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Ren M, Sambuughin N, Mungunshukh O, Edgeworth DB, Hupalo D, Zhang X, Wilkerson MD, Dalgard CL, O’Connor FG, Deuster PA. Genome-Wide Analysis of Exertional Rhabdomyolysis in Sickle Cell Trait Positive African Americans. Genes (Basel) 2024; 15:408. [PMID: 38674343 PMCID: PMC11049803 DOI: 10.3390/genes15040408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Sickle cell trait (SCT), although generally a benign carrier state of hemoglobin S (HbAS), is a risk factor for exertional rhabdomyolysis (ERM), a rare but potentially fatal consequence of highly intense physical exercise, particularly among active-duty military personnel and high-performance athletes. The association between SCT and ERM is poorly understood. The objective of this study was to elucidate the genetic basis of ERM in an SCT-positive African American cohort. SCT-positive African Americans with a personal history of ERM (cases, n = 30) and without history of ERM (controls, n = 53) were enrolled in this study. Whole-genome sequencing was performed on DNA samples isolated from peripheral white blood cells. Participants' demographic, behavioral, and medical history information was obtained. An additional 131 controls were extracted from SCT-positive subjects of African descent from the 1000 Genomes Project. SCT carriers with ERM were characterized by myotoxicity features, significant muscle involvement dominated by muscle weakness, and severe pain and substantial increase in serum creatine kinase, with a mean value of 50,480 U/L. A distinctive feature of the SCT individuals with ERM was exertional collapse, which was reported in 53.3% of the cases in the study cohort. An important factor for the development of ERM was the duration and frequency of strenuous physical activity in the cases compared to the controls. Whole-genome sequencing identified 79,696 protein-coding variants. Genome-wide association analysis revealed that the p.C477R, rs115958260 variant in the SLC44A3 gene was significantly associated with ERM event in SCT-positive African Americans. The study results suggest that a combination of vigorous exercise and a genetic predisposing factor is involved in ERM.
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Affiliation(s)
- Mingqiang Ren
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Nyamkhishig Sambuughin
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Ognoon Mungunshukh
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Daniel Baxter Edgeworth
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Daniel Hupalo
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Xijun Zhang
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Matthew D. Wilkerson
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Clifton L. Dalgard
- Department of Anatomy, Physiology, and Genetics, Center for Military Precision Health, Uniformed Services University, Bethesda, MD 20814, USA
| | - Francis G. O’Connor
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA (D.B.E.); (F.G.O.)
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de Almeida KY, Cetolin T, Marrero AR, Aguiar Junior AS, Mohr P, Kikuchi N. A Pilot Study on the Prediction of Non-Contact Muscle Injuries Based on ACTN3 R577X and ACE I/D Polymorphisms in Professional Soccer Athletes. Genes (Basel) 2022; 13:2009. [PMID: 36360246 PMCID: PMC9690673 DOI: 10.3390/genes13112009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 09/28/2023] Open
Abstract
Muscle injuries are among the main reasons for medical leavings of soccer athletes, being a major concern within professional teams and their prevention associated with sport success. Several factors are associated with a greater predisposition to injury, and genetic background is increasingly being investigated. The aim of this study was to analyze whether ACTN3 R577X and ACE I/D polymorphisms are predictors of the incidence and severity of muscle injury in professional soccer athletes from Brazil, individually and in association. Eighty-three professional athletes from the first and second divisions of the Brazilian Championship were evaluated regarding the polymorphisms through blood samples. Nighty-nine muscle injuries were identified during the seasons of 2018, 2019 and 2020 and categorized according to severity. ACTN3 XX individuals had a higher frequency of severe injuries compared to the RX and RR genotypes (p = 0.001), and in the dominant model (compared to RX+RR), with p < 0.001. The trend p-value test showed an increased number of injuries/season following the order XX > RX > RR (p = 0.045). Those with the ACE II genotype had almost 2 fold the number of injuries per season compared to those with the ID+DD genotypes (p = 0.03). Logistic regression showed that the polymorphisms are predictors of the development of severe injury (ACTN3 R577X model with p = 0.004, R2: 0.259; ACE I/D model with p = 0.045, R2: 0.163), where ACTN3 XX individuals were more likely to suffer from severe injury (OR: 5.141, 95% CI: 1.472-17.961, p = 0.010). The combination of the ACTN3 577X allele and the ACE II genotype showed an increased number of injuries per season, enhanced by 100% (1.682 injuries/season versus 0.868 injuries/season, p = 0.016). Our findings suggest that both polymorphisms ACTN3 R577X and ACE I/D (and their interaction) are associated with the susceptibility and severity of non-contact muscle injury in soccer players.
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Affiliation(s)
- Kathleen Y. de Almeida
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo 158-8508, Japan
| | - Tiago Cetolin
- Graduate Program in Neurosciences, Federal University of Santa Catarina, Araranguá 88905-120, Brazil
| | - Andrea Rita Marrero
- Graduate Program in Cell and Developmental Biology, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
| | | | - Pedro Mohr
- Sports Center, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
| | - Naoki Kikuchi
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo 158-8508, Japan
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3
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Alele FO, Otto JR, Malau-Aduli BS, Malau-Aduli AEO. Next Generation Sequencing of Genotype Variants and Genetic Association between Heat Shock Proteins HSPA1B Single Nucleotide Polymorphism at the g.31829044 Locus and Heat Tolerance: A Pilot Quasi-Experimental Study. Biomolecules 2022; 12:biom12101465. [PMID: 36291674 PMCID: PMC9599234 DOI: 10.3390/biom12101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 11/18/2022] Open
Abstract
Heat tolerance and exertional heat stroke (EHS) are rare health conditions that have been described and characterised but have never been genetically solved. Knowledge of the role of single nucleotide polymorphisms (SNPs) in heat shock proteins (HSPs) genes and their associations with heat tolerance and EHS is limited. This pilot study aimed to identify SNP in HSPA1B, HSP90AA2 and DNAJA1 genes and their associations with heat tolerance and EHS history in a quasi-experimental design. Participants comprised Australian Defence Force members (ADF) who had a history of EHS and the general population. Genomic DNA samples were extracted from the venous blood samples of 48 participants, sequenced and analysed for SNP. Forty-four per cent (44%) of the participants were heat intolerant, and 29% had a history of EHS. Among participants with a history of EHS, there was an association between heat tolerance and HSPA1B SNP at the g.31829044 locus. However, there were no associations between HSPA1B and HSP90AA2 SNP and heat tolerance. All participants had the same distribution for the DNAJA1 SNP. In conclusion, the findings indicate an association between the HSPA1B genetic variant at the g.31829044 locus and heat tolerance among ADF participants with a history of EHS. Further research with a larger number of military participants will shed more light on the associations between HSP genes and heat tolerance.
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Affiliation(s)
- Faith O. Alele
- College of Healthcare Sciences, James Cook University, Townsville, QLD 4811, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
| | - John R. Otto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- Correspondence: ; Tel.: +61-7-4781-5339
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Li Y, Hong Y, Shen Y, Liu Q, Chen Y, Shao K, Shen Y, Ye B, Wu D. Acute rhabdomyolysis in hepatitis-associated aplastic anemia patient undergoing allogeneic hematopoietic stem-cell transplantation: case report and literature review. Eur J Med Res 2022; 27:45. [PMID: 35313994 PMCID: PMC8935704 DOI: 10.1186/s40001-022-00675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Hepatitis-associated aplastic anemia (HAAA) is a specific type of aplastic anemia, and hematopoietic stem-cell transplantation (HSCT) is recommended as the first-line. Acute rhabdomyolysis (AR) during hematopoietic stem-cell transplantation (HSCT) is a rare, serious complication, with only 10 cases reported in the world so far. Case presentation Herein, we present a case of AR developing during HLA-haploidentical HSCT in a 55-year-old man who suffered from HAAA. On day 7 after stem cell transfusion, the patient reported a muscle pull in thigh and complained of muscle swelling, pain and change in urine color. Despite the timely diagnosis (based on the levels of myoglobin and creatine kinase, and muscle MRI findings, etc.) and rapid hydration and alkalization, the situation progressed dramatically, and the patient died of multi-organ failure during the preparation for continuous renal replacement therapy (CRRT). Five days after his death, the whole-exome sequencing result confirmed that the patient had a germline missense mutation in SCN4A I 1545 V and ACTN3 R577X. Conclusion AR is a rare but threatening complication during HSCT, especially in cases with kidney dysfunction. The creatine kinase level may not truly and completely reflect the severity and prognosis for cases with localized lesion. We suggest that genetic analysis should be performed for better understanding the pathological changes of AR during HSCT, especially for patients with bone marrow failure.
