Variable inflammation and intramuscular STAT3 phosphorylation and myeloperoxidase levels after downhill running

Peripheral inflammatory biomarkers as predictive tools for HyperCKemia risk assessment post-seizures

BACKGROUND

This study evaluates the potential of inflammatory biomarkers, especially the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), for early detection of hyperCKemia after seizures. Addressing the challenge of delayed hyperCKemia diagnosis, which can escalate to rhabdomyolysis, this research emphasizes the use of these accessible biomarkers.

METHODS

Conducted retrospectively, data from October 1, 2022, and October 1, 2023, were extracted from electronic medical records. Following univariate analysis (P-value < 0.05 for selection), Spearman's rank correlation and binary logistics regression were employed to examine the relationship between hyperCKemia and various clinical variables. Receiver operating characteristic curves (ROCs) defined the cut-off values for seizure-related hyperCKemia.

RESULTS

Among 98 seizure patients, 31 (31.63 %) developed hyperCKemia. Notable differences in leukocytes, neutrophils, CRP, and NLR levels were observed between hyperCKemia and normal CK groups (P < 0.05). Leukocytes, NLR, and CRP correlated with hyperCKemia, exhibiting odds ratios of 1.24 (95 % CI: 1.11-1.39, P < 0.001), 1.03 (95 % CI: 1.01-1.05, P = 0.001), and 1.22 (95 % CI: 1.09-1.35, P = 0.017). The optimal cut-off values were established as 9.78 × 10^9/L for leukocytes, 32.40 mg/L for CRP, and 7.35 for NLR.

CONCLUSION

Elevated levels of leukocytes, CRP, and NLR post-seizure are strong indicators of hyperCKemia risk, with significant implications for enhancing clinical decision-making and patient care strategies.

Effect of Eccentric Exercise on Metabolic Health in Diabetes and Obesity

There is a growing body of evidence showing the importance of physical activity against civilization-induced metabolic diseases, including type 2 diabetes (T2DM) and obesity. Eccentric contraction, when skeletal muscles generate force by lengthening, is a unique type of skeletal muscle activity. Eccentric contraction may lead to better power production characteristics of the muscle because eccentric contraction requires less energy and can result in higher tension. Therefore, it is an ideal tool in the rehabilitation program of patients. However, the complex metabolic effect (i.e., fat mass reduction, increased lipid oxidation, improvement in blood lipid profile, and increased insulin sensitivity) of the eccentric contraction alone has scarcely been investigated. This paper aims to review the current literature to provide information on whether eccentric contraction can influence metabolic health and body composition in T2DM or obesity. We also discussed the potential role of myokines in mediating the effects of eccentric exercise. A better understanding of the mechanism of eccentric training and particularly their participation in the regulation of metabolic diseases may widen their possible therapeutic use and, thereby, may support the fight against the leading global risks for mortality in the world.

Exercise Limitation after Critical Versus Mild COVID-19 Infection: A Metabolic Perspective

Exercise limitation in COVID-19 survivors is poorly explained. In this retrospective study, cardiopulmonary exercise testing (CPET) was coupled with an oxidative stress assessment in COVID-19 critically ill survivors (ICU group). Thirty-one patients were included in this group. At rest, their oxygen uptake (VO₂) was elevated (8 [5.6–9.7] mL/min/kg). The maximum effort was reached at low values of workload and VO₂ (66 [40.9–79.2]% and 74.5 [62.6–102.8]% of the respective predicted values). The ventilatory equivalent for carbon dioxide remained within normal ranges. Their metabolic efficiency was low: 15.2 [12.9–17.8]%. The 50% decrease in VO₂ after maximum effort was delayed, at 130 [120–170] s, with a still-high respiratory exchange ratio (1.13 [1–1.2]). The blood myeloperoxidase was elevated (92 [75.5–106.5] ng/mL), and the OSS was altered. The CPET profile of the ICU group was compared with long COVID patients after mid-disease (MLC group) and obese patients (OB group). The MLC patients (n = 23) reached peak workload and predicted VO₂ values, but their resting VO₂, metabolic efficiency, and recovery profiles were similar to the ICU group to a lesser extent. In the OB group (n = 15), no hypermetabolism at rest was observed. In conclusion, the exercise limitation after a critical COVID-19 bout resulted from an altered metabolic profile in the context of persistent inflammation and oxidative stress. Altered exercise and metabolic profiles were also observed in the MLC group. The contribution of obesity on the physiopathology of exercise limitation after a critical bout of COVID-19 did not seem relevant.

