipólise e/ou apoptose da célula
adiposa de indivíduos obesos.
Métodos: trata-se de um estudo comparativo de intervenção baseado em análises imuno-histoquímicas
de um conjunto de amostras de tecido subcutâneo de mulheres com obesidade, submetidas ao
tratamento ESWT. O material biológico foi coletado no momento da cirurgia bariátrica.
Resultados: 14 mulheres obesas foram incluídas na pesquisa. Foi evidenciada positividade na expressão
de Casp3 (p