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Affiliation(s)
- Yuzhu Li
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yilei Hong
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yingying Shen
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Qi Liu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ying Chen
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Keding Shao
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, People's Republic of China.,Office of Academic Research, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yiping Shen
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.,Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Baodong Ye
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China. .,Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, People's Republic of China.
| | - Dijiong Wu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China. .,Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, Zhejiang, People's Republic of China.
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Saparamadu AADNS, Teo WZY, Arsad A. Avoidable healthcare costs of spinning-induced rhabdomyolysis: a case series. Intern Med J 2021; 51:1946-1949. [PMID: 34796635 DOI: 10.1111/imj.15568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/23/2021] [Accepted: 07/11/2021] [Indexed: 01/06/2023]
Abstract
Spinning-induced rhabdomyolysis (SIR) is a well documented cause of exertional rhabdomyolysis. We aim to raise awareness and to call for preventive action towards avoidable healthcare costs associated with SIR. To this end, we describe three cases of SIR, associated healthcare costs and possible preventive strategies. We propose that community-based preventive measures should be considered in addressing the economic consequences of SIR.
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Affiliation(s)
| | - Winnie Z Y Teo
- Fast Program, Alexandra Hospital, National University Health System, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), National University Health System, Singapore
| | - Asrie Arsad
- Fast Program, Alexandra Hospital, National University Health System, Singapore.,Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
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6
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Gleason BH, Hornsby WG, Suarez DG, Nein MA, Stone MH. Troubleshooting a Nonresponder: Guidance for the Strength and Conditioning Coach. Sports (Basel) 2021; 9:sports9060083. [PMID: 34198730 PMCID: PMC8227041 DOI: 10.3390/sports9060083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 12/20/2022] Open
Abstract
Ideally an athlete would continue to improve performance indefinitely over time, however improvement slows as the athlete approaches their genetic limits. Measuring performance is complex—performance may be temporarily depressed following aggressive training for multiple reasons, physiological and psychosocial. This reality may be vexing to the strength and conditioning coach, who, as a service provider, must answer to sport coaches about an athlete’s progress. Recently an evaluation mechanism for strength and conditioning coaches was proposed, in part to help coaches establish their effectiveness within the organization. Without formal guidance and realistic expectations, if an athlete is not bigger, leaner, stronger, etc. as a result of training within a specified timeframe, blame is often placed upon the strength and conditioning coach. The purpose of this article is to explore possible causes of what may be perceived as athlete non-responses to training and to provide guidance for the coach on how to handle those issues within their domain. A process of investigation is recommended, along with resources to assist coaches as they consider a broad range of issues, including enhancing existing testing methods, improving athlete behaviors, and adjusting processes designed to bring about performance improvement.
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Affiliation(s)
- Benjamin H. Gleason
- Department of Kinesiology, Louisiana Tech University, Ruston, LA 71272, USA
- Correspondence:
| | - William G. Hornsby
- College of Physical Activity and Sport Sciences, West Virginia University, Morgantown, WV 26505, USA;
| | - Dylan G. Suarez
- Center of Excellence for Sport Science and Coach Education, Department of Sport, Exercise, Recreation, & Kinesiology, East Tennessee State University, Johnson City, TN 37614, USA; (D.G.S.); (M.H.S.)
| | - Matthew A. Nein
- Department of Athletics, Salisbury University, Salisbury, MD 21801, USA;
| | - Michael H. Stone
- Center of Excellence for Sport Science and Coach Education, Department of Sport, Exercise, Recreation, & Kinesiology, East Tennessee State University, Johnson City, TN 37614, USA; (D.G.S.); (M.H.S.)
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7
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Carneiro A, Viana-Gomes D, Macedo-da-Silva J, Lima GHO, Mitri S, Alves SR, Kolliari-Turner A, Zanoteli E, Neto FRDA, Palmisano G, Pesquero JB, Moreira JC, Pereira MD. Risk factors and future directions for preventing and diagnosing exertional rhabdomyolysis. Neuromuscul Disord 2021; 31:583-595. [PMID: 34193371 DOI: 10.1016/j.nmd.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/19/2022]
Abstract
Exertional rhabdomyolysis may occur when an individual is subjected to strenuous physical exercise. It is occasionally associated with myoglobinuria (i.e. "cola-colored" urine) alongside muscle pain and weakness. The pathophysiology of exertional rhabdomyolysis involves striated muscle damage and the release of cellular components into extracellular fluid and bloodstream. This can cause acute renal failure, electrolyte abnormalities, arrhythmias and potentially death. Exertional rhabdomyolysis is observed in high-performance athletes who are subjected to intense, repetitive and/or prolonged exercise but is also observed in untrained individuals and highly trained or elite groups of military personnel. Several risk factors have been reported to increase the likelihood of the condition in athletes, including: viral infection, drug and alcohol abuse, exercise in intensely hot and humid environments, genetic polymorphisms (e.g. sickle cell trait and McArdle disease) and epigenetic modifications. This article reviews several of these risk factors and proposes screening protocols to identify individual susceptibility to exertional rhabdomyolysis as well as the relevance of proteomics for the evaluation of potential biomarkers of muscle damage.
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Affiliation(s)
- Andréia Carneiro
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Brazil; Departamento de Química, Diretoria de Sistemas de Armas da Marinha, Marinha do Brazil, Brazil; Departamento de Parasitologia, Universidade de São Paulo, Instituto de Ciencias Biomédicas, Brazil.
| | - Diego Viana-Gomes
- Departamento de Corridas, Universidade Federal do Rio de Janeiro, Escola de Educação Física, Brazil
| | - Janaina Macedo-da-Silva
- Departamento de Parasitologia, Universidade de São Paulo, Instituto de Ciencias Biomédicas, Brazil
| | - Giscard Humberto Oliveira Lima
- Departamento de Biofísica, Universidade Federal de São Paulo, Brazil; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Italy
| | - Simone Mitri
- Centro de Ecologia Humana e Saúde do Trabalhador, Fundação Oswaldo Cruz, Brazil
| | | | | | - Edmar Zanoteli
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | | | - Giuseppe Palmisano
- Departamento de Parasitologia, Universidade de São Paulo, Instituto de Ciencias Biomédicas, Brazil
| | - João Bosco Pesquero
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Italy
| | | | - Marcos Dias Pereira
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Brazil.