Mitochondrial Functionality in Inflammatory Pathology-Modulatory Role of Physical Activity

The incidence and severity of metabolic diseases can be reduced by introducing healthy lifestyle habits including moderate exercise. A common observation in age-related metabolic diseases is an increment in systemic inflammation (the so-called inflammaging) where mitochondrial reactive oxygen species (ROS) production may have a key role. Exercise prevents these metabolic pathologies, at least in part, due to its ability to alter immunometabolism, e.g., reducing systemic inflammation and by improving immune cell metabolism. Here, we review how exercise regulates immunometabolism within contracting muscles. In fact, we discuss how circulating and resident macrophages alter their function due to mitochondrial signaling, and we propose how these effects can be triggered within skeletal muscle in response to exercise. Finally, we also describe how exercise-induced mitochondrial adaptations can help to fight against virus infection. Moreover, the fact that moderate exercise increases circulating immune cells must be taken into account by public health agencies, as it may help prevent virus spread. This is of interest in order to face not only acute respiratory-related coronavirus (SARS-CoV) responsible for the COVID-19 pandemic but also for future virus infection challenges.

Downhill Running: What Are The Effects and How Can We Adapt? A Narrative Review

Downhill running (DR) is a whole-body exercise model that is used to investigate the physiological consequences of eccentric muscle actions and/or exercise-induced muscle damage (EIMD). In a sporting context, DR sections can be part of running disciplines (off-road and road running) and can accentuate EIMD, leading to a reduction in performance. The purpose of this narrative review is to: (1) better inform on the acute and delayed physiological effects of DR; (2) identify and discuss, using a comprehensive approach, the DR characteristics that affect the physiological responses to DR and their potential interactions; (3) provide the current state of evidence on preventive and in-situ strategies to better adapt to DR. Key findings of this review show that DR may have an impact on exercise performance by altering muscle structure and function due to EIMD. In the majority of studies, EIMD are assessed through isometric maximal voluntary contraction, blood creatine kinase and delayed onset muscle soreness, with DR characteristics (slope, exercise duration, and running speed) acting as the main influencing factors. In previous studies, the median (25th percentile, Q1; 75th percentile, Q3) slope, exercise duration, and running speed were - 12% (- 15%; - 10%), 40 min (30 min; 45 min) and 11.3 km h-1 (9.8 km h-1; 12.9 km h-1), respectively. Regardless of DR characteristics, people the least accustomed to DR generally experienced the most EIMD. There is growing evidence to suggest that preventive strategies that consist of prior exposure to DR are the most effective to better tolerate DR. The effectiveness of in-situ strategies such as lower limb compression garments and specific footwear remains to be confirmed. Our review finally highlights important discrepancies between studies in the assessment of EIMD, DR protocols and populations, which prevent drawing firm conclusions on factors that most influence the response to DR, and adaptive strategies to DR.

C-Reactive Protein Is Elevated Only in High Creatine Kinase Responders to Muscle Damaging Exercise

The purpose of this study was to investigate if exertional rhabdomyolysis induced by an acute bout of plyometric exercise in untrained individuals was associated with histological characteristics of skeletal muscle, creatine kinase (CK) polymorphism or secondary damage. Twenty-six healthy male untrained individuals completed a bout of plyometric exercise (10 sets of 10 maximal squat jumps, with each standardized to achieve at least 95% of individual maximal jump height). Blood samples were taken, and perceived pain was scored immediately before the exercise intervention and 6 h, 1, 2, and 3 days post-intervention. Muscle biopsies were collected 9 or 4 days before (baseline) and 3 days after plyometric jumps. Subjects were divided into two groups, high (n = 10) and low responders (n = 16), based on a cut-off limit for exertional rhabdomyolysis of peak CK activity ≥ 1000 U/L in any post-exercise blood sample. Perceived pain was more severe assessed in squat than standing position. Low responders perceived more pain at 6 h and 1 day, while high responders perceived more pain than low responders on days three and four after exercise; structural (dystrophin staining) and ultra-structural (transmission electron microscopy) analysis of muscle fibers revealed no baseline pathology; damage was evident in all individuals in both groups, with no difference between high and low responders in either damage or fiber type proportion. High responders had significantly higher total white blood cell and neutrophil counts 6 h and significantly higher C-reactive protein (CRP) 6 h and days one and two after exercise compared to low responders. High responders had significantly greater muscle myeloperoxidase (MPO) levels in baseline and 3 day post-exercise biopsies compared to baseline of low responders. MLCK C49T single polymorphism was present in 26% of volunteers, whose CK responses were not higher than those with MLCK CC or CT genotype. In conclusion, perceived pain is more effectively assessed with potentially affected muscle under eccentric strain, even if static. High CK responders also have pronounced CRP responses to unaccustomed plyometric exercise intervention. Exertional rhabdomyolysis after unaccustomed eccentric exercise may be related to underlying inability to resolve intramuscular MPO.