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Laitano O, Oki K, Leon LR. The Role of Skeletal Muscles in Exertional Heat Stroke Pathophysiology. Int J Sports Med 2021; 42:673-681. [PMID: 33772503 DOI: 10.1055/a-1400-9754] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The active participation of skeletal muscles is a unique characteristic of exertional heat stroke. Nevertheless, the only well-documented link between skeletal muscle activities and exertional heat stroke pathophysiology is the extensive muscle damage (e. g., rhabdomyolysis) and subsequent leakage of intramuscular content into the circulation of exertional heat stroke victims. Here, we will present and discuss rarely explored roles of skeletal muscles in the context of exertional heat stroke pathophysiology and recovery. This includes an overview of heat production that contributes to severe hyperthermia and the synthesis and secretion of bioactive molecules, such as cytokines, chemokines and acute phase proteins. These molecules can alter the overall inflammatory status from pro- to anti-inflammatory, affecting other organ systems and influencing recovery. The activation of innate immunity can determine whether a victim is ready to return to physical activity or experiences a prolonged convalescence. We also provide a brief discussion on whether heat acclimation can shift skeletal muscle secretory phenotype to prevent or aid recovery from exertional heat stroke. We conclude that skeletal muscles should be considered as a key organ system in exertional heat stroke pathophysiology.
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Affiliation(s)
- Orlando Laitano
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, United States
| | - Kentaro Oki
- Thermal & Mountain Medicine Devision, United States Army Research Institute of Environmental Medicine, Natick, United States
| | - Lisa R Leon
- Thermal & Mountain Medicine Devision, United States Army Research Institute of Environmental Medicine, Natick, United States
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9
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O'Connor FG, Franzos MA, Nye NS, Nelson DA, Shell D, Voss JD, Anderson SA, Coleman NJ, Thompson AA, Harmon KG, Deuster PA. Summit on Exercise Collapse Associated with Sickle Cell Trait: Finding the "Way Ahead". Curr Sports Med Rep 2021; 20:47-56. [PMID: 33395130 DOI: 10.1249/jsr.0000000000000801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Although largely benign, sickle cell trait (SCT) has been associated with exertion-related events, to include sudden death. In 2011, a summit on SCT introduced the term exercise collapse associated with SCT (ECAST). A series of ECAST deaths in military personnel in 2019 prompted reevaluation of current efforts and led to a second summit in October 2019 hosted by the Consortium for Health and Military Performance of the Uniformed Services University in Bethesda, MD. The goals were to (1) review current service policies on SCT screening, (2) develop draft procedural instructions for executing current policy on SCT within the Department of Defense, (3) develop draft clinical practice guidelines for management of ECAST, (4) establish a framework for education on SCT and ECAST, and (5) prepare a research agenda to address identified gaps.
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Affiliation(s)
- Francis G O'Connor
- Department of Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD
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10
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Del Coso J, Salinero JJ, Lara B, Gallo-Salazar C, Areces F, Herrero D, Puente C. Polygenic Profile and Exercise-Induced Muscle Damage by a Competitive Half-Ironman. J Strength Cond Res 2020; 34:1400-1408. [PMID: 29140910 DOI: 10.1519/jsc.0000000000002303] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Del Coso, J, Salinero, JJ, Lara, B, Gallo-Salazar, C, Areces, F, Herrero, D, and Puente, C. Polygenic profile and exercise-induced muscle damage by a competitive half-ironman. J Strength Cond Res 34(5): 1400-1408, 2020-To date, it is still unknown why some individuals develop higher levels of muscle damage than other individuals, despite participating in exercise with comparable levels of physical intensity. The aim of this investigation was to analyze 7 single-nucleotide polymorphisms (SNPs) that are candidates to explain individual variations in the level of muscle damage attained during a half-ironman competition. Using the model of Williams and Folland (2, 1, and 0 points for optimal, intermediate, and suboptimal genotype), we determined the total genotype score from the accumulated combination of 7 SNPs (ACE = 287bp Ins/Del; ACTN3 = p.R577X; creatine kinase, muscle type = NcoI; insulin-like growth factor 2 = C13790G; interleukin-6 = 174G>C; myosin light chain kinase = C37885A; and tumor necrosis factor-α = 308G>A) in 22 experienced triathletes. Before and after the race, a sample of venous blood was obtained to measure serum markers of muscle damage. Two groups of triathletes were established according to their postcompetition serum CK concentration: low CK responders (n = 10; 377 ± 86 U·L) vs. high CK responders (n = 12; 709 ± 136 U·L). At the end of the race, low CK responders had lower serum myoglobin concentrations (384 ± 243 vs. 597 ± 293 ng·ml, p = 0.04). Although the groups were similar in age, anthropometric characteristics, and training habits, total genotype score was higher in low CK responders than in high CK responders (7.7 ± 1.1 vs. 5.5 ± 1.1 point, p < 0.01). A favorable polygenic profile can contribute to reducing the level of muscle damage developed during endurance exercise.
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Affiliation(s)
- Juan Del Coso
- Sports Sciences Department, Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
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11
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Abstract
Muscle stiffness, muscle elasticity and explosive strength are the main components of athletes' performance and they show a sex-based as well as ethnicity variation. Muscle stiffness is thought to be one of the risk factors associated with sports injuries and is less common in females than in males. These observations may be explained by circulating levels of sex hormones and their specific receptors. It has been shown that higher levels of estrogen are associated with lower muscle stiffness responsible for suppression of collagen synthesis. It is thought that these properties, at least in part, depend on genetic factors. Particularly, the gene encoding estrogen receptor 1 (ESR1) is one of the candidates that may be associated with muscle stiffness. Muscle elasticity increases with aging and there is evidence suggesting that titin (encoded by the TTN gene), a protein that is expressed in cardiac and skeletal muscles, is one of the factors responsible for elastic properties of the muscles. Mutations in the TTN gene result in some types of muscular dystrophy or cardiomyopathy. In this context, TTN may be regarded as a promising candidate for studying the elastic properties of muscles in athletes. The physiological background of explosive strength depends not only on the muscle architecture and muscle fiber composition, but also on the central nervous system and functionality of neuromuscular units. These properties are, at least partly, genetically determined. In this context, the ACTN3 gene code for α-actinin 3 has been widely researched.
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12
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Liem RI. Balancing exercise risk and benefits: lessons learned from sickle cell trait and sickle cell anemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:418-425. [PMID: 30504341 PMCID: PMC6245992 DOI: 10.1182/asheducation-2018.1.418] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Development of exercise guidelines for individuals with sickle cell trait (SCT) and sickle cell anemia (SCA) is hampered by the need to weigh the benefits against risks of exercise in these populations. In SCT, concern for exercise collapse associated with sickle cell trait has resulted in controversial screening of student athletes for SCT. In SCA, there exists unsubstantiated concerns that high-intensity exercise may result in pain and other complications. In both, finding the "right dose" of exercise remains a challenge for patients and their providers. Despite assumptions that factors predisposing to adverse events from high-intensity exercise overlap in SCT and SCA, the issues that frame our understanding of exercise-related harms in both are distinct. This review will compare issues that affect the risk-benefit balance of exercise in SCT and SCA through these key questions: (1) What is the evidence that high-intensity exercise is associated with harm? (2) What are the pathophysiologic mechanisms that could predispose to harm? (3) What are the preventive strategies that may reduce risk? and (4) Why do we need to consider the benefits of exercise in this debate? Addressing these knowledge gaps is essential for developing an evidence-based exercise prescription for these patient populations.
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Affiliation(s)
- Robert I Liem
- Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Naik RP, Smith-Whitley K, Hassell KL, Umeh NI, de Montalembert M, Sahota P, Haywood C, Jenkins J, Lloyd-Puryear MA, Joiner CH, Bonham VL, Kato GJ. Clinical Outcomes Associated With Sickle Cell Trait: A Systematic Review. Ann Intern Med 2018; 169:619-627. [PMID: 30383109 PMCID: PMC6487193 DOI: 10.7326/m18-1161] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Although sickle cell trait (SCT) is largely a benign carrier state, it may increase risk for certain clinical outcomes. Purpose To evaluate associations between SCT and clinical outcomes in children and adults. Data Sources English-language searches of PubMed, CINAHL, the Cochrane Library, Current Contents Connect, Scopus, and Embase (1 January 1970 to 30 June 2018) and bibliographies of review articles. Study Selection Observational controlled studies (published in English) in children or adults that examined an association between SCT and any of 24 clinical outcomes specified a priori in the following 6 categories: exertion-related injury; renal, vascular, pediatric, and surgery- or trauma-related outcomes; and overall mortality. Data Extraction A single reviewer extracted study data, which was checked by another; 2 reviewers independently assessed study quality; and strength of evidence was assessed by consensus. Data Synthesis Of 7083 screened studies, 41 met inclusion criteria. High-strength evidence supported a positive association between SCT and risk for pulmonary embolism, proteinuria, and chronic kidney disease. Moderate-strength evidence supported a positive association between SCT and exertional rhabdomyolysis and a null association between SCT and deep venous thrombosis, heart failure or cardiomyopathy, stroke, and pediatric height or weight. Absolute risks for thromboembolism and rhabdomyolysis were small. For the remaining 15 clinical outcomes, data were insufficient or strength of evidence was low. Limitation Publication bias was possible, and high-quality evidence was scant. Conclusion Sickle cell trait is a risk factor for a few adverse health outcomes, such as pulmonary embolism, kidney disease, and exertional rhabdomyolysis, but does not seem to be associated with such complications as heart failure and stroke. Insufficient data or low-strength evidence exists for most speculated complications of SCT. Primary Funding Source National Human Genome Research Institute.
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Affiliation(s)
| | - Kim Smith-Whitley
- Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, Pennsylvania
| | | | - Nkeiruka I. Umeh
- National Human Genome Research Institute of the National Institutes
of Health, Bethesda, Maryland
| | | | - Puneet Sahota
- Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, Pennsylvania
| | - Carlton Haywood
- University of Pennsylvania, Philadelphia, Pennsylvania; Johns
Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - Jean Jenkins
- National Human Genome Research Institute of the National Institutes
of Health, Bethesda, Maryland
| | | | | | - Vence L. Bonham
- National Human Genome Research Institute of the National
Institutes of Health, Bethesda, Maryland
| | - Gregory J. Kato
- Vascular Medicine Institute at the University of Pittsburgh School
of Medicine, Pittsburgh, Pennsylvania
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Del Coso J, Hiam D, Houweling P, Pérez LM, Eynon N, Lucía A. More than a 'speed gene': ACTN3 R577X genotype, trainability, muscle damage, and the risk for injuries. Eur J Appl Physiol 2018; 119:49-60. [PMID: 30327870 DOI: 10.1007/s00421-018-4010-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/05/2018] [Indexed: 12/11/2022]
Abstract
A common null polymorphism (rs1815739; R577X) in the gene that codes for α-actinin-3 (ACTN3) has been related to different aspects of exercise performance. Individuals who are homozygous for the X allele are unable to express the α-actinin-3 protein in the muscle as opposed to those with the RX or RR genotype. α-actinin-3 deficiency in the muscle does not result in any disease. However, the different ACTN3 genotypes can modify the functioning of skeletal muscle during exercise through structural, metabolic or signaling changes, as shown in both humans and in the mouse model. Specifically, the ACTN3 RR genotype might favor the ability to generate powerful and forceful muscle contractions. Leading to an overall advantage of the RR genotype for enhanced performance in some speed and power-oriented sports. In addition, RR genotype might also favor the ability to withstand exercise-induced muscle damage, while the beneficial influence of the XX genotype on aerobic exercise performance needs to be validated in human studies. More information is required to unveil the association of ACTN3 genotype with trainability and injury risk during acute or chronic exercise.
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Affiliation(s)
- Juan Del Coso
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain.
| | - Danielle Hiam
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | | | - Laura M Pérez
- Universidad Europea de Madrid (Faculty of Sport Sciences) and Research Institute i+12, Madrid, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Madrid, Spain
| | - Nir Eynon
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - Alejandro Lucía
- Universidad Europea de Madrid (Faculty of Sport Sciences) and Research Institute i+12, Madrid, Spain
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15
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Pickering C, Kiely J. Hamstring injury prevention: A role for genetic information? Med Hypotheses 2018; 119:58-62. [DOI: 10.1016/j.mehy.2018.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/24/2018] [Accepted: 07/11/2018] [Indexed: 01/19/2023]
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Manspeaker S, Henderson K, Riddle D. Treatment of exertional rhabdomyolysis in athletes: a systematic review. ACTA ACUST UNITED AC 2018; 14:117-47. [PMID: 27532656 DOI: 10.11124/jbisrir-2016-001879] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Exertional rhabdomyolysis (ER) is the breakdown of skeletal muscle tissue following intense physical activity that results in impairment of the cell membrane, which allows intracellular contents to be released into the bloodstream. Signs and symptoms include myalgia, myoglobinuria and increased creatine kinase (CK) levels. Athletes are vulnerable to this condition due to their increased level of physical activity. The severity and effects of this condition vary between individuals; however, all athletes are at risk of significant muscle damage, renal failure and perhaps death if not recognized and treated quickly. Effective methods for treatment and return to activity following this condition should be established. OBJECTIVES The objective of this review was to identify effective treatment methods associated with ER in athletes. INCLUSION CRITERIA TYPES OF PARTICIPANTS Adult and adolescent patients (15 years of age and older) in the athletic population who have been diagnosed with ER. TYPES OF INTERVENTIONS Fluid resuscitation/replacement or other treatment methods that aim to improve CK levels and decrease myoglobinuria and treat ER. TYPES OF STUDIES Due to the absence of randomized control trials, the quantitative component of the review considered descriptive studies, case series and individual case reports for inclusion. OUTCOMES PRIMARY OUTCOMES CK and myoglobinuria levels. SECONDARY OUTCOMES length of hospital stay; length of time from diagnosis to premorbid levels of physical activity. SEARCH STRATEGY A comprehensive search of the following databases with no date limitation was conducted: CINAHL, PubMed, ProQuest, Embase, SPORTDiscus and Physical Education Index. Results were limited to those available in English. METHODOLOGICAL QUALITY Two independent reviewers evaluated the retrieved articles for methodological quality using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics and Review Instruments. DATA EXTRACTION Data were extracted from the articles by two independent reviewers using the standardized Joanna Briggs Institute extraction tool. DATA SYNTHESIS Narrative and tabular synthesis. RESULTS Fourteen studies with a combined total of 53 participants were included. Aggressive intravenous (IV) fluid resuscitation was found to be the most commonly utilized treatment method for decreasing CK levels and resolving myoglobinuria. The addition of compounds within the IV fluid varied between studies. CONCLUSION Due to the types of included studies and variation in reported treatment methods and outcomes for ER among athletes, effectiveness of treatment could not be determined. The limited evidence available indicates that IV fluid replacement, specifically normal saline, is the most commonly reported treatment for decreasing CK levels and myoglobinuria following ER. It appears that normal saline may be combined with other compounds including sodium bicarbonate, sodium chloride or potassium chloride to achieve reduction of CK levels and myoglobinuria. Clinically, early IV fluid replacement appears to be delivered at a rate of approximately 400 ml/hour, with adjustments ranging between 200 and 1000 ml/hour, depending on severity and volume states. Hospitalization time varies, depending on severity of condition, and return to activity is widely inconsistent among the athletic population.