Investigation of Circulating Extracellular Vesicle MicroRNA Following Two Consecutive Bouts of Muscle-Damaging Exercise

Background: Extracellular vesicles (EVs) are nano-sized vesicles that are known to be powerful mediators of intercellular communication via their microRNA (miR) content. A paucity of information on EV-mediated communication arising from skeletal muscle (SkM) in response to exercise-induced muscle damage is present in the published literature. Lack of such information inhibits our understanding of muscle injury and repair processes. Aims: To assess circulating EV levels and selected miR content within them, in response to two consecutive bouts of muscle-damaging exercise. Methods: Serum creatine kinase activity (CK) and EVs were analyzed from the blood of 9 healthy, untrained males at baseline, and at 2 and 24 h post-exercise. The exercise regimen consisted of a combination of plyometric jumping and downhill running. Perceived muscle pain (PMP) was assessed on a scale from 1 to 10. Plasma EVs were isolated using size exclusion columns and visualized with transmission electron microscopy (TEM). EV size and number were quantified using nanoparticle tracking analysis (NTA). miR expression was quantified using qPCR, with normalization to an exogenous control (cel-miR-39). Results: PMP and CK were significantly elevated post-exercise compared to baseline levels, providing indirect evidence for muscle damage. EV visualization using TEM revealed an abundant and heterogeneously sized pool of intact particles within the exosome size range (30-150 nm). No significant change in mean EV size or number was seen over time. The SkM-specific miR-206 in EVs was found to be variable among participants and no significant change occurred in SkM-important miRs; 1, 133a, 133b, 486, and 499a. However, EV miR-31 decreased from baseline to 24 h post-exercise (p = 0.027). Conclusion: Mild to moderate exercise-induced muscle damage altered the miR-31 profile of circulating EVs within the first 24 h post-exercise, but not that of myomiRs in EVs. These data demonstrate that EVs carry selectively packaged cargo which can be affected by exercise. Future research into the total miR content of EVs in response to exercise-induced muscle damage may reveal other miRs responsive to this relatively mild perturbation. More time points post-muscle-damaging exercise would provide a better understanding of the temporal EV myomiR response.

Irisin response to downhill running exercise in humans

[Purpose]

To determine the effects of exercise-induced muscle damage, we examined irisin responses during level running (LR), with less muscle damage, and downhill running (DHR), with greater muscle damage under equivalent exercise duration and oxygen consumption (⩒O₂) conditions.

[Methods]

Fifteen healthy men (age: 21.6 ± 2.0 y, height: 170 ± 1.3 cm, weight: 64.8 ± 2.7 kg) were randomly assigned to either the LR group (n = 8) or the DHR group (n = 7). Subjects in the LR group performed treadmill running at 70% of maximum oxygen uptake (⩒O_2max) for 30 min on a 0% gradient. In contrast, subjects in the DHR group performed the same exercise on a –10% gradient. Blood samples were collected before exercise, immediately after exercise, and 1, 3, and 24 h after exercise.

[Results]

No significant interaction (group × time) or main effect of group or time was observed for changes in plasma irisin concentrations over time (P > 0.05). However, the area under the curve of plasma irisin concentrations during a 3-h post-exercise period was significantly greater in the DHR (239,197 ± 8,166 ng/mL) group than in the LR (92,293 ± 8,755 ng/ml) group (P < 0.05). The blood lactate, serum cortisol, myoglobin, and plasma interleukin-6 concentrations were significantly higher in the DHR group than in the LR group after exercise (P < 0.05 for all variables).

[Conclusion]

DHR associated with marked muscle damage promoted a greater increase in exercise-induced irisin did LR after the same duration under identical VO2 conditions.

Comparison of the inflammatory and stress response between sprint interval swimming and running

The aim of the study was to compare myocellular damage, metabolic stress, and inflammatory responses as well as circulating sodium (Na⁺ ) and potassium (K⁺ ) between a single sprint swimming and running training. Eighteen subjects regularly involved in swimming and running training for at least 2 years were recruited. The subjects performed 8 × 30 seconds "all out" exercise on different days either by running or by swimming in a random order. Blood was collected before each training session, after the cessation of exercise (post) and after 2 hours of rest (2 hours). We then analyzed tumor necrosis factor alpha (TNF-α), interleukin 10 (IL-10), interleukin 6 (IL-6), cortisol, creatine kinase MB isoform (CK-MB), lactate dehydrogenase (LDH), K⁺ , and Na⁺ . Neither TNF-α nor IL-10 differed between swimming and running. Most of the subjects showed a non-statistically significant increase of LDH and CK-MB after swimming. On the other hand, IL-6 (P < .05) and cortisol (P < .05) were significantly lower after 2 hours of swimming than after running. In addition, post-exercise K⁺ was significantly lower (P < .001) for swimming than for running. Our results provide evidence of similar inflammatory responses between exercise modes but lower metabolic stress in response to swimming than in response to running.