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Affiliation(s)
- Sarah Manspeaker
- 1Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA 2Texas Christian University Center for Evidence-based Practice and Research: a Collaborating Center of the Joanna Briggs Institute, Fort Worth, Texas, USA 3Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, Florida, USA 4Nursing, Texas Christian University: a Collaborating Center of the Joanna Briggs Institute, Fort Worth, Texas, USA
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17
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Pickering C, Kiely J. ACTN3: More than Just a Gene for Speed. Front Physiol 2017; 8:1080. [PMID: 29326606 PMCID: PMC5741991 DOI: 10.3389/fphys.2017.01080] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/08/2017] [Indexed: 12/31/2022] Open
Abstract
Over the last couple of decades, research has focused on attempting to understand the genetic influence on sports performance. This has led to the identification of a number of candidate genes which may help differentiate between elite and non-elite athletes. One of the most promising genes in that regard is ACTN3, which has commonly been referred to as “a gene for speed”. Recent research has examined the influence of this gene on other performance phenotypes, including exercise adaptation, exercise recovery, and sporting injury risk. In this review, we identified 19 studies exploring these phenotypes. Whilst there was large variation in the results of these studies, as well as extremely heterogeneous cohorts, there is overall a tentative consensus that ACTN3 genotype can impact the phenotypes of interest. In particular, the R allele of a common polymorphism (R577X) is associated with enhanced improvements in strength, protection from eccentric training-induced muscle damage, and sports injury. This illustrates that ACTN3 is more than just a gene for speed, with potentially wide-ranging influence on muscle function, knowledge of which may aid in the future personalization of exercise training programmes.
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Affiliation(s)
- Craig Pickering
- School of Sport and Wellbeing, Institute of Coaching and Performance, University of Central Lancashire, Preston, United Kingdom.,Exercise and Nutritional Genomics Research Centre, DNAFit Ltd., London, United Kingdom
| | - John Kiely
- School of Sport and Wellbeing, Institute of Coaching and Performance, University of Central Lancashire, Preston, United Kingdom
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18
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Cho J, Lee I, Kang H. ACTN3 Gene and Susceptibility to Sarcopenia and Osteoporotic Status in Older Korean Adults. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4239648. [PMID: 28626757 PMCID: PMC5463164 DOI: 10.1155/2017/4239648] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/14/2017] [Accepted: 05/07/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Little information is available about molecular markers for sarcopenia and osteoporosis in Asian populations. OBJECTIVE This study investigated the association of the ACTN3 polymorphism with sarcopenia and osteoporotic status in older Korean adults. METHODS Older Korean 62 men and 270 women (mean age 73.7 ± 6.6 years) participated in this study. Body mass index, percent body fatness, appendicular skeletal muscle mass, and bone mineral density of the lumbar spine, femur, and total body were analyzed with dual-energy X-ray absorptiometry. ACTN3 R/X genotyping was determined using TaqMan probes. RESULTS Determination of odds ratios (ORs) and 95% confidence intervals (CIs) using binary logistic regression analyses showed that XX homozygotes were at a significantly higher risk of sarcopenia (OR = 2.056, 95% CI = 1.024-4.127, p = 0.043) and osteoporosis (OR = 2.794, 95% CI = 1.208-5.461, p = 0.016) than RR homozygotes (reference group, OR = 1). The OR of XX homozygotes for having sarcopenia remained significant (OR = 2.237, 95% CI = 1.044-4.836, p = 0.038) after adjustments for age, gender, body fatness, and serum vitamin D. The OR of XX homozygotes for having osteoporosis was no longer significant (OR = 2.682, 95% CI = 0.960-7.942, p = 0.075) after adjustments for the covariates. CONCLUSION Our findings suggest that the ACTN3 R577X genotype may influence decline in muscle and bone health phenotypes in older Korean adults.
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Affiliation(s)
- Jinkyung Cho
- College of Sport Science, Sungkyunkwan University, Suwon, Republic of Korea
| | - Inhwan Lee
- College of Sport Science, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hyunsik Kang
- College of Sport Science, Sungkyunkwan University, Suwon, Republic of Korea
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19
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Montalvo AM, Tse-Dinh YC, Liu Y, Swartzon M, Hechtman KS, Myer GD. Precision Sports Medicine: The Future of Advancing Health and Performance in Youth and Beyond. Strength Cond J 2017. [DOI: 10.1519/ssc.0000000000000292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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20
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Del Coso J, Valero M, Salinero JJ, Lara B, Gallo-Salazar C, Areces F. Optimum polygenic profile to resist exertional rhabdomyolysis during a marathon. PLoS One 2017; 12:e0172965. [PMID: 28257486 PMCID: PMC5336235 DOI: 10.1371/journal.pone.0172965] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/13/2017] [Indexed: 12/27/2022] Open
Abstract
Purpose Exertional rhabdomyolysis can occur in individuals performing various types of exercise but it is unclear why some individuals develop this condition while others do not. Previous investigations have determined the role of several single nucleotide polymorphisms (SNPs) to explain inter-individual variability of serum creatine kinase (CK) concentrations after exertional muscle damage. However, there has been no research about the interrelationship among these SNPs. The purpose of this investigation was to analyze seven SNPs that are candidates for explaining individual variations of CK response after a marathon competition (ACE = 287bp Ins/Del, ACTN3 = p.R577X, CKMM = NcoI, IGF2 = C13790G, IL6 = 174G>C, MLCK = C37885A, TNFα = 308G>A). Methods Using Williams and Folland’s model, we determined the total genotype score from the accumulated combination of these seven SNPs for marathoners with a low CK response (n = 36; serum CK <400 U·L-1) vs. marathoners with a high CK response (n = 31; serum CK ≥400 U·L-1). Results At the end of the race, low CK responders had lower serum CK (290±65 vs. 733±405 U·L-1; P<0.01) and myoglobin concentrations (443±328 vs. 1009±971 ng·mL-1, P<0.01) than high CK responders. Although the groups were similar in age, anthropometric characteristics, running experience and training habits, total genotype score was higher in low CK responders than in high CK responders (5.2±1.4 vs. 4.4±1.7 point, P = 0.02). Conclusion Marathoners with a lower CK response after the race had a more favorable polygenic profile than runners with high serum CK concentrations. This might suggest a significant role of genetic polymorphisms in the levels of exertional muscle damage and rhabdomyolysis. Yet other SNPs, in addition to exercise training, might also play a role in the values of CK after damaging exercise.
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Affiliation(s)
- Juan Del Coso
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
- * E-mail:
| | - Marjorie Valero
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
| | - Juan José Salinero
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
| | - Beatriz Lara
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
| | | | - Francisco Areces
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
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21
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ACTN3 genotype influences exercise-induced muscle damage during a marathon competition. Eur J Appl Physiol 2017; 117:409-416. [DOI: 10.1007/s00421-017-3542-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022]
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22
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Lee SE, Stewart CP, Schulze KJ, Cole RN, Wu LSF, Yager JD, Groopman JD, Khatry SK, Adhikari RK, Christian P, West KP. The Plasma Proteome Is Associated with Anthropometric Status of Undernourished Nepalese School-Aged Children. J Nutr 2017; 147:304-313. [PMID: 28148680 PMCID: PMC5320403 DOI: 10.3945/jn.116.243014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/06/2016] [Accepted: 01/04/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Malnutrition affects body growth, size, and composition of children. Yet, few functional biomarkers are known to be associated with childhood morphology. Objective: This cross-sectional study examined associations of anthropometric indicators of height, musculature, and fat mass with plasma proteins by using proteomics in a population cohort of school-aged Nepalese children. Methods: Height, weight, midupper arm circumference (MUAC), triceps and subscapular skinfolds, upper arm muscle area (AMA), and arm fat area (AFA) were assessed in 500 children 6–8 y of age. Height-for-age z scores (HAZs), weight-for-age z scores (WAZs), and body mass index–for-age z scores (BAZs) were derived from the WHO growth reference. Relative protein abundance was quantified by using tandem mass spectrometry. Protein-anthropometry associations were evaluated by linear mixed-effects models and identified as having a false discovery rate (q) <5%. Results: Among 982 proteins, 1, 10, 14, and 17 proteins were associated with BAZ, HAZ, MUAC, and AMA, respectively (q < 0.05). Insulin-like growth factor (IGF)-I, 2 IGF-binding proteins, and carnosinase-1 were associated with both HAZ and AMA. Proteins involved in nutrient transport, activation of innate immunity, and bone mineralization were associated with HAZ. Several extracellular matrix proteins were positively associated with AMA alone. The proteomes of MUAC and AMA substantially overlapped, whereas no proteins were associated with AFA or triceps and subscapular skinfolds. Myosin light-chain kinase, possibly reflecting leakage from muscle, was inversely associated with BAZ. The proteome of WAZ was the largest (n = 33) and most comprehensive, including proteins involved in neural development and oxidative stress response, among others. Conclusions: Plasma proteomics confirmed known biomarkers of childhood growth and revealed novel proteins associated with lean mass in chronically undernourished children. Identified proteins may serve as candidates for assessing growth and nutritional status of children in similar undernourished settings. The antenatal micronutrient supplementation trial yielding the study cohort of children was registered at clinicaltrials.gov as NCT00115271.
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Affiliation(s)
- Sun Eun Lee
- Center for Human Nutrition, Department of International Health, and
| | - Christine P Stewart
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, CA
| | - Kerry J Schulze
- Center for Human Nutrition, Department of International Health, and
| | - Robert N Cole
- Mass Spectrometry and Proteomics Facility, Department of Biological Chemistry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lee S-F Wu
- Center for Human Nutrition, Department of International Health, and
| | - James D Yager
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - John D Groopman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal; and
| | | | - Parul Christian
- Center for Human Nutrition, Department of International Health, and
| | - Keith P West
- Center for Human Nutrition, Department of International Health, and
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Scalco RS, Snoeck M, Quinlivan R, Treves S, Laforét P, Jungbluth H, Voermans NC. Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy? BMJ Open Sport Exerc Med 2016; 2:e000151. [PMID: 27900193 PMCID: PMC5117086 DOI: 10.1136/bmjsem-2016-000151] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 12/14/2022] Open
Abstract
Exertional rhabdomyolysis is characterised by muscle breakdown associated with strenuous exercise or normal exercise under extreme circumstances. Key features are severe muscle pain and sudden transient elevation of serum creatine kinase (CK) levels with or without associated myoglobinuria. Mild cases may remain unnoticed or undiagnosed. Exertional rhabdomyolysis is well described among athletes and military personnel, but may occur in anybody exposed to unaccustomed exercise. In contrast, exertional rhabdomyolysis may be the first manifestation of a genetic muscle disease that lowers the exercise threshold for developing muscle breakdown. Repeated episodes of exertional rhabdomyolysis should raise the suspicion of such an underlying disorder, in particular in individuals in whom the severity of the rhabdomyolysis episodes exceeds the expected response to the exercise performed. The present review aims to provide a practical guideline for the acute management and postepisode counselling of patients with exertional rhabdomyolysis, with a particular emphasis on when to suspect an underlying genetic disorder. The pathophysiology and its clinical features are reviewed, emphasising four main stepwise approaches: (1) the clinical significance of an acute episode, (2) risks of renal impairment, (3) clinical indicators of an underlying genetic disorders and (4) when and how to recommence sport activity following an acute episode of rhabdomyolysis. Genetic backgrounds that appear to be associated with both enhanced athletic performance and increased rhabdomyolysis risk are briefly reviewed.
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Affiliation(s)
- Renata S Scalco
- MRC Centre for Neuromuscular Diseases , Institute of Neurology, University College London , London , UK
| | - Marc Snoeck
- MH-investigation Unit, Department of Anesthesia , Canisius-Wilhelmina Hospital , Nijmegen , The Netherlands
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases , Institute of Neurology, University College London , London , UK
| | - Susan Treves
- Departments of Anesthesia and of Biomedicine, Basel University Hospital, Basel, Switzerland; Department of Life Sciences, General Pathology Section, University of Ferrara, Ferrara, Italy
| | - Pascal Laforét
- Institut de Myologie, Hôpital Pitié-Salpêtrière , Paris , France
| | - Heinz Jungbluth
- Department of Paediatric Neurology-Neuromuscular Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; Randall Division of Cell and Molecular Biophysics, Muscle Signalling Section, London, UK; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Nicol C Voermans
- Department of Neurology , Radboud University Medical Centre , Nijmegen , The Netherlands
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Potential factors involved in the causation of rhabdomyolysis following status asthmaticus. Allergy Asthma Clin Immunol 2016; 12:43. [PMID: 27555875 PMCID: PMC4994408 DOI: 10.1186/s13223-016-0149-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 08/09/2016] [Indexed: 12/18/2022] Open
Abstract
Rhabdomyolysis is a rare but potentially fatal complication of status asthmaticus. Since the first case was reported in 1978, only a few dozen cases have been described till date. We performed a literature review with the aim to characterize the pathophysiological basis of the occurrence of rhabdomyolysis in patients with status asthmaticus. Excessive exertion of respiratory muscles, hypoxia and acidosis, electrolyte imbalance, infections, some drugs used for asthma control, use of mechanical ventilation, prolonged cardiopulmonary resuscitation, higher age of the patient and some underlying diseases or genetic factors appear to be involved in its causation. In patients with status asthmaticus, it is important to pay more attention to these factors and to closely monitor creatine kinase levels in blood so as to ensure early detection of rhabdomyolysis.
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25
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Del Coso J, Valero M, Lara B, Salinero JJ, Gallo-Salazar C, Areces F. Myosin Light Chain Kinase (MLCK) Gene Influences Exercise Induced Muscle Damage during a Competitive Marathon. PLoS One 2016; 11:e0160053. [PMID: 27483374 PMCID: PMC4970719 DOI: 10.1371/journal.pone.0160053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/13/2016] [Indexed: 11/22/2022] Open
Abstract
Myosin light chain kinase (MLCK) phosphorylates the regulatory light chain (RLC) of myosin producing increases in force development during skeletal muscle contraction. It has been suggested that MLCK gene polymorphisms might alter RLC phosphorylation thereby decreasing the ability to produce force and to resist strain during voluntary muscle contractions. Thus, the genetic variations in the MLCK gene might predispose some individuals to higher values of muscle damage during exercise, especially during endurance competitions. The aim of this investigation was to determine the influence of MLCK genetic variants on exercise-induced muscle damage produced during a marathon. Sixty-seven experienced runners competed in a marathon race. The MLCK genotype (C37885A) of these marathoners was determined. Before and after the race, a sample of venous blood was obtained to assess changes in serum myoglobin concentrations and leg muscle power changes were measured during a countermovement jump. Self-reported leg muscle pain and fatigue were determined by questionnaires. A total of 59 marathoners (88.1%) were CC homozygotes and 8 marathoners (11.9%) were CA heterozygotes. The two groups of participants completed the race with a similar time (228 ± 33 vs 234 ± 39 min; P = 0.30) and similar self-reported values for fatigue (15 ± 2 vs 16 ± 2 A.U.; P = 0.21) and lower-limb muscle pain (6.2 ± 1.7 vs 6.6 ± 1.8 cm; P = 0.29). However, CC marathoners presented higher serum myoglobin concentrations (739 ± 792 vs 348 ± 144 μg·mL-1; P = 0.03) and greater pre-to-post- race leg muscle power reduction (-32.7 ± 15.7 vs -21.2 ± 21.6%; P = 0.05) than CA marathoners. CA heterozygotes for MLCK C37885A might present higher exercise-induced muscle damage after a marathon competition than CC counterparts.