Fatigue associated with prolonged graded running

Scientific experiments on running mainly consider level running. However, the magnitude and etiology of fatigue depend on the exercise under consideration, particularly the predominant type of contraction, which differs between level, uphill, and downhill running. The purpose of this review is to comprehensively summarize the neurophysiological and biomechanical changes due to fatigue in graded running. When comparing prolonged hilly running (i.e., a combination of uphill and downhill running) to level running, it is found that (1) the general shape of the neuromuscular fatigue-exercise duration curve as well as the etiology of fatigue in knee extensor and plantar flexor muscles are similar and (2) the biomechanical consequences are also relatively comparable, suggesting that duration rather than elevation changes affects neuromuscular function and running patterns. However, 'pure' uphill or downhill running has several fatigue-related intrinsic features compared with the level running. Downhill running induces severe lower limb tissue damage, indirectly evidenced by massive increases in plasma creatine kinase/myoglobin concentration or inflammatory markers. In addition, low-frequency fatigue (i.e., excitation-contraction coupling failure) is systematically observed after downhill running, although it has also been found in high-intensity uphill running for different reasons. Indeed, low-frequency fatigue in downhill running is attributed to mechanical stress at the interface sarcoplasmic reticulum/T-tubule, while the inorganic phosphate accumulation probably plays a central role in intense uphill running. Other fatigue-related specificities of graded running such as strategies to minimize the deleterious effects of downhill running on muscle function, the difference of energy cost versus heat storage or muscle activity changes in downhill, level, and uphill running are also discussed.

Amyloid deposits and inflammatory infiltrates in sporadic inclusion body myositis: the inflammatory egg comes before the degenerative chicken

Sporadic inclusion body myositis (sIBM) is the most frequently acquired myopathy in patients over 50 years of age. It is imperative that neurologists and rheumatologists recognize this disorder which may, through clinical and pathological similarities, mimic other myopathies, especially polymyositis. Whereas polymyositis responds to immunosuppressant drug therapy, sIBM responds poorly, if at all. Controversy reigns as to whether sIBM is primarily an inflammatory or a degenerative myopathy, the distinction being vitally important in terms of directing research for effective specific therapies. We review here the pros and the cons for the respective hypotheses. A possible scenario, which our experience leads us to favour, is that sIBM may start with inflammation within muscle. The rush of leukocytes attracted by chemokines and cytokines may induce fibre injury and HLA-I overexpression. If the protein degradation systems are overloaded (possibly due to genetic predisposition, particular HLA-I subtypes or ageing), amyloid and other protein deposits may appear within muscle fibres, reinforcing the myopathic process in a vicious circle.

Identification of novel Kirrel3 gene splice variants in adult human skeletal muscle

Background

Multiple cell types including trophoblasts, osteoclasts and myoblasts require somatic cell fusion events as part of their physiological functions. In Drosophila Melanogaster the paralogus type 1 transmembrane receptors and members of the immunoglobulin superfamily Kin of Irre (Kirre) and roughest (Rst) regulate myoblast fusion during embryonic development. Present within the human genome are three homologs to Kirre termed Kin of Irre like (Kirrel) 1, 2 and 3. Currently it is unknown if Kirrel3 is expressed in adult human skeletal muscle.

Results

We investigated (using PCR and Western blot) Kirrel3 in adult human skeletal muscle samples taken at rest and after mild exercise induced muscle damage. Kirrel3 mRNA expression was verified by sequencing and protein presence via blotting with 2 different anti-Kirrel3 protein antibodies. Evidence for three alternatively spliced Kirrel3 mRNA transcripts in adult human skeletal muscle was obtained. Kirrel3 mRNA in adult human skeletal muscle was detected at low or moderate levels, or not at all. This sporadic expression suggests that Kirrel3 is expressed in a pulsatile manner. Several anti Kirrel3 immunoreactive proteins were detected in all adult human skeletal muscle samples analysed and results suggest the presence of different isoforms or posttranslational modification, or both.

Conclusion

The results presented here demonstrate for the first time that there are at least 3 splice variants of Kirrel3 expressed in adult human skeletal muscle, two of which have never previously been identified in human muscle. Importantly, mRNA of all splice variants was not always present, a finding with potential physiological relevance. These initial discoveries highlight the need for more molecular and functional studies to understand the role of Kirrel3 in human skeletal muscle.