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Affiliation(s)
- Juan Del Coso
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
- * E-mail:
| | - Marjorie Valero
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
| | - Beatriz Lara
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
| | - Juan José Salinero
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
| | | | - Francisco Areces
- Exercise Physiology Laboratory, Camilo José Cela University, Madrid, Spain
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Baumert P, Lake MJ, Stewart CE, Drust B, Erskine RM. Genetic variation and exercise-induced muscle damage: implications for athletic performance, injury and ageing. Eur J Appl Physiol 2016; 116:1595-625. [PMID: 27294501 PMCID: PMC4983298 DOI: 10.1007/s00421-016-3411-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/03/2016] [Indexed: 02/06/2023]
Abstract
Prolonged unaccustomed exercise involving muscle lengthening (eccentric) actions can result in ultrastructural muscle disruption, impaired excitation-contraction coupling, inflammation and muscle protein degradation. This process is associated with delayed onset muscle soreness and is referred to as exercise-induced muscle damage. Although a certain amount of muscle damage may be necessary for adaptation to occur, excessive damage or inadequate recovery from exercise-induced muscle damage can increase injury risk, particularly in older individuals, who experience more damage and require longer to recover from muscle damaging exercise than younger adults. Furthermore, it is apparent that inter-individual variation exists in the response to exercise-induced muscle damage, and there is evidence that genetic variability may play a key role. Although this area of research is in its infancy, certain gene variations, or polymorphisms have been associated with exercise-induced muscle damage (i.e. individuals with certain genotypes experience greater muscle damage, and require longer recovery, following strenuous exercise). These polymorphisms include ACTN3 (R577X, rs1815739), TNF (-308 G>A, rs1800629), IL6 (-174 G>C, rs1800795), and IGF2 (ApaI, 17200 G>A, rs680). Knowing how someone is likely to respond to a particular type of exercise could help coaches/practitioners individualise the exercise training of their athletes/patients, thus maximising recovery and adaptation, while reducing overload-associated injury risk. The purpose of this review is to provide a critical analysis of the literature concerning gene polymorphisms associated with exercise-induced muscle damage, both in young and older individuals, and to highlight the potential mechanisms underpinning these associations, thus providing a better understanding of exercise-induced muscle damage.
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Affiliation(s)
- Philipp Baumert
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Mark J Lake
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Claire E Stewart
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Barry Drust
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Robert M Erskine
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK.
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Ghosh A, Mahajan PB. Can genotype determine the sports phenotype? A paradigm shift in sports medicine. J Basic Clin Physiol Pharmacol 2016; 27:333-9. [PMID: 26812785 DOI: 10.1515/jbcpp-2015-0090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/12/2015] [Indexed: 01/14/2023]
Abstract
In last two decades, there has been an evolution in sports medicine. Several researchers have worked on different domains of sports medicine, like strength, endurance, sports injury, and psychology. Besides this, several groups have explored the changes at cellular and molecular levels during exercise, which has led to the development of the new domain in sports science known as genetic medicine. Genetic medicine deals with the genotypic basis of sports phenotype. In this article, we try to provide an up-to-date review on genetic determinants of sports performance, which will be like a journey from the nostalgic past towards the traditional present and the romantic future of sports medicine. Endurance and power performance are two important domains of athletes. They vary in individuals, even among trained athletes. Researches indicate that the genetic makeup of sportsmen play a vital role in their performance. Several genetic factors are reported to be responsible for endurance, power, susceptibility to injury, and even psychology of the individual. Besides this, proper training, nutrition, and environment are also important in shaping their potential. The aim of this discussion is to understand the influence of the environment and the genetic makeup on the performance of the athletes. There is sufficient evidence to suggest that genotype determines the sports phenotype in an athlete. Choosing the right sports activity based on genetic endowment is the key for achieving excellence in sports.
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GARTON FLEURC, NORTH KATHRYNN. The Effect of Heterozygosity for the ACTN3 Null Allele on Human Muscle Performance. Med Sci Sports Exerc 2016; 48:509-20. [DOI: 10.1249/mss.0000000000000784] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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29
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Asplund CA, O'Connor FG. Challenging Return to Play Decisions: Heat Stroke, Exertional Rhabdomyolysis, and Exertional Collapse Associated With Sickle Cell Trait. Sports Health 2015; 8:117-25. [PMID: 26896216 PMCID: PMC4789928 DOI: 10.1177/1941738115617453] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Context: Sports medicine providers frequently return athletes to play after sports-related injuries and conditions. Many of these conditions have guidelines or medical evidence to guide the decision-making process. Occasionally, however, sports medicine providers are challenged with complex medical conditions for which there is little evidence-based guidance and physicians are instructed to individualize treatment; included in this group of conditions are exertional heat stroke (EHS), exertional rhabdomyolysis (ER), and exertional collapse associated with sickle cell trait (ECAST). Evidence Acquisition: The MEDLINE (2000-2015) database was searched using the following search terms: exertional heat stroke, exertional rhabdomyolysis, and exertional collapse associated with sickle cell trait. References from consensus statements, review articles, and book chapters were also utilized. Study Design: Clinical review. Level of Evidence: Level 4. Results: These entities are unique in that they may cause organ system damage capable of leading to short- or long-term detriments to physical activity and may not lend to complete recovery, potentially putting the athlete at risk with premature return to play. Conclusion: With a better understanding of the pathophysiology of EHS, ER, and ECAST and the factors associated with recovery, better decisions regarding return to play may be made.
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Affiliation(s)
- Chad A Asplund
- Athletic Medicine, Division of Health Services, Health and Kinesiology, Georgia Southern University, Statesboro, Georgia
| | - Francis G O'Connor
- Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Chen L, Cheng C, Chen B, Zhao Y, Zhang J, Wang B. Cumulative incidence and risk factors of creatine kinase elevation associated with telbivudine. Eur J Clin Pharmacol 2015; 72:235-41. [PMID: 26566799 DOI: 10.1007/s00228-015-1978-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE An increasing number of studies are reporting a high frequency of creatine kinase (CK) elevation during telbivudine therapy; however, few reports have focused on the cumulative incidence and risk factors of CK elevation. This study was performed to investigate the cumulative incidence and risk factors of CK elevation in Chinese patients treated with telbivudine. METHODS In this observational study, patients with chronic hepatitis B receiving telbivudine therapy between July 2008 and December 2013 were enrolled. The cumulative incidence of CK elevation was analyzed using the Kaplan-Meier method combined with the log rank test. Risk factors were determined using Cox proportional hazards regression models. RESULTS A total of 207 eligible patients were analyzed. The cumulative incidence of CK elevation at 12, 24, 36, 48, 60, and 72 months was 51.2 %, 68.9 %, 75.1 %, 78.1 %, 78.1 %, and 78.1 %, respectively. Multivariate analysis revealed that male and lower baseline estimated glomerular filtration rate (eGFR) were significant risk factors for CK elevation. CONCLUSIONS The cumulative incidence of CK elevation after long-term telbivudine use is quite high, and gender and baseline eGFR may be useful predictors. However, when combined with regular monitoring of CK levels, especially for patients with lower eGFR, telbivudine is a relatively safe nucleoside analog treatment for chronic hepatitis B.
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Affiliation(s)
- Li Chen
- Department of Pharmacy, HuaShan Hospital, Fudan University, No. 12 Middle Wu Lu Mu Qi Road, Shanghai, 200040, China
| | - Cai Cheng
- College of Pharmacy, Fudan University, Shanghai, China
| | - Bicui Chen
- Department of Pharmacy, HuaShan Hospital, Fudan University, No. 12 Middle Wu Lu Mu Qi Road, Shanghai, 200040, China
| | - Yue Zhao
- Department of Pharmacy, HuaShan Hospital, Fudan University, No. 12 Middle Wu Lu Mu Qi Road, Shanghai, 200040, China
| | - Jiming Zhang
- Department of Infectious Diseases, HuaShan Hospital, Fudan University, No. 12 Middle Wu Lu Mu Qi Road, Shanghai, 200040, China.
| | - Bin Wang
- Department of Pharmacy, HuaShan Hospital, Fudan University, No. 12 Middle Wu Lu Mu Qi Road, Shanghai, 200040, China.
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Affiliation(s)
- Philippe Connes
- Laboratory CRIS EA647, Team "Vascular Biology and Red Blood Cell", University of Lyon, Lyon, France; Institut Universitaire de France, Paris, France.
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Scalco RS, Gardiner AR, Pitceathly RD, Zanoteli E, Becker J, Holton JL, Houlden H, Jungbluth H, Quinlivan R. Rhabdomyolysis: a genetic perspective. Orphanet J Rare Dis 2015; 10:51. [PMID: 25929793 PMCID: PMC4522153 DOI: 10.1186/s13023-015-0264-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/09/2015] [Indexed: 01/19/2023] Open
Abstract
Rhabdomyolysis (RM) is a clinical emergency characterized by fulminant skeletal muscle damage and release of intracellular muscle components into the blood stream leading to myoglobinuria and, in severe cases, acute renal failure. Apart from trauma, a wide range of causes have been reported including drug abuse and infections. Underlying genetic disorders are also a cause of RM and can often pose a diagnostic challenge, considering their marked heterogeneity and comparative rarity. In this paper we review the range of rare genetic defects known to be associated with RM. Each gene has been reviewed for the following: clinical phenotype, typical triggers for RM and recommended diagnostic approach. The purpose of this review is to highlight the most important features associated with specific genetic defects in order to aid the diagnosis of patients presenting with hereditary causes of recurrent RM.
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Affiliation(s)
- Renata Siciliani Scalco
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK. .,Department of Neurology, HSL, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil. .,CAPES Foundation, Ministry of Education of Brazil, Brasilia, DF, Brazil.
| | - Alice R Gardiner
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
| | - Robert Ds Pitceathly
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK. .,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London (KCL), London, UK.
| | - Edmar Zanoteli
- Department of Neurology, School of Medicine, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Jefferson Becker
- Department of Neurology, HSL, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Janice L Holton
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
| | - Henry Houlden
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
| | - Heinz Jungbluth
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London (KCL), London, UK. .,Department of Paediatric Neurology, Evelina Children's Hospital, Guy's & St Thomas NHS Foundation Trust, London, UK. .,Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College London, London, UK.
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London (UCL) Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK. .,Dubowitz Neuromuscular Centre, Great Ormond Street Hospital, London, UK.
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Abstract
Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. Serum creatine kinase and urine myoglobin levels are markedly elevated. Clinical examination, history, laboratory studies, muscle biopsy, and genetic testing are useful tools for diagnosis of rhabdomyolysis, and they can help differentiate acquired from inherited causes of rhabdomyolysis. Acquired causes include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbances, and autoimmune myopathies. Inherited predisposition to rhabdomyolysis can occur with disorders of glycogen metabolism, fatty acid β-oxidation, and mitochondrial oxidative phosphorylation. Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle-cell disease. This review focuses on the differentiation of acquired and inherited causes of rhabdomyolysis and proposes a practical diagnostic algorithm. Muscle Nerve 51: 793-810, 2015.
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Affiliation(s)
- Jessica R Nance
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew L Mammen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 50, Room 1146, Bethesda, Maryland, 20892, USA
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35
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Key NS, Connes P, Derebail VK. Negative health implications of sickle cell trait in high income countries: from the football field to the laboratory. Br J Haematol 2015; 170:5-14. [PMID: 25754217 DOI: 10.1111/bjh.13363] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Worldwide, sickle cell trait is a highly prevalent gene carrier state. While generally a benign condition with a normal life expectancy, it is becoming increasingly clear that the sickle trait is associated with certain adverse outcomes. This article will focus on three of these outcomes, namely exertional rhabdomyolysis and sudden death, chronic renal dysfunction, and venous thromboembolism. In each case, the epidemiological evidence for the association is reviewed, together with the existing data on potential underlying mechanisms. Because newborn screening programmes for sickle cell anaemia also identify those with sickle cell trait, it is imperative that further studies determine what, if any, preventive measures can be taken to reduce the burden of these uncommon but potentially morbid complications in affected individuals.
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Affiliation(s)
- Nigel S Key
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philippe Connes
- Laboratoire CRIS EA647, Section 'Vascular Biology and Red Blood Cell', Université Claude Bernard Lyon 1, Lyon, France.,Institut Universitaire de France, Paris, France
| | - Vimal K Derebail
- Division of Nephrology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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36
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Jauchem JR. Exposures to conducted electrical weapons (including TASER® devices): how many and for how long are acceptable? J Forensic Sci 2014; 60 Suppl 1:S116-29. [PMID: 25443856 DOI: 10.1111/1556-4029.12672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/28/2014] [Accepted: 02/03/2014] [Indexed: 01/04/2023]
Abstract
TASER(®) conducted electrical weapons (CEWs) are an important law-enforcement tool. The purposes of this study are a) to review recent literature regarding potential pathophysiological responses to applications of CEWs, and other related issues and b) to evaluate whether enough data exist to determine the acceptability of longer-duration (or repeated) exposures. This is a narrative review, using a multidisciplinary approach of analyzing reports from physiological, legal-medical, and police-strategy literature sources. In general, short-duration exposures to CEWs result in limited effects. Longer-duration or repeated exposures may be utilized with caution, although there are currently not enough data to determine the acceptability of all types of exposures. Data examined in the literature have inherent limitations. Appropriateness of specific types of CEW usage may be determined by individual police agencies, applying risk/benefit analyses unique to each organization. While more research is recommended, initial concepts of potential future long-duration or repeated CEW applications are presented.
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Affiliation(s)
- James R Jauchem
- Bio-effects Division, Human Effectiveness Directorate, 711th Human Performance Wing, U.S. Air Force Research Laboratory, Fort Sam Houston, TX, 78234
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37
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Tantawy AA. The scope of clinical morbidity in sickle cell trait. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2014. [DOI: 10.1016/j.ejmhg.2014.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Creatine kinase levels during preseason camp in National Collegiate Athletic Association Division I football athletes. Clin J Sport Med 2014; 24:438-40. [PMID: 24346738 DOI: 10.1097/jsm.0000000000000057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate mean creatine kinase (CK) levels in National Collegiate Athletic Association (NCAA) Division I football athletes and the relationship between mean CK levels and demographic variables. DESIGN Observational cohort. SETTING NCAA Division I football program. PARTICIPANTS NCAA Division I football athletes. INTERVENTIONS Blood and urine samples were obtained from 32 athletes on the first (time 1), third (time 2), and seventh (time 3) days of football camp. MAIN OUTCOME MEASURES Mean CK levels. The hypotheses were formulated before the data were collected. RESULTS All urine samples tested negative for blood. Mean CK levels were 284.7 U/L at time 1, 1299.8 U/L at time 2, and 1562.4 U/L at time 3. The increases in means were statistically significant (P < 0.005 for all pairwise comparisons). Most demographic variables were not related to mean CK levels. The number of days in the precamp conditioning program was negatively associated with mean CK levels (P = 0.0284). CONCLUSIONS Mean CK levels in NCAA Division I football athletes during camp were higher than the serological criteria for rhabdomyolysis commonly used in clinical practice. More data are needed to assess if the number of days of participation in precamp conditioning is related to lower CK levels in NCAA Division I football athletes during camp.
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Abstract
AbstractCarriers of a single sickle cell gene mutation generally enjoy normal lifespans without serious health consequences related to their sickle cell status, but under extreme conditions such as severe dehydration and high-intensity physical activity, complications such as exertional rhabdomyolysis, splenic infarction, and papillary necrosis can occur. Recently, the National Collegiate Athletic Association (NCAA) adopted a policy that requires sickle cell solubility testing for all incoming student athletes. However, the American Society of Hematology (ASH) and other physician organizations oppose this policy. What is the basis for this controversy and how have new findings moved the field forward? I discuss herein the epidemiology, genetics, and clinical studies of sickle cell trait; review the implications of current policies regarding sickle cell trait screening and interventions for the student athlete; and examine additional areas where more information is needed.
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